By Elizabeth Elander, PA-C

Physician Assistants (PAs) are medical professionals typically trained at a graduate level, who are able to diagnose illness, develop and manage treatment plans, prescribe mediations, and perform procedures. All PAs are required to work with a collaborating physician, though the exact requirements of that collaborative agreement vary by state. PAs work in every state in the US and every medical specialty, with a well-established role in orthopedic surgery. Unfortunately, the benefits of a PA in hand surgery may be less obvious. As a PA who has worked solely in hand surgery for more than six years, I would like to elaborate on some ways hand surgeons can benefit from employing a PA in the outpatient, OR, and hospital settings.

Outpatient. PAs are able to perform physical exams, develop treatment plans, prescribe medications and perform injections and minor procedures. By having a PA in the outpatient clinic with you, you can essentially double the volume of patients you are able to see. You can also adjust clinic schedules so that the PA is seeing many of the post op patients, nonsurgical patients, or patients who tend to take more time, thereby allowing the physician to be more efficient in clinic and see more new or complex patients. One concern often raised is that some insurers only reimburse PA services at 85% of the physician rate. However, the “lost” 15% is negligible when considering how much time these patients often require and the hourly equivalent of a PA vs physician salary.

Operating Room. PAs are able to work in the operating room as first assists. Unfortunately, many common hand surgeries (carpal tunnel release, trigger finger, etc.) do not allow for reimbursement of a first assist, which may make it seem illogical to have a PA in the OR as a hand surgeon. However, there are many indirect benefits to be considered. By having a PA to close and splint, the physician is able to move on to the next room and perform more cases in the same amount of time. Even if your facility does not have the capability for physicians to use multiple ORs, while the PA is closing the physician can be talking to family, completing the surgical op note, and seeing the next patient(s) in pre-op holding. Another benefit to having a PA in the OR is having someone who knows your preferences to help make sure things are set up correctly and make sure the case goes as smoothly as possible, therefore decreasing your overall operating time.

Hospital. PAs are able to perform consults and daily rounds. They are also qualified to perform procedures in the ED or at the bedside (closed reduction, I&D, etc.), as delineated by their hospital privilege agreement and understanding with their collaborating physician. This can give the physician more time for other matters. The biggest barrier to PAs’ ability to work in the hospital are the regulations and requirements of individual hospitals. In teaching hospitals, PAs can be a valuable member of the team providing some consistency for the ever-changing group of residents.