Shortage of first assistants
First assistants support surgeons by providing aid in intraoperative technical functions, thereby allowing the surgeon to improve operation safety and optimize patient results, according to the American College of Surgeons. A first assistant’s role varies based on surgical specialty and facility but generally includes patient positioning, skin preparation, procedural assistance, closure of body planes and wound dressing selection and application.
A first assistant may be another surgeon or a mid-level provider, such as a nurse practitioner or a physician assistant. In the case of mid-level providers, a physician or practice can employ these providers to accompany the surgeon to each facility where he or she performs surgery. However, for this model to be successful, the physician or practice must perform a large volume of complex cases that allow for reimbursement of the NP’s or PA’s services. An additional obstacle is the shortage of properly trained mid-level providers.
“There aren’t a lot of physician extenders out there as compared to physicians, so the question becomes ‘how can we bring services similar to the ones NPs and PAs provide to all surgeons?’ ” says Ms. Woods.
Physicians who do not employee mid-level providers often rely on their local hospital or ASC to provide someone to fill the first assistant role. It is uncommon for these facilities to have certified first assistants, and these facilities are often unaware of the availability or benefits of first assistant outsourcing, according to Ms. Woods. In fact, 65 percent of all surgeries are not covered by a specifically trained assistant, according James Johnson, a partner with YEHSS.
“Hospitals and ASCs often provide an RN or scrub tech to serve as the first assistant, but these professionals aren’t generally trained to fill a true surgical first assistant role,” says John Atwater, MD, a Bloomington, IL based spine surgeon. “A scrub tech might know instruments and counts, but a first assistant knows the procedures and how to put his or her hands in the field.”
First assistant marketplace
Many certified surgical first assistants choose to work independently as opposed to being employed by a facility because they receive better compensation in the open market. Facilities are thus often faced with the decision of whether to bring in independent assistants, perhaps through a first assistant outsourcing company, or whether to use their own, less-qualified employees to fill the role.
Outsourced solutions traditionally save facilities staffing costs because an outsourced assistant is paid as needed and can reduce the number of facility staff. However, outsourced models can create a perception of inequality among employed staff given that an independent contractor works fewer hours at the facility and is often more highly compensated than employed staff.
After being dissatisfied with his surgical support options, Dr. Atwater began searching for alternative solutions. Dr. Atwater met James Johnson, CSA, SA-C, and Ruben West, CFA, SA-C, two faculty members at a first assistant training program in Illinois where Dr. Atwater had sent one of his employees.
“James and Ruben, with the help of a few others, created an outstanding first assistant training program. When I sent my nurse practitioner there, she was enamored by their curriculum,” says Dr. Atwater.
Thereafter, Mr. Johnson and Mr. West formed YEHSS. YEHSS partners with ASCs and hospitals to train the facilities’ current RNs, LPNs and surgical technicians to become first assistants, giving them the opportunity to obtain national certification. Through YEHSS’s proprietary system, facilities save on their full-time equivalent expenses and the trained staff members receive additional compensation while working in the role of a surgical first assistant.
Deanne Burnett, one of the program participants, says that becoming a first assistant has helped to advance her career. “Becoming a first assistant was an excellent career step for me and the other surgical technicians that decided to participate. We pride ourselves in providing excellent service to the surgeons that operate our facility and now that we are trained as assistants, we can increase the level of service that we provide.”
Employees who participate in the program complete first assistant classes through a distance learning program. Typically, grant funds are available to cover the education expenses of participating students.
“We give these employees the opportunity to achieve a higher skill level and better assist surgeons,” says Mr. Johnson. “Essentially, we provide a scholarship to them that will allow them to receive their first assistant training while continuing to work at their facility.”
Benefits of first assistants
The use of certified first assistants in the operating room can increase the efficiency of procedures by ensuring that staff remain constant through the procedure, which can improve the overall level of patient care. “I can do more cases, I’m more efficient, I am more in tune with the staff, and I don’t have to supervise training of a new grad or someone without experience in my field of specialty,” says Dr. Atwater.
First assistants can also transform the culture of the operating room, according to Dr. Atwater. “When you are the surgeon, you do a case from beginning to end, no matter how short or long it is. The same is true for a NP, PA or first assistant. Anyone else in the OR is on the clock. With a first assistant, you don’t have staff scrubbing in or out, taking morning, afternoon or lunch breaks.”
Certified first assistants also bring a level of commitment to the OR that is usually not present otherwise, says Dr. Atwater. “A first assistant with proper training that buys into the culture of accountability elevates the services the facility provides. The hospital or ASC will keep surgeons coming back, which increases volume and creates more revenue.”
To learn more about YEHSS’s program, contact Debra Woods, dwoods@yehss.com, 309-846-4716.
