I was discussing this matter with the director of the surgical technology program at Methodist hospital in Indiana (One of only 2 level 1 trauma centers in the state and considered THE best hospital in the state), and the program director said that surgical technologists can, instead of participating simply as scrub techs, can choose to mainly work as the second assist under the surgeon, doing suctioning, sponging, clamping, etc. Is this true?
First you need to understand the terminology. There are a number of people in the OR. For any operation you generally need at least four people.
The surgeon is a physician that is responsible for the surgery.
You need anesthesia (who can be an anesthesiologist, AA or CRNA) who keeps the patient from getting up and leaving during the surgery.
Then you have the scrub. This is the person (can be a nurse or tech) who maintains the sterile field and sterile instruments.
Then you have the circulator. This is an RN who is responsible for the room and getting things needed during the case (simplification).
Those are the minimum number of people that you need for surgery. The rest are optional. The first assist is the person who assists the surgeon. They do all the things that you mentioned above. This is a completely payment driven terminology. The second assist is someone else who is not the first assist who assists the surgeon. A third assist is someone who is not a first or second assist who assists the surgeon etc.
The other part of this is that insurance will only pay for assistance on some cases. For example, lets say WS has a breast biopsy case. Her offices PA can scrub the case and would then be the first assist. However, the insurance reimbursement for a first assist on a breast biopsy is $0. So they would be doing that for free. More likely, WS would scrub the case alone and the scrub would also be expected to cut suture, suction etc. Given that experience will vary widely they probably wouldn't clamp or suture anything.
On the other hand lets say that WS does a total mastectomy with axillary node dissection and rotational TRAM flap which insurance does pay for an assist (I have no idea if insurance pays for an assist for this or not). Then if the PA assists for a Medicare patient the practice will get 14.5% of the surgeons fee for the assist. If WS's partner assisted instead then she would get 18% of the surgeons fee. If this was a non-Medicare case then a first assist would be reimburse according to the contract. In this case she could use a non provider assist (RNFA or CFA) and bill for them at whatever the contract says.
So first assist is completely a construct of billing. There are very few operations that will pay for a second assist. In academic institutions it not unusual to have first, second and third assists if its a complex case that lots of people want to see.
To go back to your original question yes there are CSTs that just assist. There are essentially two methods. The first is to go to a CFA program. There are a number of these. Most are two year programs where you get your CST after the first year and CFA after the second. The other way is to get your CST work in the field for a while then take some more classes and get your certification. There are also several other competing certification agencies.
The other issue is how you get a job assisting. Depending on the area there are a number of first assist groups that contract with physicians or hospitals to provide first assists. They generally use very experience techs. Hospitals also have first assists. The most common way I've seen is they pay RNs or CSTs an extra dollar or two when they assist. This has its own problems. Finally the joint commission frowns on non hospital or physician employed first assists because of supervision issues.
David Carpenter, PA-C
