The Surgical Hospitalist PA

October 26, 2018


By Erin Sherer EdD, PA-C, RD
AASPA President Elect

Surgical hospitalist physician assistants (PAs) work throughout the United States to manage both adult and pediatric patients and are becoming vital to the more nuanced and patient-specific care that modern medical practice is providing.  While the actual job duties, types of patients cared for, and the co-management process with other services may vary among institutions, these positions are becoming more and more prominent—as it turns out, for very good reasons (Rappaport et al., 2014).

This surgical hospitalist role was created to address the burden of emergency department call for existing general surgeons, and also serves to help manage some of the complex medical problems that many surgical patients may have that need to be cared for before and after their surgery (Nelson, 2007).  For example, when surgical hospitalist physicians (or PAs) handle emergency department consults and provide services for pre- and post-operative visits, the surgeons have bandwidth to schedule more elective surgeries (Nelson, 2007).  Another driving force leading to more PAs in this role may be the overall physician shortage within the United States.  While some hospitals have already embraced this model and have several surgical hospitalist PAs on staff, there are a number that are actively adopting this new provider role.

There are other benefits associated with surgical hospitalist PAs that hospitals should consider.  Rappaport et al. (2014), suggest that surgical hospitalists can improve quality and safety while lowering costs of patient care.  Soohoo and Owens (2015) reported improvements in surgical call coverage and timeliness of care, and associated reductions in complications, lengths of stay, and costs. They indicated that a surgical hospitalist program at one California hospital saved the organization an estimated $2 million in one year. Dua et al. (2016), who conducted a study examining the efficacy of hospitalists co-managing pediatric surgical patients in a community hospital, found that including hospitalists in the management of these patients allowed for improved medication management and better medical comorbidity.  The most recent study involved hospitalists in the care of colorectal surgery patients (Rohatgi, Wei, Grujic, and Ahuja, 2018).  There, the authors indicated that surgical co-management reduced intensive care unit transfers, lengths of stay, medical consultations, and the overall cost of care.

Overall PAs can (and do) provide cost-effective, high-quality, and prompt medical and surgical care to patients in need.  And with so-called “surgeon-shortages”  and other instances where providers are in high demand but short supply, there is a demand for specialists PAs that only seems to be increasing.  Not only are hospitals embracing surgical hospitalist PAs, the expectation is that more of these (and other varied) specialist positions will be demanded in the future.

 

References:
Dua, K., McAvoy, W. C., Klaus, S. A., Rappaport, D. I., Rosenberg, R. E., & Abzug, J. M. (2016). Hospitalist co-management of pediatric orthopaedic surgical patients at a community hospital. Maryland medicine: MM: a publication of MEDCHI, the Maryland State Medical Society, 17(1), 34-36.

Nelson, J.  (2007).  A Surgical Surge.  The Hospitalist. from https://www.the-hospitalist.org/hospitalist/article/123475/surgical-surge

Rappaport, D. I., Rosenberg, R. E., Shaughnessy, E. E., Schaffzin, J. K., O'connor, K. M., Melwani, A., & McLeod, L. M. (2014). Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations. Journal of Hospital Medicine, 9(11), 737-742.

Rohatgi, N., Wei, P. H., Grujic, O., & Ahuja, N. (2018). Surgical Comanagement by Hospitalists in Colorectal Surgery. Journal of the American College of Surgeons.

SooHoo, R., & Owens, L. J. (2015). Beyond surgical call coverage reaping the benefits of a surgical hospitalist program. Healthcare financial management: journal of the Healthcare Financial Management Association, 69(6), 46-49.