The Case for Surgical First Assistants

This article appears in Outpatient Surgery Magazine
Aug 28, 2014
5 good reasons to partner with these physician extenders.
Surgical first assistants (SFAs) set up my instruments, communicate my needs to the surgical team and anticipate my every move during procedures, which lets me focus more of my attention on the intricacies of surgery. With an SFA by my side providing advanced, hands-on support, I’m able to reduce my procedure time and increase my procedure volume. My outcomes are better, too. Here are 5 key benefits to working with SFAs.
1. Greater efficiency
Clearly your surgeons and staff can successfully perform the procedures you host. But are they performing them as efficiently as possible?
I’m a busy general and vascular surgeon who operates in hospitals and surgery centers in St. Petersburg, Fla. I need to perform efficient surgeries to keep up with my high-volume caseload. SFAs who are familiar with how I work and what I need help me perform up to 17 cases a day and nearly 1,000 procedures a year. They anticipate the next step in procedures and have needed equipment primed and ready to place in my hand.
SFAs also close cases for me — I complete abdominal wall closures, but they close superficial skin layers — which lets me turn my attention to completing paperwork and checking on the next case’s patient. I’m able to complete carotid atherectomies in about 30 minutes, open abdominal aortic aneurysms in an hour, gallbladders in 10 to 15 minutes and hernia repairs in about 20 minutes. I run a very efficient OR, thanks to the pace SFAs help me maintain.
2. Increased case volume
Surgeons who work with SFAs can increase their elective case volume. We’re very restrictive in many of the ways we’re reimbursed, so streamlining the repetitive aspects of surgery helps generate higher volume and increases revenue. It becomes a self-fulfilling prophecy: Surgeons who produce more volume get more surgical time from facilities — at one of my hospitals I’ve had 2 ORs running every Wednesday for the past 6 years because I’ve filled the rooms consistently — letting them further increase their volume of revenue-generating cases. It’s a win-win for surgeons and facility administrators.
3. Better pre-op prep
Because I work in several facilities, SFAs help prepare the ORs and prep the surgical team about my specific needs and preferred techniques before I arrive to operate. Working with SFAs also means I don’t have to acclimate staff to how I work, which can be a slow laborious process every time I work in a new facility. Because SFAs understand and communicate my needs, I can hit the ground running, regardless of where I’m operating. SFAs are also familiar with how to set up a back table for my particular aortogram procedures, which to be honest, I have little knowledge about. I’m barely involved in the mechanics of getting a room organized, so when I arrive, the team is often ready to go. It’s a more efficient process.
4. Improved communication
In larger facilities, it’s unlikely the same nurses cover every case performed by individual physicians. They likely work procedures done 3 different ways by 3 different doctors. SFAs bridge the communication gap between surgeons and surgical teams. They’re extremely familiar with what surgeons need and how they operate, and they’re in the OR before and after each case to help expedite the set up and turnover of rooms. It’s an indirect way SFAs improve communication between surgeons and staff. That’s not necessarily what they’re there to do, but it’s a beneficial byproduct.
5. Versatile help
I’ve worked with surgeons serving as first assistants, but they don’t make the best helpers. They tend to have an urge to perform procedures themselves or have ideas as to how it
could be done better and aren’t as willing or able as SFAs to adapt to my style.
Some surgeons like to hire their own SFAs. There are definite advantages to doing so, but larger services (, for example) let surgeons pick and choose among several SFAs who are expert in different clinical areas and have different working styles. I team with SFAs who are very efficient and very fast, but not every physician is interested in working at that pace. Services can provide SFAs that match surgeons’ clinical requirements.
I’ve worked with 16 different service-provided SFAs — nearly all have been physician assistants — since 2009. They have expertise in a wide variety of specialties, so I’m able to work with someone who’s trained in the specific cases I perform. If I were to hire SFAs on my own, it’s highly unlikely they’d have the versatility to meet my various clinical needs.
Surgeons without the significant volume needed to pay for an SFA on their own can partner with a service and still enjoy the benefits. And even if surgeons have the volume to pay for a personal SFA who might be expert is several facets of their practice, it’s doubtful they’ll end up with an assistant who’ll be able to cover every procedure they perform. Plus, if surgeons work with someone from a service who’s not a good match, they can easily find a better fit. In contrast, surgeons who hire SFAs on their own might end up in an endless cycle of hiring and firing until they find the perfect partner.