All about Advanced Practice Providers in the Department of Surgery
Advanced practice providers (APP) are medical professionals who work in tandem with a supervising doctor. In the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, APPs include nurse practitioners, clinical nurse specialists and physician assistants. And these APPs work in a variety of settings from the ICU to clinics.
As part of National APP week, we wanted to highlight a few APPs in the department:
Ashley Waldon, physician assistant and instructor in the Division of Colorectal Surgery at Baylor College of Medicine
Q: What led you to become an APP?
A: I wanted to be an APP as I want share my passion for health and wellness with my patients so that I can empower them to take charge of their wellbeing. I also want to be an advocate for all of my patients, show them care and compassion and do everything I can for those under my care.
Q: What drew you to surgery?
A: As part of the application process for most of the physician assistant programs I applied to, it was a requirement to have experience working with a physician assistant (~ 1800 hours) so you understood what your career would look like. I ended up working at a general surgery office to obtain those hours and I fell in love with the specialty. I loved that my day had variety (surgery, clinic, in-office procedures, etc.) and the hands-on aspect of medicine. I also found it fascinating that a patient could potentially be cured of cancer/disease with the help of surgical intervention.
Q: What do you enjoy most about being an APP?
A: The best parts of being an APP are my patients as well as the ample opportunities that are presented with this career. I absolutely love my patients, being able to care for them and making their medical experience not so daunting. I also am involved in education and allow PA students to rotate on our surgery service. There are research opportunities and I am able to be a part of multiple multidisciplinary teams for patient care, which allows me continue to learning as I am exposed to a variety of different specialties.
Q: Explain the importance of APPs on our teams.
A: APPs are important as we work together with our physician/surgeons and are involved as a team in patient care. APPs know the protocols of their doctors and we also are able to operate alongside our surgeons. By having an APP/physician team, not only do patients benefit from increased access to medical care, but they also have better outcomes due to the coordination. The physician can also have greater access to time outside the office and OR because of the support the APP lends to them.
Example daily schedule:
7 am – 8 am: Meetings (may involve: Tumor Board, Grand Rounds, M&M)
Tumor Board Conference: At tumor board conferences, a team of physicians and APPs will discuss case presentations of individual cancer patients. This allows experts from multiple specialties (medical oncology, radiation oncology, surgery, pathology, radiology) to meet and discuss ongoing, complex cancer cases. Tumor board meetings allow physicians and APPs to trade knowledge and work as a group to consider potential treatment plans.
Grand Round Conference: Grand rounds is where physicians, APPs and trainees (fellows, residents and students) listen to a faculty member or a guest speaker present in a variety of ways which include lectures, case presentations, literature review, and/or panel discussions to remain current on procedures, research, patient care and other innovations
Morbidity and Mortality Conference (M&M): M&M conferences are where physicians, APPs, and trainees (fellow and residents) identify and discuss adverse outcomes in an open manner. This is to modify behavior and decision making/judgment skills based on previous experiences. This is to prevent repetition of errors leading to complications and to focus on improving patient care.
8 a.m. – 12:30 p.m.: Operating Room
1 p.m. – 5 p.m.: Clinic and in-office procedures
Taylor Vickers, physician assistant and instructor in the Division of Trauma and Acute Care Surgery
Q: What led you to become an APP?
A: It was always my goal from college. I loved the role APPs filled on the healthcare team. I’m able to fill in on just about any task that needs to be done instead of being the lone wolf in charge. Often this lets me talk at length to patients about their hospital course or educate them on their surgeries and recovery.
Q: What drew you to surgery?
A: Surgery as a concept is fascinating when you think about it. It’s super satisfying fix a problem that a patient is suffering from. And surgical critical care has that same mindset as well: see a problem, fix it. Our patients are fast-paced and complex and because of that the workday also tends to go quickly.
Q: What do you enjoy most about being an APP?
A: Being an APP is super satisfying. Most importantly, at the end of the day I get to go home feeling like I made a difference. But practicing medicine also is really fun. There’s a lot of learning, a lot of problem solving and a lot of critical thinking. In this career path, there are a lot of types of schedules for work, which allows for flexibility. Currently, I do night shift, which allows for scheduling vacations every month. But I also could do dedicated clinic like some of my colleagues for a more traditional Monday to Friday job schedule.
Q: Explain the importance of APP on our teams.
A: In an environment with many learners that come and go for a month at a time, APPs are super important to have a constant backbone for the team. They know how the day-to-day procedures go and what resources are available. Additionally, we’re good to bounce ideas off of since we’ve seen these same patients in this setting for however long we’ve been there.
Example day schedule:
6 p.m.- Receive sign-out from the day team over the patients in the unit on any changes and what events have happened.
7 p.m. – Review the chart for labs, notes, imaging and any changes on all the patients, and start walking around to see them.
8 p.m. – midnight – This is generally the time where known admits happen after surgery finishes or to do tasks that haven’t been completed during the day, such as taking patients to scans, placing lines and following up on consults and recommendations.
Midnight -3 a.m. – This time of night is putting out any fires that happen or dealing with any issues we did not expect: emergency admits, rapid responses, critical patients. In short, this is the stuff that happens that nobody wanted to happen. But on less busy nights, it’s a good place for free time to catch up on clerical work or eat lunch.
4 a.m.- This is the hour labs start coming back, so this is a good time to chart check everyone for anything you may have missed while putting in orders.
5 a.m.- Time dedicated to catching up on anything not yet done.
6 a.m.- Give sign out to the day team that is arriving.
7 a.m.- Time to go home
Sarah Allen, physician assistant and assistant professor in the Division of Trauma and Acute Care Surgery
Q: What led you to become an APP?
A: Influence from my mom and my aunt. They were surgical ICU nurses for the longest time and really liked the APPs they worked with.
Q: What drew you to surgery?
A: I love helping people get BETTER! With surgery, a lot of the time we can take care of someone’s ailments with a procedure. It is really rewarding!
Q: What do you enjoy most about being an APP?
A: I enjoy the people I work with and I really enjoy the specialty. I have worked in surgery my entire career and I don’t ever see that changing.
Q: Explain the importance of APP on our teams.
A: The APP is really the physician “extender.” We are the liaison between the patient and the doctors and are huge patient advocates. We also provide continuity of care for our service, which is important to have!
Example daily schedule:
6 a.m.: Surgical ICU sign out
6:30 a.m.: Morning report
7 a.m.: Pre-round in ICU/Zoom for Grand Rounds
8:30 a.m.- noon: ICU Rounds/Cover trauma codes
12:30 p.m.: Lunch
1 p.m. – 3:30 p.m.: Admin/clinic tasks
4 p.m.: APP meeting (via Zoom)
By Tiffany Harston, communications associate in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine
