Official Position on Non-Physician Surgical Assistants

American College of Surgeons | American Medical Association

AMERICAN COLLEGE OF SURGEONS

The qualifications of the Surgical First Assistant in the operating room, according to the American College of Surgeons is the following: (see excerpt directly from their statements of principles)

The first assistant to the surgeon during a surgical operation should be a trained individual who is capable of participating in the operation and actively assisting the surgeon as part of a good working team. The first assistant provides aid in exposure, hemostasis, and other technical functions, thereby helping the surgeon carry out a safe operation with optimal results for the patient. This role will vary considerably with the surgical operation, specialty area, and type of hospital.

The American College of Surgeons supports the concept that, ideally, the first assistant to the surgeon at the operating table should be a qualified surgeon or resident in a surgical education program that is approved by the appropriate residency review committee and accredited by the Accreditation Council for Graduate Medical Education. It is a principle of surgical education and care that residents at appropriate levels of training should be provided with opportunities to assist at and participate in operations. Other physicians who are experienced in assisting the responsible surgeon may participate when a trained surgeon or a resident in an accredited program is not available.

Attainment of this ideal in all hospitals is recognized as being impracticable. In some circumstances it is necessary to utilize appropriately trained nonphysicians to serve as first assistants to qualified surgeons. Surgeon's assistants (SAs), or physician's assistants (PAs) with additional surgical training, may be employed if they meet national standards. These individuals are not authorized to operate independently.

Certified surgeon's or physician's assistants must make a formal application for appointment to the hospital, which should include:

1. An outline of their qualifications and credentials.
2. Stipulation of their requests to assist in a surgeon's practice including assisting at the operating table.
3. Indication of the surgeon who will be responsible for the SA's or PA's performance.

The appropriate committee or board of the hospital should review such individuals' qualifications for hospital privileges.

Registered nurses with additional specialized training may also function as first assistants to the surgeon at the operating table in those situations or hospitals where more completely trained assistants are not available. If a nurse functions in this role, however, the size of the operating room team should not be reduced; the assigned nurse should function solely as the first assistant and not also as the scrub or instrument nurse. Similarly, surgical technologists may function as first assistants in the absence of more qualified individuals.

In some hospitals in this country, there may be no specifically trained and readily available surgical assistants in the operating room. Traditionally, the first assistant's role in such institutions has been filled by a variety of individuals from diverse backgrounds. It is the surgeon's responsibility to designate an individual who is most appropriate for this purpose in keeping with the bylaws of the medical staff of the hospital.

Practice privileges of individuals acting as first assistants should be based upon verified credentials, should be reviewed and approved by the hospital credentialing committee, and should be within the defined limits of state law.
top

AMERICAN MEDICAL ASSOCIATION

(2) recognizes that the responsible surgeon may delegate the performance of part of a given operation to surgical assistants, provided the surgeon is an active participant throughout the essential part of the operation. Given the nature of the surgical assistant’s role and the potential of risk to the public, it is appropriate to ensure that qualified personnel accomplish this function;

(3) policy related to surgical assistants, consistent with the American College of Surgeons’ Statements on Principles states:(a) The surgical assistant is limited to performing specific functions as defined in the medical staff bylaws, rules and regulations. These generally include the following tasks: aid in maintaining adequate exposure in the operating field, cutting suture materials, clamping and ligating bleeding vessels, and, in selected instances, actually performing designated parts of a procedure. (b) It is the surgeon’s responsibility to designate the individual most appropriate for this purpose within the bylaws of the medical staff. The first assistant to the surgeon during a surgical operation should be a credentialed health care professional, preferably a physician, who is capable of participating in the operation, actively assisting the surgeon. (c) Practice privileges of individuals acting as surgical assistants should be based upon verified credentials and the supervising physician’s capability and competence to supervise such an assistant. Such privileges should be reviewed and approved by the institution’s medical staff credentialing committee and should be within the defined limits of state law. Specifically, surgical assistants must make formal application to the institution’s medical staff to function as a surgical assistant under a surgeon’s supervision. During the credentialing and privileging of surgical assistants, the medical staff will review and make decisions on the individual’s qualifications, experience, credentials, licensure, liability coverage and current competence. (d) If a complex surgical procedure requires that the assistant have the skills of a surgeon, the surgical assistant must be a licensed surgeon fully qualified in the specialty area. If a complication requires the skills of a specialty surgeon, or the surgical first assistant is expected to take over the surgery, the surgical first assistant must be a licensed surgeon fully qualified in the specialty area. (e) Ideally, the first assistant to the surgeon at the operating table should be a qualified surgeon or resident in an education program that is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and/or the American Osteopathic Association (AOA). Other appropriately credentialed physicians who are experienced in assisting the responsible surgeon may participate when a trained surgeon or a resident in an accredited program is not available. The AMA recognizes that attainment of this ideal in all surgical care settings may not be practicable. In some circumstances it is necessary to utilize appropriately trained and credentialed unlicensed physicians and non-physicians to serve as first assistants to qualified surgeons. (BOT Rep. 32, A-99; Reaffirmed: Res. 240, 708, and Reaffirmation A-00)
top

|About Us|Membership|Position on Surgical Assistants|Events|Surgical Assistant Resources|State Surgical Assistants Legislation|
| Contact Us |Privacy Policy|