Supervisor, Colleague, or Assistant: General Surgery Resident Perceptions of Advanced Practitioners

Clark, Clancy J.; Hildreth, Amy N.; Migaly, John; Sieren, Leah M.; Carter, Jeffrey; Stewart, John H.

doi:10.1177/000313481808400240

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…28 Importantly, the increased prevalence of sharing clinical responsibilities with mid-level providers is likely to decrease the double-burden surgical residents face in managing both the operating room and floor. 29 Nonetheless, the time demands of surgery continue to be a deterrent for career choice.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Pursuing a Career in Surgery

et al. 2019

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Objective:This study aimed to elucidate current medical student perceptions on barriers to a career in surgery, with a particular focus on gender-specific differences.Summary Background Data:Although gender parity in medical school composition has been reached, women continue to be underrepresented in the field of surgery.Methods:An anonymous, single-institution, internet-based survey conducted at Harvard Medical School.Results:Approximately 720 medical students were surveyed and 261 completed the questionnaire (36.3%; 58.6% women, 41% men, 0.4% transgender). Overall, there was no significant gender difference in intention to pursue surgery (27% of men, 22% of women; P = 0.38). Sixty-nine percent of all students and 75% of those pursuing surgery reported verbal discouragement from pursuing a surgical career. Women were significantly more likely to perceive that the verbal discouragement was based on gender (P < 0.0001), age (P < 0.0001), and family aspirations (P = 0.043) compared to men. Surgical work hours and time for outside interests were the greatest deterrents for both genders. Significantly more women reported concerns about time to date or marry (P = 0.042), time to spend with family (P = 0.015), finding time during residency to have a child (P < 0.0001), taking maternity/paternity leave during residency (P < 0.0001), and being too old after residency to have a child (P < 0.0001).Conclusions:Both men and women reported high rates of verbal discouragement, but more women perceived that the discouragement was gender-based. Concerns about marriage and childbearing/rearing significantly deterred more women than men. Family aspirations were also a significant factor for men to choose an alternative career path. Additional support within the surgical field is needed to mitigate these concerns and support trainees in both their career and familial aspirations.

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Section: Discussionmentioning

confidence: 99%

Barriers to Pursuing a Career in Surgery

et al. 2019

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“…This is the first study of its kind assessing psychiatrist workload and satisfaction. The perceived benefit of PAs to the health care team has also been noted by a survey of surgical residents [ 13 ]. A study of family medicine found that having a PA increased the family practice physician panel by 410 patients [ 14 ].…”

Section: Discussionmentioning

confidence: 92%

Physician Assistant Utilization in Inpatient Psychiatry: A Qualitative Study

Curran

Boyette

Callison-Burch

et al. 2020

Cureus

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There is a national shortage of psychiatric care providers, with approximately 1% of physician assistants (PAs) working in psychiatry. The study aimed to understand the utilization of PAs in inpatient psychiatry. Methods A qualitative study was performed utilizing semi-structured interviews focusing on PA autonomy, reimbursement, specialized certifications, training structure, and overall satisfaction with PAs in inpatient psychiatric care. Results Of the nine locations interviewed, four are currently using PAs, and five have never utilized PAs. All facilities utilizing PAs reported a decrease in physician workload with varying structures for training and billing, and required specialized certifications. Conclusion Most facilities surveyed do not utilize PAs and either preferred physicians or were unaware of the qualifications of PAs. Of the facilities utilizing PAs, there is wide variation in their utilization and reimbursement models; however, they reported a high level of satisfaction, reinforcing that PAs can provide high-quality care in inpatient psychiatric settings.

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“…Although PAs greatly contribute to resident education, their current role in GME programs is not formally defined. 27 , 28 By formally including PAs in GME program design, AMCs could potentially evade the opportunity costs associated with residents first-assisting rather than PAs, and could also relieve administrative burden on attending surgeons and enhance the quality of their resident instruction. It would also expand the roles and responsibilities of PAs, and increase educational exposure for residents.…”

Section: Discussionmentioning

confidence: 99%

Hidden Costs in Resident Training: Financial Cohort Analysis of First Assistants in Reduction Mammaplasty

Malloy

Sanchez

Cho

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Graduate medical education (GME) programs are vital to developing future plastic surgeons. However, their cost-efficiency has yet to be contextualized. This cohort quality improvement (QI) project aimed to measure the indirect costs an institution assumes in training surgical residents, by comparing the differences in operative time and procedural charges between a resident and a physician assistant (PA) first-assisting during adolescent reduction mammaplasty. Methods: From 2013 to 2019, adolescent bilateral reduction mammaplasty procedures first-assisted by either a resident or physician assistant were considered for analysis. Financial data, including all hospital and physician expenditures and operation duration, patient demographics, and outcomes data were retrospectively collected. Results: A total of 49 reduction mammaplasty cases were included for analysis. Residents had an average of 5.9 ± 1.5 years of post-graduate surgical training, whereas the PA had 2 years of surgical experience. Procedures first-assisted by a surgical resident took a mean/median of 34 minutes longer and were $3750 more expensive, respectively, than cases first-assisted by a PA ( P < 0.01, both). Conclusions: Reduction mammaplasty procedures were longer and accrued higher charges when first-assisted by a surgical resident than by a PA. Although Graduate Medical Education programs are necessary to train the next generation of surgeons, they may result in unintended opportunity costs for teaching hospitals. Federal support to academic medical centers aims to cushion the cost of residential training, but is insufficient to compensate for resident inefficiency. Hospitals may consider incorporating PAs into the Graduate Medical Education paradigm to alleviate administrative burden, lower operational charges, and enhance resident training curricula.

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Supervisor, Colleague, or Assistant: General Surgery Resident Perceptions of Advanced Practitioners

Cited by 7 publications

References 15 publications

Barriers to Pursuing a Career in Surgery

Barriers to Pursuing a Career in Surgery

Physician Assistant Utilization in Inpatient Psychiatry: A Qualitative Study

Hidden Costs in Resident Training: Financial Cohort Analysis of First Assistants in Reduction Mammaplasty

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