I am currently a PGY-1 in FM and very interested in doing minor procedures and assisting surgeries. I am wondering if in small towns FM physicians still go to the OR assisting surgery. In my hospital, none of the FM doctor does that, although there are more than 50 of them seeing pts in the hospital. It is a town with population only 20,000.
Do Family Medicine physician still assist surgery in small towns?
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Surgical assisting: http://www.aafp.org/online/en/home/aboutus/specialty/facts/44.html
Minor surgery in the hospital (whatever that means): http://www.aafp.org/online/en/home/aboutus/specialty/facts/45.html
Minor surgery in the hospital (whatever that means): http://www.aafp.org/online/en/home/aboutus/specialty/facts/45.html
I saw that table too, and it seems quite a few FM physicians are still assisting surgery. However, a FM attending recently told me that there is no surgery-assisting fee now, any body know if this is true?
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Assist surgery? Nurses and medical students hold retractors and sew up why would you need an attending physician to "assist surgery" unless it paid well I don't see it.
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That, I'm not sure... but I do know it's being done. And, I do know it's being reimbursed... A quick Google search yielded some answers for me:
- It depends on the procedure
http://www.aaos.org/news/bulletin/jun07/managing5.asp
(last part of article)
http://www.trailblazerhealth.com/Tools/Fee Schedule/MedicareFeeSchedule.aspx
(Look under Indicators if assistant surgeon is allowed for a particular CPT code)
- It depends on the insurance carrier
https://www.oxhp.com/secure/policy/assistants_at_surgery_109.html
(and see the Eligible List for CPTs that will pay)
- It depends on the procedure
http://www.aaos.org/news/bulletin/jun07/managing5.asp
(last part of article)
http://www.trailblazerhealth.com/Tools/Fee Schedule/MedicareFeeSchedule.aspx
(Look under Indicators if assistant surgeon is allowed for a particular CPT code)
- It depends on the insurance carrier
https://www.oxhp.com/secure/policy/assistants_at_surgery_109.html
(and see the Eligible List for CPTs that will pay)
That is interesting information. The reason why I raised this question is that I heard different answers why FM docs do not assist surgeries in OR. Somebody told me surgeons do not want FM docs to use such ways by "assist surgery" to boost their salary, that is why they would rather hire PAs or surgical Techs to help surgery in hospitals where no surgical residents available. Well, another attending told me there is no such assisting fee any more since about five years ago. It seems even FM attendings do not know the correct answer, but it is true that in my hospital I do not see any FM doc has interest going to OR to assist.
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I met a crew out in San Antonio that assist in surgery. There's 1 attending out in SoCal who works for an HMO who assists. A couple of new grads up in Silicone Valley assisted in surgery to fill in down time as they were building their private practices while bringing in revenue & making contacts. They were able to source a couple of preoperative evaluations out of it. It's being done.
The argument I've heard why majority of FM docs aren't interested in assisting in surgery has to do with lack of interest, lack of interest for involvement in surgical malpractice, and opportunity costs. FM docs work mostly out of an outpatient facility which means there's rent/mortgage to be paid. Any time not spent there means there're are empty rooms costing a pretty penny. The reimbursement for surgical assist isn't that great (it's a % of the surgery reimbursement and allowable only on certain cases). And volume and coordination (i.e. efficient OR's) are a big issue.
I don't know how these people set it up. Do you arrange a day that coincides with your favorite surgeon to do surgeries, knowing that you may not have a case that you can be involved in that day? Or do you run back and forth between the OR and clinic? The guys whom I've heard who assist either have their office at the hospital, are at the hospital anyways taking care of inpatients, or have their office practice in a multispecilaty group next door to an outpatient surgery center (which I bet they own stock in).
It's very important to a surgeon to have an assistant who understands the surgery, the flow, whom the surgeon can trust. It takes time to develop it. If you operate with a particular surgeon long enough, you would move down the learning curve faster. Maybe that's why surgical groups will hire their own midlevels who stick by their surgeons all day to assist.
Not wanting FP's to earn assistant fees sounds like BS. You bill the insurance company separately. It's no slack off the surgeon and if you have a continuity practice, it ensures continuity of care because you were present at the surgery. Most FP's don't want to do the work that requires a masters degree (PA/NP) or bachelors/associates (surgical assistant) can do. I can understand a surgical group not wanting to employ a FP to do a job that can be employed by midlevels because of cost. But if you are a independent contractor or had a practice of your own, why should the surgeon care other than you doing a good job in the OR? I don't know enough about it to answer your question.
The truth of the matter is FP's have so many different ways they can make money that surgical assisting doesn't exactly float to the top. That being said, if you're interested in doing so, I can be done.
I'm curious about it too and would like to know more about it... my surgery friends have agreed to take me on as their assistant when I'm old and tired of the clinic/hospital work... There's a guy in my hospital who was formerly a surgeon in Cuba, came to the states and did an FP residency. He put his son through medical school and when his son became a surgeon, the father retired, closed his practice, and worked as his son's surgical assistant. There's a couple of husband and wife duos out there that do surgery & assist together. Personally, I think it's pretty neat.
I don't know if there is such a thing as a correct answer as you put it. I imagine the most correct answer would be the one that makes the most economic sense, since that's truly the principal driver behind what we all do anyways.
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Oh this is interesting. Read Chapter 3.
http://books.google.com/books?id=pG...&q=family medicine surgical assistant&f=false
http://books.google.com/books?id=pG...&q=family medicine surgical assistant&f=false
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I'm out in the wilds of Montana in a town of 4000, there are 5 of us who are FP. The specialists come up once a month and we assist when needed. Also in Alaska there are plenty of FP's who assist regularly especially on OB patients. Its a matter of how interested you are and how much experience you have. The FP's here do C-sections, tonsils, colonoscopy/EGD. I do joint injections, moles, nails, warts, my own splints/casts, trigger points, biopsies etc. Pretty much what needs to be done since there is no one else out here. There are plenty of jobs out there that offer OR time and assist opportunity, you just have to want to do it.
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