Gift of Education

– Program Director Article –


“The Gift of Education”

Are you glad you became a First Assistant?
I am often asked this question by CST’s and Nurses alike.
Before I give you my answer, lets go back a few years.

I became a CST in 1996 – a mere 18 years ago. For many years, I really basked in my job and truly enjoyed every minute of it. I couldn’t imagine that my work career could get any better. It was so exciting for me to learn new procedures such as an anterior to posterior lumbar fusion, prostatectomy or revision of a total joint procedure. The dizzying array of pans didn’t deter me one bit; in fact I often found myself volunteering to do these cases. I would read about the procedure the night before the case and felt prepared to jump right in. And that’s exactly what I did. It didn’t matter to me that the cases sometimes lasted 6-8 hours and that I might be required to wear lead the entire time. I became so engrossed in learning these cases and trying to improve my efficiency that often I’d forget it was lunch time! I’d be lying if I said that a restroom break could be ignored, but as every CST knows, if you don’t drink, you don’t need to use the restroom!

In the late 1980s I began thinking that I just might be able to take the next step in my career and become a First Assistant. I enrolled in an on-line course and began completing the surgical modules. Honestly, in hindsight I never really believed that I could become a First Assistant. Talk about self-limiting behavior! Let my mistake be a lesson to you: if you don’t believe, you won’t achieve! After about six modules, I just stopped the lessons and slipped back into my comfortable position as a CST. Of course, I was disappointed in myself, but apparently wasn’t ready to take the step.

In 2005 I packed up all of my belongings and made the cross country trip to Colorado, where I now live. I had already secured a full time CST position at a surgical center in Pueblo, as well as a new place to live. I was ready to start a new life here. I was quickly promoted to Lead CST at the surgical center and had added responsibilities of scheduling, ordering orthopedic supplies, troubleshooting equipment and staff training.

Shortly thereafter, I decided to move to Colorado Springs and began working in the hospital on Ft. Carson. I again found myself in a position of teaching new CST’s fresh out of school. It was challenging to teach a new surgical technologist not to be afraid of the instrumentation and to have confidence in their abilities. It was fun to watch them grow, but it wasn’t long before I again began thinking about becoming a First Assistant.

I worked with a number of PA First Assistants at the hospital and really focused on what they did. I thought, “I can do this!” I got on my computer and searched for on-line First Assistant schools and found NIFA (RASA acquired their Surgical Assisting program). I contacted them about enrolling in their on-line course in early 2008. I was working full time as a CST and part time as a medical transcriptionist for four surgeons back in my home state of Maine at the time. I provided 24-hour turnaround time for their transcribed reports (all conducted on line) so this provided me with a little extra income. I had a laptop computer at the time and carried it everywhere I went – even on vacations. The reports came in whether I was on vacation or not.

Once again, doubt settled in and I started to worry about my success with this program. Would I have time to fit in studying for this program? Would I be able to continue the transcription service that I had worked so hard to build? Would I be able to afford the program? Would I have any free time at all with a full time job, my transcription business and school? I decided right then and there to look at this challenge in much the same way as I did with a mound of instrument pans on my back table. I faced it head on and jumped right in. It was time to make a move if I was ever going to!

I contacted the program again and put the entire tuition costs on my credit card. This was very scary as I knew if I failed, I would still be stuck with the bill, plus interest and minus my First Assistant Certification. Once I went ahead and made the decision and began the program, there was no looking back. Was I busy? You bet! I was busy doing something that I’d always wanted to do and I was determined to make it work this time. I knew there was a light at the end of the tunnel so I just kept plugging along. Towards the end of 2008, three of the surgeons that I had been transcribing for joined a hospital based practice and didn’t need my services any longer. I was secretly relieved, but a little worried as well because the income from my transcription business was how I planned to pay my credit card bill. Then, the remaining surgeon decided to move his practice out of state a few months later and was provided a transcription service there. I was slowly losing my income source, but at the same time, I was getting closer and closer to my goal. Early in 2009 I was ready to begin my clinicals and requested part time status at the hospital so I could obtain more hours to devote to them. I didn’t know any of the surgical staff in Colorado Springs as I was working at the Army hospital, so was unsure of just how to get started.

