Surgical PA Specialities

According to the AAPA, 25% of PAs have a general surgery specialty or surgical subspecialty.

Surgical PAs are able to work anywhere the supervising surgeon has practice privileges. A strong background in family practice or internal medicine is helpful for any PA seeking specialty work. This foundational knowledge is invaluable in both the clinical and hospital settings. Many surgeons seek well-rounded PAs so they can augment their own specialty knowledge with current generalized practice skills.

Administration

PAs in Administration oversee the staffing and overall function of other physician assistants. They institute departmental and hospital policies and ensure that the staff consistently provides professional and quality patient health care.

PAs in Administration may have one of the following titles: Director, Coordinator or Senior Physician Assistant.

Job Qualifications

Qualifications may include numerous years of physician assistant practice and a master degree in a related field.

Duties & Responsibilities

  • Recruit and credential new applicants as needed.
  • Orient new employees
  • Oversee the staffing of physician assistants on various services, both medical and surgical
  • Inform and educate staff of any new policies and/or procedures
  • Act as a liaison between the physician assistant staff, physicians and other health care professionals
  • Perform chart review
  • Investigate and respond to incidents from Quality Management Committees
  • Maintain personnel files
  • Coordinate in-service programs
  • Assist with peri-operative in-patient, and out-patient care as needed
  • Attend and/or chair various mandatory committee meetings
  • Update the Director of Surgery/Medicine and/or Senior Administrator as needed
  • Formulate new policies and procedures as necessary to comply with medical standards, JCAHO, as well as state and governmental laws
  • Keep Policy and Procedure Manuals up to date
  • Act as a hospital representative in dealing with patient or family complaints
  • Assist in the reporting, investigating and follow-up of reportable incidents
  • Formulate budget requirements with the finance department
  • Secure vacation coverage
  • Counsel and/or discipline as needed
  • Work with OR nursing management to keep the OR booked and on schedule

Anesthesia



PAs in Anesthesia functions as a specialty physician assistant under the direction of a licensed Anesthesiologist to develop and implement anesthesia care plans.

Job Qualifications

Qualifications may include numerous years of physician assistant practice and a master degree in a related field.

Duties & Responsibilities

Performs the same duties as Certified Registered Nurse Anesthetists.

Burn Surgery

According to the American Burn Association, more than 2 million thermal injuries occur each year. Of this number, about 75,000 require hospitalization and 14,000 of these injuries result in death. As the largest organ in our body, disruption of the skin layer can result in severe physical and physiologic consequences.

PAs working in Burn Surgery usually practice in similar practice areas as the supervising burn surgeon. This can include the acute resuscitation period (including involvement on the trauma or burn team), intra-operative management (first assisting), post-resuscitation, intensive care and long-term follow-up.

The William Randolph Hurst Burn Center at New York Presbyterian Hospital is well known as one of the busiest burn centers in the world. In that institution, PAs are employed in the peri-operative environment (surgical first assisting) as well managing care on the step-down unit.

Job Qualifications

Qualifications may include numerous years of physician assistant practice and a master degree in a related field.

Duties & Responsibilities

  • Assesses and monitors burn injury
  • Prescribes topical agents (depending on the supervising surgeon and individual institution) such as Mafenide, silver sulfadiazine, and others, in either a closed method or exposure therapy
  • Works with grafts, Xenografts, Biobrane, homografts, etc., in the intra-operative environment
  • Focuses on restoration and maintenance of normal physiologic function and the control of infection in the critical care setting

Cardiothoracic Surgery

PAs play an integral role in the global management of cardiothoracic surgery patients, including all aspects of peri-operative care from performing patient histories and daily rounds to invasive surgical procedures, including the critical retrieval of vascular tissue in coronary bypass procedures.

CT PAs often fill the role as first assistant and primary care PA on all adult and pediatric cardiac cases. They also exhibit extensive knowledge of artificial cardiac devices, ventilators and the pharmacologic effects of vasoactive/cardiotonic drugs. Most CT PAs work 50-60 hours each week, providing patient care expertise in the postoperative acute care units, step-down units and regular floors.

