– Program Director Article –
A Day in the Life of a Surgical Assistant: The Truth, Un-Sugar Coated
What are the main differences between being a Surgical Technologist and Surgical Assistant?
The main difference here is you must get used to not having control of the Mayo stand! Also, it simply feels weird to not set up the case. As we all know, there are Surgical Technologists who are very protective of their Mayo’s (understandably) and do not appreciate you messing with this area. There is a definite transition period that you must go through to learn to keep your hands off the instruments unless you ask for and are handed them to use. Although surgical first assistants always arrive at the cases in time to help position the patient and make sure everything that is needed is available, they don’t have to be there early enough to set up the case; that is now someone else’s job. Relinquishing this duty is sometimes difficult for a new Surgical Assistant.
Instead of passing instruments and anticipating what is needed, you now wait for someone to pass them to YOU! It can be a little frustrating; as we all believe that we are the best Surgical Technologist that ever walked the planet! How can they be so slow? Can’t they anticipate what we need? As a Surgical Assistant, your primary role is to help position and drape the patient and then assist the surgeon during the procedure. Following the case, of course, you will stand by to close the incision, apply dressings and/or drains as needed, and help move the patient to the stretcher. I also assist the staff in cleanup following the cases; they are always very appreciative of an extra pair of hands!
Do you make more money being a Surgical Assistant? What does a Surgical Assistant Make?
Short answer: yes. In spite of having to do cases at times and not get reimbursed for them, if the majority of your cases are paid cases, you will be absolutely fine. Just don’t expect a fast turnaround in your pay. I sometimes get reimbursed a year or two later for a case; it’s all tied to how soon the surgeon completes his operative notes, how quickly the bill is submitted and how expeditiously the insurance carrier cuts the check.
If you are accustomed to receiving the same paycheck each week at the same time, this won’t work for you. It’s always different, but it is constant. I would caution you to find a good accountant who is well-versed in this area and who will advise you (if you are independent) to make quarterly tax payments so you won’t be shocked in April when your tax bill comes in. You are also responsible for your own insurance, vacation and sick pay and retirement plans if you are independent, so you’ll need to plan for those accordingly.
Do you have more flexibility in your schedule being a Surgical Assistant?
Absolutely! This is the part about my job that I really enjoy. Before receiving Surgical Assistant certification, I was a CST for about 15 years. This is typically an 8 hour shift, 5 days per week. I can remember for years only having the weekend to scramble around to do errands and always have to do my grocery shopping during rush hours. I normally work from three to four days per week and the random days off are such a treat. This enables me to go hiking, biking and indulge in mid-day shopping trips to the grocery store when the crowds are smaller! Depending upon your working arrangement, you may or may not take call at the hospital(s) so this also has to be factored in.
What are the other benefits of being a Surgical Assistant?
I love the ability to go to a number of different hospitals and surgery centers throughout the city. It’s great to go to work where you don’t have to get involved in the politics of the facility and are just able to enjoy your work and the people there. I tend to be an “under the radar” type of person; I love my job and I love that I don’t get bogged down by everyday gripes and groans of those who are stuck in the same place all day, five days a week.
Also, I have acquired a pretty wide base of expertise to include Orthopedics, General Surgery, ENT, OB/GYN, Vascular, Urology, Plastics and more recently, daVinci robotic cases. I enjoy a broad range of skills and the ability to go from a daVinci prostatectomy to a bowel resection or a c-section with ease! It’s challenging at times, but isn’t it great to be able to step out of your comfort zone and feel as if you have provided the very best that you are capable of? It’s great when you arrive in the OR and the staff will exclaim, “Are you helping Dr.______? Oh good; it’s gonna be a great day!” That feels good.
What is a typical day like?
There is nothing typical about a day’s work as a certified first assistant. If you’ve ever worked a typical “9 to 5” job, you’ll need to seriously change your expectations, as a surgical schedule is as variable as the weather. You may THINK you have your day planned, but there are other forces much bigger than you out there waiting to derail your plans. There are days when you will arrive in the OR to discover that your case has been delayed; there are days when your case will be bumped for an emergency or cancelled altogether and no one remembered to call you. And, if you are a solo practitioner such as myself, there are days when you will find that your case is a non-paying case and you’ll do it gratis!
What is the most rewarding part of your day?
