Surgeons Discuss Increased Use of PAs in Hospitals

from November 15, 2002, issue of AAPA News

By Nancy Hughes

One topic generating a great deal of discussion at the American College of Surgeons (ACS) conference in San Francisco in early October was how to meet the demand for surgical care while also complying with new restrictions on residents’ work hours.


In July 2003, new rules will go into effect restricting medical residents in all specialties to working no more than 80 hours a week. The questions facing teaching hospitals is how to meet patient care needs with fewer resident hours and how to do it in a cost-effective way.


An ACS panel presentation entitled Impact of Midlevel Providers in Resident Surgical Education examined how PAs have been utilized in hospitals with surgical residency programs. No presenter claimed to have a universal solution appropriate for all hospitals, but all mentioned PAs as valuable members of the surgical team.


Paul Friedmann, M.D., from Springfield, Massachusetts, past chair of the Accreditation Council for Graduate Medical Education, pointed out that PAs “can provide support on teaching services if they are integrated into the teams and do not compete for experiences or cases that the residents need.”


Lynn Chao, M.D., with the Department of Surgery, St Vincent’s Catholic Medical Center in New York City, said that PAs were the department’s choice of providers when the hospital was forced to cut back on resident hours. PA students “rotated through our hospital, so we knew what they were capable of,” she explained. But the hospital’s planned use of PAs was not a quick fix. “[A] continual process of re-evaluation is necessary,” she said. The hospital is utilizing its third revised PA/resident work schedule after the first two caused some confusion and dissatisfaction among staff. When preparing a work schedule, Chao advised the surgeons in the room to keep in mind that, “it’s a parallel universe, not a hierarchy between the PAs and the residents.”


Panel moderator Peter J. Fabri, M.D., associate dean in the Office of Graduate Medical Education, University of South Florida College of Medicine, echoed Chao’s comment. The future “will not be a vertical world, it will be more horizontal,” he said. Fabri predicted that future medical school graduates will have shared educational experiences with nonphysician providers and “will be absolutely comfortable to pass responsibility on to others.” He stressed to the surgeons, “Remember: [PAs and nurse practitioners] are not people who could not get into medical school. They are NPs and PAs because that’s what they want to do.” Fabri is a former member of the Accreditation Review Commission on Education for the Physician Assistant.


A physician who recently completed his residency in south Florida, Scott Gallader, M.D., agreed that PAs and nonphysician providers can be significant assets to surgical residency programs. He advised those in the audience to be selective about who they hire to work on the surgical team, set expectations for the team, provide clear communication, and quickly solve any frustrations between the PAs and residents. “Be actively involved in the issue,” he advised. “Embrace it and make it work for you.”


During a question and answer session, surgeons raised concerns about the cost of hiring PAs. One hospital administrator estimated that it will cost his facility millions of dollars to hire others to make up for the cutback in resident hours. Other questions addressed the issues of who would supervise all the new PAs, how the hospital will be able to recoup its costs (since Medicare doesn’t pay hospitals to employ PAs), and how a supervisor sorts out who does what.


Fabri stressed that if residency programs and hospitals focus just on meeting resident duty hours guidelines, they won’t come up with the right solution. “We have to re-engineer what we’ve been doing,” he said.

 

Last Revised: 7/15/03