As the specialty of cardiothoracic surgery continues to evolve, the flexible and adaptable nature of the surgical PA will be an essential element for every successful practice.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate surgical residency.

Duties & Responsibilities

  • Performs patient histories and physical exams
  • Handles daily patient rounds (including the CVICU), patient education and discharge summaries
  • Performs invasive procedures, such as thoracenteses, chest tube insertions, placement of central venous, dialysis and Swan-Ganz catheters, arterial lines and intra-aortic balloon pumps
  • Exhibits autonomy in the operating room when required
  • Retrieves vascular tissue, including greater and lesser saphenous veins and/or radial arteries, for use as a bypass conduit
  • Often uses endoscopic retrieval methods and involved in the industrial aspect of EVH
  • Performs first assistant duties on all adult and pediatric cardiac cases, thoracic and major/minor vascular cases
    • Meets the specific needs of the attending surgeon, often assisting several surgeons in a single practice
    • Has exacting knowledge of each surgeon's idiosyncrasies to expedite the procedure and limit patient morbidity and mortality
    • Uses knowledge of medical model to promote synergistic relationship between physician and PA
    • Has extensive knowledge of the pharmacologic effects of vasoactive/ cardiotonic drugs, ventilator management and artificial cardiac devices
  • Performs duties of a primary care PA
  • Manages other disease entities frequently encount

Colon Rectal Surgery

PAs in Colon and Rectal Surgery (CRS) is among the most valuable attributes to the comprehensive care of the colon and rectal surgical patient. In addition to performing history and physicals as they pertain to this surgical focus, CRS PAs function as a fully integrated member of CRS team in pre-, intra- and post-operative care of the CRS patient.

Most CT PAs work 50-60 hours each week, performing pre-operative assessments using diagnostic procedures, serving as first surgical assistant and functioning as primary care PA. They have extensive knowledge of pharmacologic effects of drugs specific to the colon and rectum as well as advanced understanding of surgical anatomy, including but not limited to the neurovascular anatomy.

One of the finer points of this specialty is the ability to not only work with patients who are afflicted with benign colon, rectal and anal disease, but to work with patients affected with neoplastic disease of the colon, rectum and anus. This brings the understanding of not only how to treat the CRS patient from a surgical approach, but combines the understanding of multi-modality therapies of medical oncology and radiation oncology.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate surgical residency.

Duties & Responsibilities

  • Performs patient histories and physical exams
  • Conducts pre-operative assessment using diagnostic procedures, such as digital rectal examination, colonoscopy, sigmoidoscopy, anoscopy, endo-rectal ultrasound and anal manometry
  • Exhibits autonomy in the operating room when required
  • Performs first assistant duties with complete knowledge of the disease process and whole patient care scenario
  • Manages post-operative patient care until discharge
  • Enables continuity of care by managing patient care in pre-, intra- and post-operative settings
  • Has extensive knowledge of the pharmacologic effects of drugs specific to the colon and rectum
  • Understands surgical anatomy, including but not limited to the neurovascular anatomy
  • Performs duties of a primary care PA
  • Manages other disease entities frequently encountered in the CRS population

Critical Care

Surgical PAs are ideal practitioners in many critical care settings in the hospital, including the cardiac ICU, medical ICU, or surgical ICU.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Duties & Responsibilities

  • Provides comprehensive management of acutely or critically ill patients requiring intensive monitoring
  • Collaborates with a team of practitioners to apply basic and advanced physiologic concepts and technology
  • Functions as the primary provider for critically ill patients
  • Presents patients to the ICU team
  • Determines plan of patient care

General Surgery

PAs in General Surgery manage a broad range of medical and surgical conditions and are usually involved in all aspects of patient care, both in the outpatient and inpatient setting.