The most rewarding part of my day is knowing that I have given 100 percent to each and every patient. I look at them as if they are my mother, father, sister, brother, daughter or son. It is my job to be their eyes and ears when they cannot do so for themselves and to speak for them when they are unable. As a surgical patient, they are in a complete position of trust and that trust must never be compromised. When I finish a case, I know that I have done everything I can to assure that professional, dignified and competent care has been given.
What is the most challenging part of your day?
My greatest challenge is when the schedule gets interrupted for whatever reason and I am required to wait for sometimes extended periods of time for it to resume. Recently I was scheduled for two total thyroidectomies back to back beginning at 1:00 pm. When I arrived in the OR, unbenownst to me, a tonsillectomy had been added to the schedule, which was to be done before we started the thyroidectomies. That was the first curve. We finally completed the first thyroidectomy, which went without a hitch.
Just before skin closure, a phone call came in from the ED of a neighboring hospital stating that one of my surgeon’s recent tonsillectomy cases had presented with a serious tonsil bleed. He, of course, had to leave to attend to this patient immediately following the case. Since we had one more on the books, I could either go home (a 35 minute drive each way) or stay and wait. Ever the optimist, I decided to just stay and wait. Finally, the surgeon returned at about 4:30 pm and we started on our second case. When all was said and done, I was in my car and driving home at 8:30 pm that evening. Flexibility is probably the hardest thing to learn because there is so much that is out of your control.
What was your most memorable case that you made a difference?
The first case that comes to mind is a scheduled Laparoscopically Assisted Vaginal Hysterectomy on a mid-30 year old patient. As I recall, she was thin, healthy and I thought “a home run” case. In the OR, we call this “jinxing” yourself! It was also a snowy day and the highway was icy and visibility was poor. But as you all know, these are the days when ALL of the patients manage to arrive on time, even though half of the staff will call out!
Well, we started the case and all was going smoothly until the internal iliac artery was inadvertently nicked by the surgeon. Copious bleeding instantly obscured our visibility and we were unable to see where it was coming from so we converted the case to an open procedure. After we located the bleeder, we clamped the artery and called for a vascular surgeon.
He was to arrive from a hospital about 30 minutes away; that is if it were a summer afternoon with dry roads and sunny skies. Needless to say, the weather was terrible and not only did he have to stop what he was doing but he had to brave the elements and the icy highway. To make matters worse, there was an accident on the highway that necessitated him making a detour with a further delay (I couldn’t possibly make this up!). While we were waiting for him, we completed the hysterectomy as expeditiously as possible.
Here’s where my moment came in. Because of the location of the damaged artery, the vascular surgeon removed the clamp and I had to hold pressure while he sutured the tear. I was instantly impressed with the force that our hearts must exert to send blood throughout the body and I found it extremely difficult to hold enough pressure to keep the blood from obscuring the field. The repair took a little time and I have to say I was exhausted from holding pressure on the vessel. My arms and shoulders ached from the continuous pressure. He thanked me for my hard work at the end of the case and I have to admit, it felt good!
Do you work on staff, or do you have the option to bill independently?
As a first Surgical Assistant, you have the opportunity to do both. You can join a hospital based practice where you will be on hand to assist with whatever case comes up and it is my understanding that your billing is controlled by the hospital and you are paid an agreed-upon amount.
I am an independent practitioner and find that this works best for me. My first experience with a small group ended in a disaster because our director chose to get too greedy and pocket a portion of our earnings. This is not to say that this will happen to you, but I would urge everyone to be very careful and pay close attention to your billing and accounts receivables! Additionally, there are times when you will not be reimbursed for some cases that you do, such as Medicare, Medicaid or Tricare. That’s right, you take those on the chin. It’s disheartening, but part of the climate of reimbursement, unfortunately. But, don’t let this stop you from becoming a Surgical Assistant.
If, however, you are part of a hospital-based team, you would be reimbursed a sum for non-paying cases. More about this in the next question…You could also join a traveling Surgical Assistant company and basically choose where you want to work and for how long. I understand there are some great benefits attached to this type of arrangement, but it’s up to you if you can or want to travel for your job.
Alice Williams, CSFA
Royal Academy of Surgical Assisting Program Director, RASA Training
Update 2016: Alice was married this year and now goes by Alice Dungen! Congratulations!