A comparison of surgical assisting in a prepaid group practice and a community hospital

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the community hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and “others” also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.