In the current "specialty care" environment, many PAs in General Surgery will be involved with a wide range of abdominal procedures. However, in some smaller hospitals, General Surgery PAs deal with patients undergoing a broad range of procedures including orthopaedic, head & neck, thoracic and urologic services.

The flexibility and the adaptability of the surgical PA make them the obvious choice to assist the general surgeon in all aspects of caring for the surgical patient.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Duties & Responsibilities

  • Performs patient histories and physical exams
  • Handles daily patient rounds, patient education and discharge summaries
  • Performs a wide range of abdominal surgeries for many forms of intestinal and abdominal wall neoplasms, gallbladder disease, gastric and pancreatic disease
  • Has extensive knowledge of a wide range of pathophysiology and a complex variety of co-morbid conditions
  • Anticipates and corrects post-operative problems resulting from co-morbid conditions and stress of surgery
  • Handles a broad range of procedures including orthopaedic, head & neck, thoracic and urologic services, in some cases
  • Enables continuity of care by managing patient care in pre-, intra- and post-operative settings, such as in the case of trauma
  • Evaluates a trauma victim, institutes immediate therapy, helps with operative management, follows the patient through critical care and surgical recovery and handles outpatient care

Head & Neck Surgery

PAs in Otorhinolaryngology and Head & Neck Surgery perform a wide range of surgical and medical procedures and are usually involved in all aspects of adult and pediatric patient care, both in the outpatient and inpatient setting.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate surgical residency.

Duties & Responsibilities

  • Performs patient histories and physical exams
  • Performs a wide range of procedures, including removal of ear foreign bodies, mastoid cavity cleansing, rigid nasal endoscopy, nasal cautery, fiberoptic laryngoscopy, packs/splints removal, tracheostomy tube change, I&D of peritonsillar abscess, nasal packs, tubes removal and more
  • Enables continuity of care by managing patient care in pre-, intra- and post-operative settings

Neurosurgery

PAs in Neurosurgery play an integral role in the global management of neurosurgery patients, including all aspects of pre-, intra- and post-operative care. Neurosurgery PAs perform patient histories, help with treatment plans, serve as first assistant in surgery in which they assist with all neurosurgical procedures, manage post-operative care and handle a myriad of office-related duties.

Neurosurgery PAs work under the supervision of the Neurosurgeon. Their knowledge, education and skills benefit the Neurosurgeon and the Neurosurgical practice by reducing the amount time the Neurosurgeon spends with small issues allowing the surgeon to handle the more seriously ill patients.

It will take time to adjust to the operating room environment. If a Neurosurgical practice hires a new grad they must understand that the Neurosurgeons must instruct and demonstrate to that individual their method of dealing with Neurosurgical problems conditions surgical techniques.

Job Qualifications

  • Master degree and post-graduate surgical residency
  • PAs with no neurosurgical experience take approximately one year to fully handle the day-to-day office and hospital routine
  • Ramp up time for OR proficiency often depends on the Neurosurgeon's ability to instruct and demonstrate on their individual methods

General Duties & Responsibilities

  • Performs comprehensive and problem-focused histories and physical examinations
  • Interprets laboratory and diagnostic tests
  • Interprets and correlates subjective and objective data
  • Formulates a differential diagnosis and establishes a working diagnosis
  • Develops a treatment plan for neurosurgical conditions within the scope of practice and in conjunction with the neurosurgeon
  • Implements therapeutic intervention for specific conditions where appropriate
  • Exercise judgment on conditions requiring consultation, referral or evaluation by the supervising neurosurgeon or other healthcare professionals

Hospital Duties & Responsibilities

  • Performs first assistant duties
  • Closes deep and superficial wounds
  • Assists with neurosurgical procedures, including craniotomies, spinal procedures (including instrumentations) and microscopic procedures
  • Conducts hospital rounds on a daily basis of all patients including intensive care units
  • Write orders and progress notes
  • Performs all admission history and physicals
  • Orders appropriate laboratory and radiographic tests, such as MRIs, myleograms, bone scans and other radiographic studies
  • Performs appropriate laboratory and diagnostic studies, such as lumbar punctures, ventriculostomies, myleograms, and placement of tong traction and halo fixation devices
  • Evaluates and clarifies clinical conditions
  • Formulates and implements treatment and therapeutic plans for hospitalized patients
  • Handles discharge planning and dictates discharge summaries

Office Duties & Responsibilities

  • Sees all new office patients and completes a thorough history and physical examination that is problem-oriented for neurosurgical conditions
  • Presents the patient to attending neurosurgeons
  • Helps to formulate treatment plans
  • Orders appropriate radiographic studies
  • Performs office procedures such as local blocks
  • Evaluates post-operative patients and does routine follow-up visits
  • Is available to see patients requiring same-day office visits
  • Returns phone calls of from patients
  • Handles prescription refills
  • Reviews radiographic reports and laboratory reports for abnormalities
  • Reviews x-rays, MRIs and CT scans of hospitalized patients and office patients with the attending neurosurgeon
  • Evaluates, screens and counsels patients on health maintenance and promote utilization of community resources
  • Designs, conducts and or participates in research studies
  • Manages databases
  • Perform quality assurance

Ophthalmology

PAs in Ophthalmology function as specialty physician assistants under the direction of a licensed Ophthalmologist to manage all aspects of pre-, intra- and post-operative care.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Duties & Responsibilities

  • Collects and assesses medical histories
  • Performs physical examinations and diagnostic tests
  • Surgically assists surgeons in the OR in minor procedures and outpatient surgical procedures
  • Enables continuity of care by managing patient care in pre-, intra- and post-operative settings

Orthopaedic Surgery

PAs in Orthopaedic Surgery play an integral role in the global management of neurosurgery patients, including all aspects of pre-, intra- and post-operative care. Orthopaedic PAs perform patient histories, help with treatment plans, serve as first assistant in surgery, manage post-operative care and handle a myriad of office-related duties.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Duties & Responsibilities

  • Performs comprehensive and problem-focused histories and physical examinations
  • Interprets laboratory and diagnostic tests
  • Interprets and correlates subjective and objective data to formulate a differential diagnosis and establish a working diagnosis
  • Formulates a treatment plan for orthopaedic conditions within their scope of practice
  • Implements therapeutic intervention for specific conditions when appropriate
  • Exercises judgment on conditions requiring consultation, referral or evaluation by the supervising orthopaedic surgeon or other health care professionals
  • Orders, collects and performs appropriate laboratory and diagnostic studies, such as routine laboratory tests, EMG, electrocardiogram and radiologic examinations including arthrogram, ultrasound, CT, MRI and bone scan studies
  • Performs compartment pressure measurements, digital blocks and regional anesthesia
  • Performs minor outpatient surgical procedures such as tendon repair, wound closure and management, incision and drainage, needle biopsy percutaneous pinning of fractures k-wire and hardware removal
  • Performs diagnostic and therapeutic procedures such as aspirations and injections of joints, bursars and cysts.
  • Performs closed reductions of fractures and dislocations
  • Applies braces, casts, splints and other orthopaedic appliances
  • Assists in the surgical suite including first assist, deep and superficial wound closure, application of internal devices and any other procedures delegated by the supervising orthopaedic surgeon
  • Conducts hospital rounds, writes orders, takes call and sees patients in the ED for the orthopaedic surgeon
  • Evaluates and clarifies clinical conditions
  • Formulates and implements treatment and therapeutic plans for hospitalized

Plastic & Reconstructive Surgery

PAs in Plastic and Reconstructive surgery work in a variety of settings that encompass cosmetic surgery, burn management and reconstruction of both congenital and trauma related injuries. In particular, the PA in the cosmetics subspecialty will often have to deal with celebrities and other individuals who require heightened attention to confidentiality. Many plastic surgeons look for PAs with experience in a variety of surgical specialties as these skills frequently come into play within the scope of the practice.

Since many plastic surgeons practice in office-based operating rooms and "surgi-centers", the PA must be current in BCLS and ACLS and be comfortable with management of cardiac and respiratory emergencies.

Surgical PAs use the full breadth of PA training – from basic primary-care assessments to advanced intra-operative techniques – making Plastic and Reconstructive surgery a rewarding and fascinating specialty.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Operating Room Duties & Responsibilities

  • Performs first assistant duties
  • Has excellent suture skills – equal to that of the surgeon
  • Has expert knowledge of anatomy
  • Knows the latest surgical techniques
  • Contributes intelligent input into the surgical procedure
  • Performs inventory of all necessary plastic surgical supplies and prostheses

Hospital Duties & Responsibilities

  • Writes orders in Recovery Room, ICU and floor
  • Follows patients and writes daily progress notes
  • Maintains clear communication with the attending surgeon and any consultants regarding patient status, both pre and post discharge.

Office Duties & Responsibilities

  • Understands reimbursement issues
  • Understands patient insurance plans and communicates with insurance companies in writing
  • Attends at least one plastic surgical CME offering per year
  • Maintains skills of the Primary Care PA
  • Consults with product and pharmaceutical representatives
  • Performs wound checks, suture and drain removals
  • Performs minor surgical procedures without in-room supervision
  • Performs consultations in the surgeon’s absence
  • Takes call
  • Dictates operative and discharge summaries

Surgical Oncology

PAs in Surgical Oncology function as specialty physician assistants under the direction of a licensed Oncology Surgeon to manage all aspects of pre-, intra- and post-operative care.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Duties & Responsiblities

  • Collects and assesses medical histories
  • Performs physical examinations and diagnostic tests
  • Assists surgeons in the OR with surgical procedures
  • Enables continuity of care by managing patient care in pre-, intra- and post-operative settings

Transplant Surgery

Transplant Surgery PAs serve as both surgery first assist and primary care PA for transplant patients. PAs are fully trained to assist in the operating room during transplant surgery. In addition, they help patients understand the complexities of transplantation and ensure that patients understand the medical regimen and correct follow-up.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Duties & Responsibilities

  • Collects and assesses medical histories
  • Performs physical examinations and diagnostic tests
  • Handles daily patient rounds (including the CVICU), patient education and discharge summaries
  • Surgically assists surgeons in the OR in transplant procedures
  • Enables continuity of care by managing patient care in pre-, intra- and post-operative settings

Trauma Surgery

Trauma Caucus

The surgical PA practicing in Trauma Surgery exercises flexibility and adaptability to manage a broad range of medical and surgical conditions under the supervision of licensed Trauma Surgeon. 

Because the spectrum of trauma surgery encompasses many organ systems, the trauma surgery PA must be knowledgeable about a wide range of pathophysiology as well as how the injuries sustained should be prioritized. Trauma remains the leading cause of death in the first four decades of life and is surpassed only by cancer and atherosclerosis as the major cause of death in all age groups. 

Approximately 60 million injuries occur annually in the United States. Roughly one-half, or 30 million of these injuries require medical care, and 3.6 million require hospitalization. Nearly nine million of these injuries are disabling - 300,000 permanent disabilities and 8,700,000 temporary disabilities. For this reason, it is necessary that Trauma PAs have compassion for individuals involved in a trauma and are able to deal with the social issues that subsequently arise.

Job Qualifications

  • PA master degree
  • Post-graduate surgical residency in General Surgery or Emergency Medicine, or have at least two years of experience in either General Surgery or Emergency Medicine

General Duties & Responsibilities

  • Evaluates the trauma victim and institutes immediate therapy
  • Performs first assistant duties in the operating room
  • Assists with post-operative management and follows the patient through the critical care portion of their recovery
  • Attends to the patient closely on the hospital surgical ward
  • Enables continuity of care by following up in the Trauma surgery clinic
  • Makes rounds with the attending surgeon and fills her/him in on pertinent issues involving patient care
  • Fields patient calls after hospital discharge or general follow-up questions
  • Triages patients to the ER or trauma clinic
  • Manages patients undergoing a broad range of procedures, including Orthopaedic, ENT, OMFS, Urology and Vascular
  • Determines when appropriate consultation is needed and speaks with that service

