What Does a PA Do on a Plastic Surgery Team?

I filmed this one at the hospital with my PA, right before we went in to do a breast reconstruction. People ask all the time what a PA actually does in a plastic surgery practice, so here's what the job looks like on my team, and what it takes to get there.

PA stands for physician assistant. PA school is a master's-level program, and once you finish, you can practice in pretty much any specialty you want.

My PA sees my pre-op patients. She makes sure they're healthy for surgery, reviews their labs and medical clearances, and goes over everything from start to finish so they know exactly what to expect.

She also makes sure we have everything we need for the OR. In plastic surgery, we use specialized products like implants and scaffolds, and those have to be lined up before surgery day.

In the OR, my PA is my first assist. That means anything I need help with: retracting, helping with suturing and closing, and putting in drains. While I'm working on the patient, she's preparing the implant on the back table once I've picked the size.

She's constantly figuring out the most efficient way to get the surgery done: what else can happen at the same time, so I can focus on the parts I'm most specialized at. In my opinion, that's better for patients, because you get off the table faster, which means less anesthesia time. (Anesthesia is its own safety question, and it's worth knowing who's actually giving yours.)

In a lot of practices, PAs also handle post-op care: wound management and the one-day and one-week follow-ups. My practice is set up differently. My nurse practitioner helps me with post-op patients (here's what I look for when hiring one), and my PA is specifically a surgery person.

Some practices, usually smaller ones, also have their PAs do injectables. That isn't her role here.

The path looks like this:

1. An undergraduate degree. Hers is in human biology.
2. Hands-on healthcare experience. PA programs want applicants to have worked in patient care first, often for a year or two. My PA was an EKG tech (a cardiovascular technician); other common routes are medical assistant or EMT.
3. PA school, a master's program that runs two to three years, with more programs trending toward three.

If you want to go into surgery, I highly recommend becoming a PA over an NP. Surgery is really the only field in medicine that tends to favor PAs over NPs.

An NP can work as a surgical assistant, but usually needs additional RNFA (registered nurse first assistant) training. The hospital where I operate doesn't allow NPs to assist in the OR without it.

Surgical specialties are the most competitive jobs for PAs, along with dermatology, and plastics is extremely competitive. As a new grad, you usually have to start wherever is willing to hire you. The specialties that hire the most are probably primary care, urgent care, and the ER. Then you get experience and branch into what you're more interested in.

My PA didn't start in plastics. She started in general and colorectal surgery. It wasn't her first choice, but it turned out to be a really good experience: she saw a broad spectrum of surgical cases and learned how to treat high-acuity patients. (She went from butts to boobs.) From there, she met plastic surgeons who trained her and hired her, worked for another plastic surgeon for a while, and then came to work with me.

That path is typical. Plastic surgeons like people with experience. Every PA I've worked with had experience in another surgical area before going into plastics, and usually plastics experience before working with me, too. It's not so different from my own route through general surgery before plastic surgery.

On my team, the PA is the person who gets you ready for surgery and the person helping me in the OR. She runs the pre-op appointment (labs, clearances, and walking you through everything), lines up the implants and scaffolds, and first-assists so the operation moves efficiently and you spend less time under anesthesia.

If you're thinking about becoming a surgical PA: get hands-on patient care experience, expect a two-to-three-year master's program, and know that plastics usually comes after experience in another surgical field.