Becker's Spine Review

31 Practice Management Isador Lieberman, MD, MBA, Texas Back Insti- tute (Plano): The PA, in its truest sense, is a phy- sician extender. A stellar PA works in synchrony with the surgeon, extending his/her capabilities. The PA must understand the surgeon's treatment philosophy, be technically proficient when needed and they must serve the practice's patients with the same, if not more, compassion and courtesy than the surgeon. The PA should be proficient at triag- ing the appropriate patients through the diagnostic work up and initial treatment. The PA must appreciate exactly when the surgeon needs to be involved in the decision making. At times the PA can serve the role of shield in difficult situations. In addition the PA might at times have to be innovative and work to keep the surgeon on track. It takes time, effort and mutual respect to develop the trusting relation- ship needed in the coordinated effort to expand the surgeons' ability to care for more patients. Hooman Melamed, MD, DISC Sports & Spine Center (Marina Del Rey, Calif.): With the changes in healthcare occurring, the industry needs to have more providers in order to meet the demands of increased patient loads. The scope of a physician assistant does not need to change, but the role should. PAs can be on the frontlines, taking a more prominent role to reduce waiting times and allow patients to be seen in a timelier manner. In a surgi- cal environment, the role of the PA can be expanded in pain management and anesthesia. Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: The physician assistant mainly acts as a steward for the physician. My concern is that surgeons will have them act as a surrogate instead. With the pressure to see more patients, the natural tendency will be to offload more responsibility onto this midlevel practitioner. We as surgeons should re- member that the buck stops with us. Richard A. Kube II, MD, Prairie Spine & Pain Insti- tute, Peoria, Ill.: I think every practice needs to assess the role of a PA. I see them in our practice as true extenders of the surgeon. As reimbursements decline and administrative duties increase, surgeons are find- ing it increasingly necessary to multitask. Having a PA who is motivated and a surgeon willing to devote the appropriate amount of time and resources to train him/her is crucial if the model is going to work. I think the limits are really determined by the individuals and regulatory standards. Gowriharan "Ty" Thaiyananthan, BASIC, New- port Beach, Calif.: As the emphasis on seeing more patients, while still maintaining quality, patient care and satisfaction grows, I believe the use of PAs and other midlevel providers such as nurse prac- titioners will become more crucial to meet these goals. Along with that, I believe the roles and re- sponsibilities of midlevel providers will continue to expand. The question of how far their respon- sibilities will grow is really dependent on the de- mands placed on physicians to meet the ever-increasing mandates set by healthcare managing entities. n The PA's Role Today: 5 Key Thoughts By Anuja Vaidya "With the changes in healthcare occurring, the industry needs to have more providers in order to meet the demands of increased patient loads. The scope of a physician assistant does not need to change, but the role should." — Dr. Hooman Melamed, DISC Sports & Spine

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