November 14, 2022
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November 9, 2022
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In the medical world, surgical roles are notoriously not for the faint of heart. It takes a special, detail-oriented person to endure the rigor and complexity of surgical training. Yet, unlike in the popularized, melodramatic series, Grey’s Anatomy, where young, love-stricken interns prowl over first-assist surgical opportunities, in reality, Physician Assistants (PAs) are also vital characters behind the (blindingly bright) lights, (robotistic) cameras, and (meticulous) action of the operating room. PAs can work as surgical first assists in a number of subspecialties, ranging from General Surgery to Gynecological Oncology, Cardiology, Head and Neck Surgery, Neurosurgery, Orthopedics, Ophthalmology, and beyond. PAs who seek the thrill of the OR should also consider the uniqueness of each subspecialty. Additionally, most roles are more dynamic than solely surgical responsibilities.
In addition to being first assist in the operating room, job descriptions regularly encompass inpatient and outpatient duties. Often, PAs will work autonomously in an outpatient setting, such as when conducting procedures (e.g. Pap Smears in Gynecologic Oncology and flexible laryngoscopies in Otolaryngology), and then more collaboratively on the inpatient and/or surgical side.
PA first assists in the operating room are trained on various technical skills, for example how to use the da Vinci Robotic Surgical System. The da Vinci robot is a type of minimally invasive laparoscopic procedure often preferred by patients for its decreased risk of complications and shorter surgery duration (Landeen et al 2011). Surgeries that use the da Vinci are often much more cost-effective; the patient’s surgical incisions are much smaller and, thus, patients have a shorter recovery time (Halpern et al 2014). Research studies have also shown that robotic surgeries lower patient stress levels, which leads to better patient outcomes (Scandola 2011). For example, in abdominal and pelvic procedures, five ports are systematically placed throughout the abdomen. While the surgeon drives the million-dollar da Vinci robot forward in order to adjust it into its proper position over the patient, the PA angles all of the instruments to fit properly into place. Next, the surgeon uses the “video game console,” to control the robotic arms and complete the surgery. As a first assist, PAs help retract important structures out of the way by inserting instruments into the ports, passing sutures, and suctioning/removing specimens, all while viewing their moves via an endoscopic camera displayed onto the monitor of a computer screen. When the procedure is completed, it is typically the PA first assistant's duty to remove all the ports and suture closed the incisions. The training required is based upon the PA’s experience and the institutions credentialing and privileging standards.
There is a high demand for PA first assistants across the United States and because the PA First Assist replaces an additional physician in the OR, salaries are rewarding. However, in order for a Physician Assistant new graduate to find the right opportunity—or any PA seeking to shift careers to a first assist role—she or he should first take into consideration practice environments. An important aspect of any job hunt involves introspection into what matters most to you in an ideal position.
PAs have rigorous didactic and clinical training, and although they are prepared to deliver quality patient care, they also need the support of a strong orientation program, or fellowship, for a minimum of 6 months to a year depending on the specialty area. Practice environment can largely play into the type of support received.
Once you have decided on the ideal practice environment for you, here are three important processes to take into consideration with a new PA First Assist position:
Regardless of the practice environment and subspecialty you pursue, excitement exists within the sterile walls of the OR!
This article was originally published on Melnic by Jill Gilliland. Melnic was recently acquired by DirectShifts.