Physician Assistant II/ Inpatient Vascular & General Surgery
Brigham & Women's Hospital(BWH)

Boston, Massachusetts

Posted in Health and Safety


Job Info


GENERAL SUMMARY/ OVERVIEW STATEMENT:

The physician assistant (PA) is a licensed provider who has acquired a broad range of knowledge and skills through the successful completion of a physician assistant program. The PA is responsible for the assessment and management of various populations of patients, medical and/or surgical, including diagnostic and therapeutic interventions, development of appropriate plans of care and ongoing evaluation. The physician assistant works under the supervision of an attending physician and reports directly to the Chief Physician Assistant or Associate Physician Assistant or their designee administratively.

The PA will perform in accordance with all state and federal regulations and institutional policies including but not limited to the BWH PA Scope of Practice, Prescriptive Guidelines, approved clinical privileges, and BWH PA policy.

The PA II position is designed for those physician assistants who have advanced clinical skills and who are experienced enough to take on additional clinical, administrative, and/or leadership responsibilities above that of a PA I. The PA II position entails those responsibilities defined by the department/division that will become part of the performance evaluation process.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Principle Clinical Duties and Responsibilities:

  • Provides direct care, counseling, and teaching to a designated patient population in the inpatient, operative, and/or procedural setting
  • Performs complete histories and physical examinations
  • 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
  • Consistently provides high quality and timely documentation including admission and progress notes, procedure notes, operative notes and discharge summaries
  • Performs bedside procedures as are appropriate to the patient population
  • In some settings, the PA may first assist in the operating room or procedural areas
  • 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

Non-Clinical Duties and Responsibilities:
  • Demonstrates professional collaborative and consultative relationships with other 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 trainings
  • Maintains superior interpersonal and communication skills as a member of the healthcare team in order 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
  • Additional duties and responsibilities as required by the department/division

For all positions that include direct patient care, indicate with an "X" the age(s) of all patient populations served

No Direct Patient Care

All age groups

Adolescence (13 to 17 years)

X

Neonates (birth to 1 month)

Young Adult (18 to 25 years)

X

Infant (1 month to1year)

Adult (26 to 54 years)

X

Early Childhood (12 months to 5 years)

Senior Adult (55 to 64 years)

X

Late Childhood (6 to 12 years)

Geriatric (65 years and up)

X

Qualifications
  • The appropriate candidate will have successfully completed a graduate level physician assistant program (Masters degree) accredited by the Accreditation and Review Committee for Physician Assistants (ARC-PA) or such other accrediting agency as may qualify a graduate to sit for the NCCPA certifying examination
  • BS/MS joint programs and those candidates with a BS and PA certificate are eligible, but ONLY for those who graduated BEFORE 1995
  • Must have at least two years of experience practicing as a PA to qualify for the PA II position
  • Certification by the National Commission on Certification of Physician Assistants (NCCPA) must be obtained prior to first day of employment
  • Must hold a current valid license or be eligible for licensure as a physician assistant in the Commonwealth of Massachusetts
  • Must have or eligible for, and maintain, a current DEA registration and Massachusetts Controlled Substance Registration
  • Must complete 100 hours of CME according to national and state regulations during each two year period of employment
  • Must complete the BWH Professionalism Program within three months of date of hire
  • Must complete the BWH Procedural Sedation Training if deemed necessary

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:

  • Must have the ability to work in a high stress, dynamic, busy clinical setting with changing organizational climate
  • Must have the ability to be self-directive and to demonstrate initiative in addressing the responsibilities of the position
  • Must have the ability to utilize appropriate problem-solving and conflict resolution skills
  • Must be energetic and quality driven and have a proven ability to be a productive member of a team dedicated to providing optimal patient care
  • Must be proficient with BWH computer systems as needed to independently perform daily tasks (EMR, Epic preferred)
  • Must maintain the highest degree of professional judgment under the supervision and guidance of a licensed physician

WORKING CONDITIONS:

Work settings may include inpatient areas, intensive care units, operating rooms, and/or procedural areas. There may be loud noises, noxious odors, and temperature extremes. A large portion of the workday may be spent either standing or walking and the position may require heavy lifting of equipment and patients.

The PA may be exposed to radiation, potentially infectious bodily fluids, and sharp instruments such as needles and scalpels. Knowledge of Universal Precautions and proper use of surgical sharp instruments may be required. The consequences of contamination from bodily fluids or from being stuck with a sharp instrument include the possibility of physical harm to the employee or others. BWH is a fast paced, dynamic environment with a very large and complex patient volume; exposure to stress in the workplace is expected.

