The Surgical Physician Assistant (PA) practicing in the Colon and Rectal Surgery (CRS) is among one of the valuable attributes to the comprehensive care of the Colon and Rectal Surgical Patient. In addition to the fundamental job of performing history and physicals as they pertain to this surgical focus, it is not uncommon to be a fully integrated member of CRS team. This entails pre-, intra-, and post-operative care of the CRS patient. The pre-operative assessment would utilize the PA in such diagnostic procedures as digital rectal examination, colonoscopy, sigmoidoscopy (both rigid and flexible), anoscopy, endo-rectal ultrasound as well as anal manometry.

Colorectal Surgical Physician Assistants have a significant amount of autonomy in the operating room and is able to function as first assistant during most cases. The PA will fully integrate their surgical skills to the complement of the team currently operating. The PA can also be fully responsible for the post-operative management of the patient until discharge. One the attributes of this sub-specialty of general surgery is to be able to have continuity of care by taking care of the patient from the outpatient setting to the operating room to the inpatient setting and back to the outpatient setting. Based upon this paradigm, PAs are an ideal first assistant in the operating room based upon their complete knowledge of not only the disease process and thereby the subsequent management, but the whole patient as described above.

Although the role of a colorectal surgical PA may differ from practice to practice, most work 50-60 hours each week, providing patient care as described above. These PAs must have extensive knowledge of the pharmacologic effects of drugs specific to the colon and rectum as well as advanced understanding of surgical anatomy, including but not limited to the neurovascular anatomy. In addition, these specialty PAs must also assume the role of primary care PAs and be well versed in the management of other disease entities frequently encountered in the cardiac population, namely hypertension, diabetes, COPD, asthma, hypothyroidism and others.

Lastly, one of the finer points of this specialty is the ability to not only work with patients who are afflicted with benign colon, rectal and anal disease, but to work with patients affected with neoplastic disease of the colon, rectum and anus. This brings the understanding of not only how to treat the CRS patient from a surgical approach, but combines the understanding of multi-modality therapies of medical oncology and radiation oncology.

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