Surgical Ward Duties & Responsibilities

  • Orders and interprets appropriate laboratory and diagnostic studies and collates data
  • Requests and follows up on recommendations of consultants (usually after discussion with the surgeon)
  • Assesses fluid and electrolyte balance
  • Manages and removes tubes and drains
  • Formulates a differential diagnosis and confirms or refutes the options according to the physical exam and data obtained
  • Identifies and prioritizes surgical, medical and psychosocial problems
  • Orders and renews appropriate medications

Urology

PAs in Urology work under the supervision of a licensed Urologist to assist in the global management of urologic patients, including all aspects of pre-, intra- and post-operative care. 

In general, urologic PAs are authorized to perform any duties delegated to them by their supervising physician that they feel comfortable performing. Often urologic PAs can take care of many routine urological problems, freeing the surgeon to concentrate on more complex patients.

Job Qualifications

  • Master degree and post-graduate surgical residency
  • PAs with no urologic experience take approximately six to twelve months of intensive OJT to perform many urologic PA functions

General Duties & Responsibilities

  • Performs complete evaluations on patients of all ages (pediatric through geriatric)
  • Orders and interprets appropriate lab, x-ray and special studies
  • Establishes a working diagnosis based upon acquired data
  • Develops a treatment plan for urological conditions in accordance with current urology practice and in conjunction with the urologist
  • Implements therapeutic intervention
  • Provides appropriate follow-up care
  • Exercises judgment on conditions requiring consultation, referral or evaluation by the supervising urologist or other healthcare professionals

Hospital Duties & Responsibilities

  • Performs complete pre-operative H & Ps on all surgical patients, identifying and alerting the surgeon to any disqualifying conditions that present
  • Performs first assistant duties in all surgical procedures, including nephrectomies, nephrostomies, radical prostatectomies, cystectomies, orchiectomies, penile prosthetic implantations, urological trauma procedures, transurethal procedures, artificial urethral sphincter implantations, stent procedures and others
  • Conducts daily rounds of all ward and ICU patients
  • Evaluates care and order appropriate labs, special studies, IVs, diet, and therapeutic interventions required
  • Formulates and implements discharge planning and clinical follow-up in conjunction with surgeon
  • Dictates discharge summaries
  • Evaluates and provides appropriate intervention (in conjunction with supervising surgeon) for ER and nursing home patients
  • Identifies need and catheterizes patients with appropriate catheters for their condition

Office Duties & Responsibilities

  • Sees new and follow-up patients and provides problem-oriented intervention for their urological conditions
  • Presents patients, when appropriate, to the supervising surgeon
  • Assists in care, treatment and follow-up as needed
  • Performs and/or assists in office procedures, including transrectal ultrasound (TRUS) volume studies, urodynamics, cystoscopies, post-void residual (PVRs) evals, difficult catheterizations, post-op voiding trails and other necessary procedures
  • Orders and interprets lab, x-ray, special studies and clinical procedures and provides appropriate care and follow-up
  • Provides phone consultation for patient complaints and prescription refills
  • Performs on-call duties for urology
  • Evaluates, screens and counsels patients on health maintenance and promotes utilization of community resources
  • Designs, conducts, and/or participates in research studies
  • Manages databases
  • Performs quality assurance

Vascular Surgery

PAs in Vascular Surgery function as specialty physician assistants under the direction of a licensed Vascular Surgeon to manage all aspects of pre-, intra- and post-operative care.

Job Qualifications

Highly technical and demanding skills are mastered through years of physician assistant practice, master degree and post-graduate critical care residency.

Duties & Responsibilities

  • Collects and assesses medical histories
  • Performs physical examinations and diagnostic tests
  • Assists surgeons in the OR with surgical procedures
  • Enables continuity of care by managing patient care in pre-, intra- and post-operative settings