Physician Assistant Essay

Healthcare in the modern area is a complex and multilayered network. Its structure is based upon multiple different professions and departments that all work cohesively to provide quality care, diagnosis and treatment to every patient that enters the database. No matter the individual credentials, every medical professional’s role is vital to the healthcare system but presently there is a heavy demand for the physician assistant profession. The physician assistant or (PA) is a team-based patient-centered provider who can practice autonomously or in collaboration with members of a patient’s healthcare team all while under the guidance of a physician. Modeled on the medical school curriculum, they undergo rigorous education and once licensed,

are experts in general medicine with a foundation in primary care. When PA’s are allowed to practice to the full extent of their abilities, studies have shown that infection rates and readmission rates decrease thus improving the quality of healthcare. They practice in variety of settings in nearly every medical specialty. PA’s who decide to pursue a specialty with a focus in surgery can increase their skills and become a surgical physician assistant.
A surgical PA’s primary role is to work as a surgical assistant first and become a part of surgical teams during minute or intense procedures.

They are highly skilled clinicians who have received extensive didactic and clinical training which allows them to thrive in all areas of the peri-operative to the post-operative environment, write orders and prescribe medication. Even in the absence of a physician, surgical PA’s are qualified to handle many tasks of a fully trained surgeon and can exercise autonomy in medical decision making. They can also handle minor problems and procedures, write orders in the recovery room, dictate discharge summaries and explain discharge instructions to patients thus allowing the surgeon to attend to more complex patients. This end to end involvement from initial assessment to post-surgical follow up enables surgical PA’s to provide unparalleled continuity of patient care. They can also participate in research and administrative roles such as being on a hospital committee for selecting surgical equipment based on the demands of its surgeons and OR

teams.
Physician assistants usually enter the surgical practice in one of three ways.

The first is graduating from an ARC-PA Program that is surgically focused such as the University of Alabama at Birmingham’s (UAB) Physician Assistant Studies Program. Most, if not all, physician assistant programs in the United States are now accredited by the association of American Academy of Physician Assistants (AAPA) and offer a master’s degree once completed. The second is the completion of a surgical residency after attending school. The Emory University School of Medicine, based in Atlanta, Georgia, offers certified graduates the opportunity to earn their surgical license through a one-year program designed to build extensive surgical skills. While not required, such residencies offer the opportunity to expand a PA’s skill set while gaining the experience needed to manage patients in the pre-, intra- and postoperative settings. The third, and final, method for becoming a surgical PA is on-the-job training after graduating from an accredited program. Those who complete one of these three routes take a national certification exam given by the National Commission for the Certification of PAs (NCCAP), and are then licensed by that individual state to receive credentials for specific practice privileges by each hospital board. Surgical PAs are also able to practice anywhere the surgeon has

privileges.
As a surgical PA, the opportunities for specializing are practically endless. According to 2008 PA Census, approximately one quarter of the PA’s practice in surgery or other surgical subspecialties.2 Cardiothoracic surgery is an intense sub-specialty that has surgical PA’s involved in all aspects of peri-operative care which range to invasive procedures such as chest tube insertions, placement of arterial lines and retrieval of vascular tissue through a coronary bypass. A surgical physician assistant willing to take on such management roles must exhibit extensive knowledge of artificial cardiac devices and the pharmacologic effects of vasoactive/cardiotonic drugs.2 This medical professional must also understand each surgeon’s idiosyncrasies by promoting a synergistic relationship in order to expedite a procedure as well as limit morbidity and mortality rates. Another sub-specialty field that demands highly technical skills mastered through years of practice and post-graduate residency, is plastic and reconstructive surgery. This specialty encompasses cosmetic surgery, burn management and the reconstruction of any congenital and trauma injuries. Plastic surgeons looking to hire a PA will generally interview individuals with experience in a variety of surgical specialties who display excellent suture skills, possibly equal to that of a surgeon, and those who are current in Basic Cardiac Life Support (BCLS) and Advanced Cardiovascular Life Support (ACLS) certifications should any cardiac or respiratory emergencies occur. From basic primary-care assessments to advanced intra-operative techniques, the specialty of plastic and reconstructive surgery challenges surgical PAs to use the full breadth of their training making it a very rewarding and fascinating field. These two fields are only a fraction of the specialties that are available to physician assistants interested in pursuing a career focus in surgery. According to Jeff Johnson, a surgical PA in a dermatology practice, there is no better feeling than being impressed with one’s own work. “There is a difference between someone who can just pull together a wound and one who can do it skillfully”, he says.4 “My suggestion is to attend as many surgical conferences and workshops that you can and then continue to market yourself. Don’t underestimate the value that you, as a skilled physician assistant with demonstrable surgical skills, can offer a practice. If you truly have a love for surgery and it is what you want to do, then work to set yourself apart from your peers.”4
The opportunities for PA’s in surgical specialties are currently exploding. One of the many reasons why is because the number of surgery residency slots for physicians in training has been steadily decreasing while the workload has only been increasing. As such, surgical PA’s are ideal for keeping the OR on schedule, preparing pre-op patients, and performing discharge work. They will often alternate being on call with their physicians. Effective use of this relationship allows the PA to become a true partner with the surgeon and a vital asset to that medical practice. Physician residents are limited to an 80-hour work week which has put a strain on teaching hospitals and the healthcare system in general but, thankfully, PAs are now allowed to assume responsibility and pick up where the residents leave off. PA’s can also be reimbursed for their work which means having a surgical PA on a surgeon’s team allows the number of patients treated to increase revenue making PAs very effective in the business of medicine. The final reason for all this growth is due to the American Association of Surgical Physician Assistants (AASPA). This organization networks with surgeons, hospitals, HMOs and does much to help educate and guarantee that they all understand the effective role surgical PAs provide throughout the medical community.
Though still considered a very young profession, no other new health care professional has impacted the medical community like the role of the physician assistant. By giving healthcare institutions the ability to employ a medical professional who has the education and skill set second only to a physician, while bringing patient focused care and character to a team based setting, the industry is forever changed. With the addition of thorough surgical training to an already impressive resume, the surgical physician assistant raises the profession to the next level. In a report that surveyed 165 hospitals who employed surgical physician assistants, two-thirds of surgical departments’ chairmen felt that surgical PA’s improved the quality of care and one-half felt that they enhanced the quality of training received by surgical residents.1 In conclusion, if you have a passion for the surgical arts, want to enhance your skillset and improve a surgeon’s or hospital’s OR practice, then a career as a surgical PA may be your future calling.