Why do I need to see the PA and why you are better off?

A necessary reality and a common source of complaints is the use of physician assistants (PA) in the office. Statements such as “I don’t want to see the PA” or “I need to see the Doctor” are common. The misconception is that the care delivered by the PA is deficient in comparison to that of the doctor. At 3 Crosses Spine, these sentiments are wrong.

Many patients come in and have no work-up. For example, primary care providers or other specialists will refer to the spine specialist with no prior conservative treatment. Basically, a patient’s first appointment is “information gathering” to investigate what’s been done and what hasn’t been done. The algorithm with which 3 Crosses Spine obtains information is the same whether it’s the PA or the doctor. Obtaining the necessary tests or starting necessary conservative measures will be done prior to any high-level discussion regarding surgery. More importantly, the PA is aware of what information (i.e., X-ray, MRI or CT) needs to be obtained prior to meeting with the surgeon. As a result, this minimizes the number of visits required to determine whether surgical intervention is needed.

A poorly publicized reality is insurance policies will require completion of conservative measures prior to discussion of surgery. In short, conservative treatment must be exhausted prior to consideration of surgery. A patient will be required to have undergone physical therapy (PT), spinal injections, medications, and in some cases have had symptoms greater than a certain time-period. Most insurance plans require a patient to fulfill certain criteria prior to any in depth surgery discussion. The PA will help you, the patient, fulfill those criteria.

Realistically, I can only see so many patients in a day. It is essential most of my time is spent consulting surgical candidates and with patients who exhibit complicated presentations in order to ensure individuals with the most need are prioritized. The nuances with different surgeries, clarifying what the goals of surgical intervention are, the risks and benefits of treatment; this is where my time is best spent. By necessity, these appointments require more time and limits the number of patients that can be seen in a day.

Additionally, physician assistants act as triage specialists. They know what constitutes an emergency or an urgent work-up.  By selecting to be seen by the PA for an appointment, patients can be seen quicker and have a work-up initiated sooner. If a patient does present with seriousissues, identification of the problem and obtaining the necessary studies can be ordered and time saved. The PA will often tell me “X” patient needs to be seen sooner and appropriate arrangements are made. These patients are then pushed to the front of the line.

Lastly, the PA is my primary assistant in all surgeries. They are closely involved in everything that goes on in the operating room. After surgery, the physician assistants will round with me and are equally in charge of orders, discharge information, and follow-up. Post-operatively, the PA is as knowledgeable as the surgeon regarding the specifics of each case. Therefore, If the surgeon is unavailable, the PA is the best option.

To summarize, having a physician assistant involved in your care speeds up the process of information retrieval and decision making. At 3 Crosses Spine, the PA is an extension of myself. The exchange of information is immediate, even when I am not in the office. It is my belief; the perceived false negatives are easily outweighed by the benefits of having a knowledgeable physician assistant help  with your spine care.



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