Clinical Duties:
  • Assists the surgeon in the OR, acting as first or second assistant during the following phases: prepare and drape patient, make skin incisions, use staplers, fascial closure devices, set up retractors, close fascia, subcutaneous tissue and skin, dress surgical incisions,


  • Inserts nasogastric tubes and maintains suction decompression of the stomach as well as irrigation of the same tubes.


  • Catheterizes and maintains indwelling urinary drainage tubes.


  • Removes chest tubes.


  • Manages, exchanges, and removes feeding tubes and ensures that they are radiographically in the proper location.


  • Cleans,debrides and sutures minor lacerations. Cares for wounds including debridement,I&D's dressings, VAC sponge applications/removal, removal of drains and tubes and suture removal.


  • Performs doppler exams of wounds and assesses for acute changes /appropriate perfusion. Appropriately triages bypasses/grafts for vascular interventions requiring OR/cath lab.


  • Perform bedside ABIs


  • Perform Unna boot dressing /dressing change


  • Performs EKG's when technician is unavailable and reviews tracing for arrhythmias/ischemia


  • Performs cardiac resuscitation and ATLS as indicated if appropriately trained and ATLS certified.


  • Performs and records complete history and physical examination.


  • Makes daily rounds by him or herself or with surgical team on patients with a variety of surgical conditions and reports findings to the Attending Surgeon. Manages patient care, evaluates change in patient status, writes orders, obtains consultations, and interprets lab values and x-rays with assistance of physicians as necessary. Gives special instructions to patients prior to discharge.


  • Writes daily progress notes and completes discharge summaries.


  • Writes admission orders, orders pertinent imaging/labs and performs admission H&P in direct consult with the admitting Attending Physician or their Chief Resident/Fellow with whom there was direct communication.


  • Collects data from charts or interviews with patients for clinical studies being performed under the direction of the Attending Surgeon.


  • Assists the surgeon in highly specialized procedures in approved protocol of clinical investigation in patients.


  • Must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his/her assigned unit.


  • Other duties as assigned


  • Physical and mental abilities required:
  • Must be quality driven and have proven ability to be a productive member of a cohesive team of peers, dedicated to providing optimum patient care.
  • Must exercise the highest degree of professional judgment under the direct supervision and guidance of a licensed physician.
  • Must maintain a professional attitude towards patients and exercise such mature independent originality in solving problems not covered by existing guidelines, within legal limits, to meet the needs of the patients.
  • Must maintain a professional attitude towards patients at all times and an excellent and collegial working relationship with other personnel involved in patient care.
  • Must demonstrate understanding of procedures, policies and documentation required to ensure compliance with hospital standards of care.


  • Each PA II shall demonstrate the following clinical knowledge, skills and competencies:
  • For the most common diagnoses admitted to the General /Vascular surgery service, demonstrate competency to effectively diagnose, formulate appropriate treatment plan, and efficiently implement the plan without much direction, and with a greater level of independence, from the attending physician.
  • Clinical skills and knowledge as well as professionalism of the PA II candidate are assessed by chief physician assistant of the department under the direction of the division chief.
  • Candidates with two or more years of relevant PA experience prior to joining the general surgery service become eligible for a preliminary evaluation of competencies approximately 3 months after joining the service. The purpose of the preliminary evaluation is to provide feedback to the candidate on progress towards level of competency required and provide guidance on additional development needs. After approximately 6 months, after joining the (service), the candidate then becomes eligible to complete the assessment and, if successful advances to a PAII.
  • If a candidate does not pass the competency assessment, the chief physician assistant will provide feedback on additional development needs. Re-assessment is possible after 6 months of focused development.


  • SUPERVISORY RESPONSIBILITY:

    The Physician Assistant II may have elements of supervisory responsibility; please refer to the addendum section for details.

    FISCAL RESPONSIBILITY:

    The Physician Assistant II may have elements of fiscal responsibility; please refer to the addendum section for details.

    ADDENDUM:

    While the General Surgery PA can expect a relatively predictable work schedule planned in advance whenever possible, scheduling variations may occur in order to cover the needs of the General/Vascular surgery service. The General/Vascular Surgery PA may be asked to pick up additional shifts as needed with compensation.

    The PA II shall provide leadership and participation in teaching new residents and PA students.

    The PA II shall be capable of independently orienting, on-boarding and training new hire PAs within the division of general surgery.

    The PA II shall be actively involved in ongoing quality improvement and patient safety initiatives.

    The PA II shall be open to actively participating in projects and contributing to assignments that may arise as delegated by the chief CSS PA.

    EEO Statement
    Brigham and Women's Hospital is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.



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