Why does an Orthopaedic Surgeon need a Physician Assistant or PA, anyway? I think a bit of background information on the reality of an orthopaedic practice will help you to understand why this role is integral to the success of many busy Orthopaedic practices today.
The surgical/medical practice of today is a far cry from the highly- idealized and fictitious imagery portrayed on TV or in the movies. In that make-believe world, the physician always has loads of time to spend on extra-curricular activities AFTER they see a full schedule of patients every day. Surgeons are usually portrayed, sweeping in and out of ORs, just in time to save someone’s life or to help them to walk again. After a tense surgery and a tearful session with the patient’s family, they depart dramatically, usually into the arms of some gorgeous nurse, until the next dramatic surgery happens. Ask any modern day Orthopaedic Surgeon how closely that resembles their actual day and they will fall on the floor laughing!
A well-run, modern Orthopaedic practice is often a model of efficiency and organization, comprised of seeing many patients in the office for consultation about musculoskeletal problems, pain and loss of function. The other half of our work involves taking patients to surgery, where we fix those problems that cannot be ameliorated through more conservative measures, such as using medications, physical therapy, bracing, behavior modification, rest, etc.
Some days, our office practice is more like a three-ring circus than anything else. Schedules, packed with patients, can easily run behind, especially if someone has an urgent problem or needs special attention because they are confused or bewildered by decisions they must make. We see young and old, people who are highly-educated and those who are not, people who are rich and poor and every shade in-between. We see folks who really don’t have a clue about their bodies and how they work and those who think about nothing else. Regardless, they all deserve excellent care and someone to help them understand what is happening to their body and explain the treatment that they need.
Office days are crazy busy from start to finish. X-rays have to be taken, injections given, bandages and stitches removed. Patients need to be given time to absorb the fact that, yes, they really do need a knee replacement or spine surgery, and that is the only answer to help them feel better. Sometimes, they just need to talk about their pain and know someone hears them. We must dictate notes into the patient chart, talk to consulting physicians and order tests.
At OSC, our “lunchtime” for both physicians and PAs is 30 minutes and we are lucky some days to even get a break to go the restroom or to grab a bite to eat. Other physicians in town go out to eat lunch on a regular basis; we might miss lunch entirely. I don’t expect you to feel sorry for us, but I do think that it is important for you to know how seriously we take our job of patient care. I believe the physicians and PAs at OSC thrive in this busy environment. I find it so gratifying to be able to help people when they come into our office and I don’t mind working hard to do so.
In the office, my job is to help Dr. Carlson according to a predefined and structured work arrangement, meaning I have my role and he has his. We both know exactly what to do with each patient, we work well as a team and this allows us both to be more efficient and to see more patients during a day. I am an extension of him. I work under his supervision, although he does not need to be physically present with me at all times. We stay in constant communication though-out the day about the patients that I see.
Over the course of a treatment for a specific issue, I usually get to know the patient and their family quite well. During an office visit, I examine patients, ask them questions about their condition and start compiling information to help give Dr. Carlson more information by which to make a diagnosis or for him to determine if a treatment or surgery has been successful. I give injections, remove stitches, change dressings, order prescriptions and do follow-up visits for post-operative patients. I also order and review lab tests and imaging, such as MRIs and CT scans. I communicate with the patients’ other physicians, PCP’s, even oncologists, to manage and treat patients using a team-based approach to healthcare. Applying casts and instructing to patients on how to care for their casts is also in my job description. My day also involves answering a lot of phone calls, from other physicians, as well as from our patients and their family members. These questions can range from those where a simple yes or no answer will do to some that need detailed answers regarding a surgical procedure. Physical therapy can be ordered, and therapy notes reviewed to make sure patients are on the “right track” and progressing and I also offer encouragement when they are not. As a Physician Assistant, I also review medications so the appropriate medication is being utilized and that we are having the required response.
In surgery, our day can be full of unforeseen adventures and complications. Even on the best days, operating rooms can be slow to turn over and we can get behind on the schedule. Our patients deserve our very best in surgery and we work hard to make sure we surpass their expectations. The families need to know how their loved ones are doing, what to expect and need reassurance. We have to be on our “A” game at all times. Hospital orders have to be written, and the patients must be followed closely to make sure that their recovery occurs in the best possible way.
At the hospital, I complete rounds on patients who have already had surgery. This includes:
• Examining the patient and answering any questions they have
• Reviewing their lab results, vitals and writing SOAP (Subjective, Objective, Assessment Plan – medical format) notes in their chart.
We usually start surgery around 7:30 AM. I have the responsibility of speaking with and examining the patient before surgery, making sure everything is in order and reporting to Dr. Carlson that it is okay to do the surgery, based on the information I have gathered. When the surgery begins, I assist Dr. Carlson by making sure he has all of the surgical equipment he needs, by doing retraction, suction, suturing, dressing the surgical area, etc. By being his “right-hand” in the OR, we can complete surgeries in less time, which puts less stress on the patient and on us. We serve as a check for each other to ensure all surgical steps are completed appropriately. I also help move the patient to recovery after surgery.
Whether we are in the office or in the hospital, everything that I do is very important and time-consuming, in a day that doesn’t have enough hours to start. It is wonderful feeling to know that I play such an important role in helping patients feel better. I am an integral part of a team that includes Dr. Carlson and numerous other staff members, at our office and in the OR. When I consider the number of patients that we are able to see and treat, either in the office or in the OR, I am proud of what Dr. Carlson and I are able to accomplish together.
Tonia C. Yocum is an Orthopaedic Physician Assistant who practices at Orthopaedic & Spine Center in Newport News, VA. She assists Dr. Jeffrey Carlson, a Fellowship-trained Spine Surgeon who is the Managing Partner at OSC.