Surgical First Assists’ Role In Addressing Physician Shortage
This article appears in the January/February print issue of Surgical Products.
With a growing aging population, and as many as 32 million Americans entering the healthcare system in 2014, the Association of American Medical Colleges estimates there will be a shortage of 91,500 doctors by 2020.
Much of the recent physician shortage conversations have been centered on a deficiency of primary care physicians, but of the estimated shortfall, roughly 46,100 will be surgeons and specialists.
With the foreseeable demand increasing at a faster rate than our current physician supply, I’m not surprised that conversations have heated up around different approaches to address the pending shortage before care delivery is dramatically impacted. Many of these dialogues involve a number of the usual suspects, strategies that have been positioned to address physician shortage issues in the past, such as the need to increase the number of residency training programs, reform scope of practice laws, expand the National Health Services Corps, develop student loan forgiveness programs and institute new staffing models.
We know there is no magic bullet to solve our seemingly ongoing physician shortage issues. However, from the list above, there is one approach in particular that is gaining steam within the surgical suite that is helping alleviate some of the mounting pressure on surgeons to meet the needs of a growing patient population.
Recently a study by RAND Corp. found that an expansion of the role of nurse practitioners and physician assistants could help eliminate 50 percent, or more, of the primary care physician shortage in the U.S. by 2025 – a concept being implemented beyond the primary care office walls in the OR.
A growth in staffing models that emphasizes better use of “physician extenders,” healthcare professionals who are licensed to practice medicine under the direction of physicians and surgeons, has emerged successfully over the past decade.
In the OR, qualified physician extenders typically are called Surgical First Assists (SFAs). SFAs are traditionally surgeons, medical doctors (MDs), physician assistants (PA-C), registered nurse first assists (RNFA) and advanced registrar nurse practitioners (ARNP). These highly trained SFAs provide advanced support that scrub techs are unqualified to provide, which helps free up the surgeons time to focus on tasks more appropriate for their level of medical training. This allows the surgeon to provide better quality of care with fewer resources and to increase surgical throughput, arguably leading to better surgeon satisfaction and better care economics for the hospital. At Intralign, our data shows the use of SFAs can reduce surgery time by 30 percent and increase surgeon throughput by 42 percent.
From a hospital-wide perspective, SFAs also help decrease costs by avoiding reimbursement barriers and lowering administrative tasks.
A few years ago, a large metropolitan hospital based on the East Coast was experiencing an increasingly heavy surgery load and a short supply of surgeons when it employed Intralign SFAs to help reduce surgery time, increase throughput and safeguard its surgical quality reputation.
Because Intralign SFAs are trained in the latest surgical techniques and devices, they can support the surgeon in many tasks. With this level of support, procedure times are shorter. Over time, this means that surgeon time and operating room time is freed up, allowing hospitals to accommodate more procedures. The exciting part of this equation is this can all be accomplished without adding more surgeon staff and without sacrificing quality.
During the first year, SFAs were added to a small fraction of procedures, which allowed the surgical team time to adjust roles and build chemistry. Once fully implemented, the SFA structure helped reduce hip and knee replacement surgery time by more than 100 hours, which is the equivalent to conducting roughly 40 arthroplasty procedures. The team also experienced nearly 500 hours of reduced general surgery time, which translates to time available to perform almost 250 additional general surgery procedures a year.
As our healthcare landscape continues to evolve, more efficient care delivery demands will call for a continued level of clinical labor specialization that optimizes surgeon involvement without impacting quality of care.
Qualified clinical staff can fill a shortage gap by providing the support needed to allow those with the highest level of certification to address the highlight level of patient needs.
Everyone understands there are many factors that need to be addressed to be able to better serve our future surgical patient’s needs, but qualified physician extenders will be critical in getting us there. The SFA profession will only grow in volume and importance, so I encourage hospital OR leadership to take a closer look at staffing models that not only help them meet patient demand, but present increased efficiency and revenue opportunities for their organization.
About the Author:
Lars Thording is vice president of marketing and public affairs for Intralign, a specialty healthcare services company that enables hospitals to better control the economics and quality of major joint arthroplasty in order to deliver the best possible care. He is passionate about helping redefine healthcare innovation as: only strategies and technologies that provide better care at a lower cost.
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