NPs Performing Surgical Procedures!?

Dodongo, APRN, NP · Jun 22, 2018

I worked in IR as a RN, now I work in general surgery as a NP. We had a NP and PA in IR, who, quite honestly, did 80% of the procedures in any given day. The procedures which they did perform, were performed without direct oversight - the physician just had to be available.

The procedures that they were able to do included:

- Paracentesis/Thoracentesis +/- pigtail or tunneled drain

- Implanted ports, tunneled dialysis catheters, hickman catheters, non-tunneled central line insertions, PICCs

- Epidural steroid injections, nerve root injections, other joints injections (shoulder, hip, knee, CMC, SI, AC, etc)

- Liver biopsy, solid mass biopsy (superficial), lymph node biopsy

- Superficial abscess drains requiring only US

- Tube checks and changes (nephrostomy, feeding tubes, etc)

The physicians exclusively do:

- All angiographies +/- intervention

- Lung biopsies and renal biopsies

- Biliary and chole drains

- Deep abscess drains requiring CT

- Kyphoplasty and ablations

- Tube insertions (nephrostomy, perc G-Tube, etc)

These are the bread and butter cases we do on a day to day basis - and the procedures the APPs were able to do were by far the majority of procedures done on a day to day basis. They had a lot of autonomy. I wouldn't mind making a switch at some point to IR. And I probably wouldn't recommend going straight into IR as a new grad NP. You need to learn medical management, and, to be frank, there is little to no medical management in IR.

mrcleanscrubs, BSN, RN · Jun 23, 2018

@Dodongo ,

Hey Dodongo!

Wow! That is pretty impressive! Do you mind me asking what state this is in? I'm in NYC.

How do you like general surgery? What are some of the things you do day to day in your role as a General Surgery NP?

I completely agree with you about learning medical management before going into such a specialized practice dealing primarily with procedures.

Thank you for your extensive post!

Dodongo, APRN, NP · Jun 23, 2018

This is Pennsylvania. I really love general surgery. I did a RNFA program and ACNP so a hospital based surgical position is perfect for me.

My group has a handful of physicians and a couple of APPs (I'm the only NP in a sea of surgical PAs across all specialties at my health system...). So the APPs split our job duties. We get RVU bonus for first assistable cases so we try and divvy them up evenly. In addition to OR time (easily the most fun part of the job) we see all the consults and round on all the inpatients - plus everything that goes along with that. It's a great gig. Lots of autonomy, even for a surgical specialty where the surgeon is "the boss". I think people would be surprised at how much the surgeons let us do in the OR. They are, often times, acting as our first assist. Plus, when you work so closely with the physicians, you learn so so much. I think, besides working in the ICU and rounding with intensivists daily, NPs in surgery probably benefit the most from working so closely with their physician counterparts.

Oldmahubbard · Jun 23, 2018

NP's and PA's are doing amazingly complex surgical procedures, I know this for a fact. Beyond belief, and I question if most of it is even legal.

The strange thing is that almost none of this surgery was covered in their formal education, so I truly wonder who is taking on all the liability. And who is collecting the money for these procedures, done by folks that typically make maybe 100 or 120k.

Could be a "pull back the curtain" moment, that a 3 year surgical residency is not really required?

The physicians are making out short term, and screwing themselves long term.

Dodongo, APRN, NP · Jun 24, 2018

The strange thing is that almost none of this surgery was covered in their formal education, so I truly wonder who is taking on all the liability.
Could be a "pull back the curtain" moment, that a 3 year surgical residency is not really required

This is why every NP who wants to practice in surgery should do a RNFA program. An RNFA program takes months to gather the required number of hours vs 5 weeks of surgical exposure that PAs get. I mean, 5 weeks is nothing. And yet PAs rule the surgical markets across the country. 5 weeks is nothing - it's essentially all on the job training for PAs.

And a surgical residency is absolutely required. There is so much that can go wrong with even the most straight forward cases. A competent, residency trained surgeon is a must for anything beyond simple, superficial procedures. That is one area that NPs and PAs will absolute never take over.

adventure_rn, MSN, NP · Jun 24, 2018

I have a relative with a radiologist, and we were discussing this concept recently. His perception was that the primary role of ARNPs in radiology is to perform IR procedures, effectively 'tasking.' He felt that you could train somebody to do a procedure in a couple of months, whereas training a diagnostic radiologist takes several years.

Hiring ARNPs would actually be pretty lucrative for a practice, since IR procedures tend to generate some of the highest revenue in radiology. It's much cheaper for the practice to hire an ARNP than an interventional radiologist, especially if the ARNP is considered an employee rather than a partner. Unfortunately, even though IR ARNPs could generate a lot of revenue for a practice, I don't know if it would be reflected in their salary.

You may get more specific responses and examples if you post in the radiology forum.