The next step in the process was to obtain Educational Agreements with the hospitals where I would be working (which is not required by our program, but may be by your facility). This entailed contacting the hospital’s education department and obtaining the necessary form, have it signed by my sponsoring surgeon and the hospital’s education director. I chose a surgeon that I worked with as a CST, made an appointment with him and explained that I was in school to become a First Assistant. I told him that I needed a sponsor and he readily agreed to help me. Then it was off to have my picture taken for hospital badges depicting my student’s ID. It was somewhat frustrating to locate the proper person in the system to make this happen; however, with help from the program the paperwork was eventually all in place and I was ready to start clinicals. I called a fellow CST who happened to manage a group of First Assistants who had told me if I ever became a First Assistant to contact him. He was happy to have me on board and it wasn’t long before I was assigned my first case. I still remember this case as if it were yesterday. I remember the surgeon, the surgical center and being supremely nervous to close my first incision. It’s difficult for me to believe that nearly five years later I have logged about 2300 cases! I have paid off my initial investment many times over since that scary night when I charged the entire program to my credit card.

Then came the final step: certification. I hit the books with a new fervor as I was determined to pass the test the first time. I picked up a study guide, which I would highly recommend, and it was my new best friend. When the day came, off I went to Denver to sit for the certification exam. I was very nervous as our identities were verified and all of our belongings were stored in a locker. They sat us down at computers with a little camera watching us and a pencil and a slip of paper to do calculations on if needed. If memory serves me, we had three hours to complete the exam and we would know right away if we passed or failed. The test was quite challenging and made me glad that I carried my study guide everywhere I went. I hovered over the “finished” button for a minute before I pushed it. Then I got the good news: I passed! I was quite elated, to say the least. I made a promise to myself right then that I would keep up on my CEU’s (which I have) so I would never have to sit in that chair again. It was a wonderful feeling of accomplishment to do what I had always wanted to do.

Since I am now self-employed another challenge is that you have to manage your own tax deductions so you aren’t faced with a huge tax bill at the end of the year. This can be very sobering if you haven’t paid out quarterly self-employment taxes and/or saved a percentage aside on your own. I would urge you to find a good Accountant to help you with this. Also, you follow the basic premise that if you don’t work you don’t get paid. You are responsible for all of your own sick time, vacation time, etc. Having worked on hospital staffs for the majority of my professional career, this took some getting used to. Instead of receiving a check every week or bi-monthly, you will receive insurance reimbursements on a random basis. Locating health benefits as a self-employed individual may be a hurdle as well, unless you are on your spouse’s plan. The upside is the great feeling of freedom that you have knowing that you are self-employed and doing a job that you absolutely love.

So, when someone asks me if I have any regrets about becoming a First Assistant, the answer is an emphatic “no.” I absolutely love my job. I have several surgeons who schedule my services on a regular basis as well as others who randomly call me for cases. I also fill in for some of my peers when they go on vacation or take time off for other reasons, such as a sudden illness or if they just need some “cowgirl time.” Another challenge to being self-employed is my schedule. I never know from one week (or one day for that matter) to the next what I will be doing, or where. I currently hold privileges at four hospitals and four surgical centers. This can also be somewhat of a blessing, in that I am able to travel around to different facilities, meet a lot of great people, but never get involved in the day-to-day politics that I would if I were to work at one facility. This is something, if you are willing to work a very flexible schedule that you can get used to. A random day off in the middle of the week after working 5-day weeks for many years can be a wonderful thing. You will also notice seasonal highs and lows in your case load, but it always seems to average out in the end.

In hindsight, I guess I really do have one tiny regret: why did I wait so long to become a First Assistant? Think about your new education as the gift that it is. You can lose your job, you can lose your car, you can lose your car keys, but you can NEVER lose your education!

Alice Williams, CSFA
RASA Program Director


Update 2016: Alice was married this year and now goes by Alice Dungen! Congratulations!