Physician Assistant, Surgery

GENERAL SUMMARY/ OVERVIEW STATEMENT:

Under the supervision of the Orthopaedic Department Chief, Executive Director, Director of Advanced Practice Providers (APPs) and Lead Inpatient APP, the Physician Assistant (PA-C) will function as Responding Clinician and be responsible for the care of the Orthopaedic patient population in the inpatient setting. The role involves a rotating shift schedule.

Responding Clinicians are responsible for all aspects of patient care for the patients on their daily assignment, which include: (a) admitting patients from the ED, clinic, or front door (completes admission note and orders); (b) acute postoperative care and symptom management; (c) care of the non-operative patient (daily exam, note and billing); (d) coordination of care with all disciplines involved in the care of the patient during the patient's hospital stay; and (e) responding to patient emergencies. The Physician Assistant documents patient history and physical examinations; orders lab tests, diagnostic imaging, and procedures; diagnoses new medical conditions during the hospital stay and treat those various conditions; prescribes medications; writes progress notes when applicable; coordinates consultations with multiple disciplines; implements postop care and symptom management in accordance with surgeons' treatment plans; and completes discharge summaries in a timely fashion.

Discharge planning is an essential responsibility to assist with the hospital's capacity issues and requires pre-planning and daily communication with multiple interdisciplinary team members (all specialty consults, case management, OT, PT, PCP/referring physicians) as well as those involved in the transition of care (home care companies for abx, VACs, VNA or rehabs/acute and SNF).

The Physician Assistant also has a significant role relative to patient/family education to reinforce surgeons' postop plans and participates in many patient/family meetings.

The Physician Assistant will practice in accordance with federal and MA state regulations, as well as standards set forth by federal governing boards, including the American Academy of Physician Assistants (PAs) and the National Commission on Certification of PAs.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Provides direct care, counseling, and teaching to the orthopaedic patient population in the inpatient, operative, and/or procedural setting.

• Acts as responding clinician for an assigned daily patient census, average 10-12.

• Inpatient APPs evaluate the daily census and provide cross coverage to support services with a high census and/or to cover for colleague vacations, FMLAs, sick calls.

• Performs history and physical examinations.

• Consistently provides high quality and timely documentation.

• Writes admission notes for patients admitted via the ED, clinic or front door if not already done by a resident/Fellow.

• Writes progress notes on non-operative patients and bills accordingly.

• Completes ortho pass postop note if First Assist in the OR.

• Completes discharge summaries in a timely manner and preps charts for weekend discharges.

• Orders, interprets, and evaluates appropriate laboratory and diagnostic tests.

• Develops appropriate plans of care and follow-up based on the outcomes of diagnostic, laboratory, and physical examination findings.

• Orders medications and writes prescriptions according to organizational and regulatory policies and procedures.

• Responds to emergent patient issues (chest pain, SOB, wound dehiscence, syncope, falls, social-behavioral issues, codes)

• Performs bedside procedures as are appropriate to the patient population.

• Functions as first assist (PA or RNFA) in the operating room or procedural areas only if truly first assist and all services have adequate coverage.

• Practices cost effective medicine in an efficient manner, maximizing available resources.

• Discusses patient data with other physicians and professionals as appropriate in a multidisciplinary setting.

• Demonstrates expert clinical judgment skills to function in an independent role.

• Additional duties and responsibilities as required by the department/division in the environment of an ever-changing health care system.

• Demonstrates professional collaborative and interpersonal skills with inpatient Orthopaedic APP colleagues to effectively function as a team.

• Demonstrates professional collaborative and interpersonal skills with consultative relationships and other multidisciplinary providers.

• Follows all designated prescriptive practices and monitoring requirements with the designated supervising physician and administrative report.

• Participates in departmental and organizational committees and programs as appropriate and attends all required meetings, in-services, and professional annual trainings and vaccinations.

• Maintains superior interpersonal and communication skills as a member of the healthcare team to collaborate effectively with patients, families, staff, and community health workers.

• Remains actively involved in continuing education with a commitment to self and departmental growth.

• Adheres to all established safety policies, procedures, and precautions; identifies potential or actual unsafe situations in the environment and takes measures to rectify the situation.

• Demonstrates understanding of procedures, policies, and documentation required to ensure compliance with hospital standards of care.

• Discusses challenges/barriers to daily practice and creates innovative strategies to enhance patient discharge and or improve care through all phases of the patient's surgical journey.

• Contributes to Improving the quality of care of our orthopaedic population (innovative clinical practice ideas or with the work-organizational flow).

• The APP will be evaluated on an annual basis for a merit raise per competency metrics set forth by the MGB compensation.

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:

• Flexible and be able to work in a high stress, dynamic, acute clinical setting with an ever-changing organizational climate.

• Able to work rotating shifts

• Self-directed and demonstrates initiative to address the responsibilities of the position.

• Demonstrates problem-solving and conflict resolution skills.

• Must excel in effective and positive communications with surgeons, consults, nursing staff, case managers, OT, PT, and a multitude of interdisciplinary providers.

• Is quality driven to be a productive member of a team dedicated to providing optimal safe patient care.

• Proficient with MGH computer systems

• as needed to independently perform daily tasks (Epic preferred).

• Holds oneself accountable to learn, develop, and achieve the best and highest quality results.

• Treats leadership and colleagues with respect.

• Must maintain the highest degree of professional judgment under the Dept Chief and Director of Orthopaedic APPs.

WORKING CONDITIONS:

Fast paced, high volume Orthopaedic service which involves collaboration with all APP colleagues, surgeons, fellows, and residents of the department. The work may require the lifting of heavy objects and patients, as well as exposure to potentially infective material. Work requires contact with needles and other sharp instruments, electric-cautery devices, complex wound care, monitoring devices, and other state-of-the-art equipment. Prolonged standing can be expected. Walking to and from the patient care units can be expected.

QUALIFICATIONS:

• The appropriate candidate will have successfully completed an accredited graduate level physician assistant or nurse practitioner program (Master's degree).

• Certification by the National Commission on Certification of Physician Assistants (NCCPA) or American Academy Nurse Practitioners must be obtained prior to employment.

• Must hold a current valid license for PA practice.

• Must have a current DEA registration and Massachusetts Controlled Substance Registration.

• Must complete all required CME according to national and state regulations for PAs.

• Qualified in all basic and advanced cardiac life support standards as established by the American Heart Association.