It's a little easier in your environment. You presumably don't have interns. The major issue where midlevels become a problem on an academic surgical service is that "midlevel appropriate procedures" are also by definition "intern appropriate procedures". I highly doubt there are any chiefs out there disgruntled that PAs are taking their Whipples or maxillectomies.
It is a problem, especially with the new intern hours. The only useful solution I've found is if there's time when the residents are unavailable due to didactics the midlevels can cover those cases and get OR time. Otherwise you've got to give the residents the cases, try to work the midlevels into the procedure rotation (in a fair way) and hope everyone gets along.
We have rotators as PGY 1-3's. There are no PGY 4-5's unless they are taking paid weekend or night call. On any given 12 hr shift, we place on average 2-4 lines. If I have my intern placing every line and doing every procedure, they'd never finish, and the service would grind to a halt. Between my PA and I one shift last week, we placed 7 lines, 2 chest tubes, did multiple lac repairs, rounded in the ICU and admitted multiple new patients, including emergency general surgery and traumas.
The residents get more than their fair share of bedside procedures, if they're not already in the OR with the scheduled/emergent operative cases. I don't think i've heard any of the residents complain about lack of procedures with the current setup.
I remember during residency (at a different place) getting overwhelmed being the sole person on-call doing 6 line consults while trying to cross-cover 60 patients and handle new admissions. At least I was a PGY-2 and not a shell-shocked intern at that point. Makes me wish there was a PA back then to help share the workload.
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