Best orthopedic practices demonstrate a team approach
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Physician assistants are a critical component of an efficient, effective and productive orthopedic practice.
The collaboration between a physician assistant (PA) and orthopedic surgeon offers the ideal environment to provide an improved patient experience, as well as a higher quality of professional satisfaction for PAs and orthopedic surgeons. While many allied health care providers can work with orthopedic surgeons, such as nurse practitioners (NPs), medical assistants, athletic trainers and physical therapists, the training and culture for PAs maximizes the scope and quality of orthopedic surgeon practices.
Increased access
PAs are increasingly independent in their initial evaluation and treatment of patients with musculoskeletal problems. They often establish a working diagnosis, obtain and review radiographic studies, and initiate treatment, including consideration of surgical options. This model of primary care orthopedics is based on the success of increasing PA and NP autonomy as seen in primary care and nonsurgical health care.
Well-trained and experienced PAs provide increased access for patients with musculoskeletal problems at a reduced cost when compared with orthopedic surgeons. This can be without a decrease in quality of the initial management of a patient’s condition. However, rarely do health care systems collect information on the accuracy and quality of care based on diagnosis, instead focusing on patient satisfaction criteria, including availability, affability and subjective factors unrelated to the actual diagnosis.
Delivery of care
Recently, there have been increased efforts from practice and health care administrators to “dissociate” the typical relationship between orthopedic surgeons and their PAs. With increasing technology and readily available resources to help define patients’ conditions and the predicted outcomes, there is a sense that a potential gap between the nonsurgical care provided by a PA vs. the care that would have been provided by an orthopedic surgeon is becoming less significant, especially when evidence-based clinical practice guidelines are incorporated effectively into the normal flow of patient care for both PAs and orthopedic surgeons. Unfortunately, this practice model is becoming increasingly used by health care systems to standardize and unify the delivery of care across medical and surgical specialties.
Additionally, professional PA societies are lobbying to increase their scope of practice. The American Academy of Physician Associates also passed a resolution affirming “physician associate” as the new official title of the PA profession. In some states, PAs can also practice without a supervising physician.
High-quality care
Without question, PAs with additional education in musculoskeletal care are assets to orthopedic surgeons and the overall care of patients with musculoskeletal problems. PAs provide high-quality care by effective history-taking, meticulous physical examination, ordering and reviewing diagnostic tests, and initiating appropriate care plans. When closely associated with an individual orthopedic surgeon or assigned to a group of orthopedic surgeons with similar subspecialty interests, the margin of difference between nonsurgical care provided by the PA vs. orthopedic surgeon can be eliminated when the PA is also an integral part of the surgical care team. Involvement in surgical care is critical for the PA, as well as an orthopedic surgeon, so they have a full understanding of the spectrum of available care.
When a PA is not part of the surgical care or is dissociated from a close relationship with an individual orthopedic surgeon – essentially practicing in a primary care model – the practice may appear to be cost-effective. However, there is a significant compromise in the quality and expertise of care. This compromise may not be accepted by administrators due to lack of supporting data, however, practices that have a 1:1 orthopedic surgeon to PA model strongly support this concept.
When building an effective and productive orthopedic practice, surgeons should support the model in which a PA is assigned to one surgeon, or a small group of surgeons with similar subspecialty interests if the practice volume is appropriate. The PA should be expected to participate in the surgeon’s office and surgical schedule to develop a level of expertise beyond the experience of a primary care PA. Ideally, the PA has completed additional specialized orthopedic training and educational programs and has experience working directly with orthopedic surgeons, especially in the OR.
Team approach
The value of a well-trained, experienced PA assisting with surgical cases cannot be over-emphasized. Any orthopedic surgeon who has this arrangement appreciates the higher level of care for patients, better patient satisfaction, more effective relationships with the OR staff and an overall higher quality of professional experience.
The best orthopedic practices demonstrate a team approach. Each member of the team has a critical role in providing the highest quality care and patient experience. A direct and intimate connection among team members provides the greatest potential for a top-quality practice and enjoyable work environment.
At the center of the best orthopedic team is a close relationship between orthopedic surgeons and PAs. This close relationship enhances the ability to provide the highest level of clinical and surgical expertise, patient communication and education. A team-approach mentality with shared decision-making and professional and personal demeanor will differentiate a practice from the increasing competition of physicians and nonphysicians.
- For more information:
- Anthony A. Romeo, MD, is the Chief Medical Editor of Healio | Orthopedics Today. He can be reached at Healio, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
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