by James D. Hundley, MD
A Case for Encouraging, not Discouraging, Orthopaedic Assistants
A wise person has been quoted as saying, “For every action there is a good reason and then there is the real reason.” I wonder if something like that that may apply to the position being taken by the American Academy of Physician Assistants (AAPA) in regards to the American Society of Orthopaedic Assistants (ASOA). As I understand it, the AAPA has taken a position opposing the licensing of Orthopaedic Assistants based on brand infringement and an inadequate knowledge base. Is it really about patient care or is it about turf protection?
In the first case, the ASOA has conceded the use of the word “Physician” in the name of their organization. They are no longer the American Society of Orthopaedic Physician Assistants but are now the American Society of Orthopaedic Assistants. Thus, that argument has become moot. If there is an argument against their knowledge, based on my my long-term experience with an Orthopaedic Physician Assistant (OPA) and many years as a member of the National Board for Certification of Orthopaedic Physician Assistants I beg to differ.
The OPA with whom I worked for over thirty years was highly knowledgeable and served as a valuable member of our team. His services in the operating room, the hospital, and the office were invaluable. He not only made me more efficient, he made me better, which allowed us to deliver better patient care.
My role on the National Board was helping to update the written certification examination every two years. This process was directed by a nationally known, professional educator and performed by board certified Orthopaedic Physician Assistants and Board Certified Orthopaedic Surgeons. The questions and answers were evidence-based, pertinent, and difficult. As with other boards, candidates were required to have a certain amount of experience before being allowed to sit for the examination. From my detailed review of the questions, both experience and appropriate education were required to pass it.
The issue that should be getting the attention of all medical organizations is the impending growth in medical manpower needs. The population is aging; we hear that 10,000 Americans turn age 65 every day. Population growth is outstripping the growth of medical providers. Medical schools will not be able to keep up with the number of physicians needed. New schools are being opened and old ones are expanding, but they simply cannot turn out enough additional physicians quickly enough. I believe that the void will have to be filled with physician extenders. The greatest numbers will be physician assistants and nurse practitioners but I believe that there will be an important role for trained orthopaedic assistants as well.
The roles will be different and physician assistants should well know that. Their roles and, therefore their licenses, are different from physicians. Orthopaedic assistants will have to perform within their licenses, too, and I believe that they are prepared to do so.
So why is it important for Orthopaedic Assistants to be licensed by their states? Along with being certain that they are certified and qualified, the issue of payment is huge. If they are not licensed, third party payers will not pay for their services. That means that the surgeon would have to pay for the assistant out of the ever-diminishing compensation he receives for a surgical case. Alternatively, he could use another surgeon as an assistant a level of compensation higher than an OA. Thus the surgeon is incentivized to involve another surgeon in his case at a greater cost to the system and at reduced efficiency; the other surgeon should be treating his own patients. If an OA can assist just as well (often better in my experience) the above arrangement makes absolutely no sense.
My message is simple: Stop obstructing the licensing of Orthopaedic Assistants. Encourage it! There is plenty of work to go around now and there will be more in the future. Our medical system will need all of the help it can get. We need highly trained Orthopaedic Assistants and they need to be licensed and adequately compensated.
Dr. Hundley is a retired orthopaedic surgeon and a founder and the president of OrthopaedicLIST.com.
