Surgeon's Assistant Beth Ellis Is Just What the Doctor Ordered
In an average week at South Highland Hospital in Birmingham, Ala., Beth Ellis helps perform surgery on a dozen patients, some requiring complex knee, shoulder and hip operations. She closes incisions, assists in installing orthopedic devices, puts on casts and performs physicals.
But Ellis, 24, is not a doctor and never intends to be one. She is a surgeon's assistant, a medical professional whose responsibilities lie somewhere between those of nurses and doctors. There are approximately 1,500 S.A.s in the U.S., 40 percent of whom are women. They do diagnoses and surgery (with supervision) and are trained in many other medical skills. Their salaries start at about $20,000 per year, with some earning as much as $40,000. In cardiac surgery the use of an S.A. to assist instead of a full M.D. may cut costs as much as $200 per operation.
The first S.A. training program was developed 14 years ago at Birmingham's Alabama Medical Center by cardiovascular surgeon John Kirklin to free doctors from routine tasks. (Programs for physician's assistants—whose training does not emphasize surgery and who now number 12,000 in the U.S.—were precursors.) Two years of college is a prerequisite for an S.A. candidate; then there are two years of schooling. The first is devoted to basic anatomy, physiology, pharmacology and clinical medicine; the second is spent in various hospital departments. The course, says Beth Ellis, was "a real backbreaker."
"These people," notes one of Ellis' bosses, orthopedic surgeon Lawrence Lemak, "took the same training that I took when I was in medical school." (Most M.D.s spend two more years in school, then serve as interns and residents.) Ellis is licensed, like most S.A.s, under one surgeon though she also aids his two partners; she met the doctors when they treated an ankle she broke ice-skating.
Today surgeons come to Alabama from all over the country to recruit S.A.s, and several other medical schools, including Cornell, now offer training in the specialty. Yet there are still strong critics of the S.A. concept. Medical associations in New Jersey have lobbied successfully to prevent them from practicing in that state. Explains Barbara Wright, executive director of the New Jersey State Nurses Association: "Nurses do all these things, but don't get the pay."
But Robert Replogle, a heart surgeon at the University of Chicago and an advocate of the innovation, employs four S.A.s. "They are outstanding," he says. "Surgeon's assistants," adds Lemak, "allow us to focus on the things that are most necessary. I can spend more time with my patients, operating and doing rounds." He also estimates that, thanks to Ellis, he gets home at 8 p.m. instead of 10 most nights.
She says, "I am just an extension of the doctor. I wouldn't like me if I was trying to run the show. And I'm not a threat to nurses. I go in with the attitude that I'm going to be nice to them no matter what." Beth is so diplomatic in dealing with colleagues that when she bakes brownies, she puts one batch in the nurses' lounge, one in the doctors'.
As a 12-year-old in Pensacola (her dad is a chemical plant administrator, her mother a doctor's secretary), Ellis was in a head-on auto crash, fracturing her jaw, nose, cheekbones and an arm. She underwent a half-dozen operations and believes the experience gave her an empathy with patients. "You understand their fears, anxieties and pain," she says.
A graduate of the University of West Florida, Ellis racked up grades high enough for medical school, but a friend who was a physician's assistant suggested she become an S.A. "I knew I didn't want to be a doctor," she says. "I do a lot of interesting things, and yet all the responsibility does not fall into my lap. I go home at night. I have a social life." If marriage comes, adds Ellis, who lives alone in a Birmingham apartment, "fine. If it doesn't, that's all right too."
Ellis' eight-to 10-hour workday does have its annoyances. "Here's Dr. Lemak's helper," said a nurse, only half joking, as they passed at the center recently. "I like what I do," Ellis responds, "and I get paid the same, no matter what they call me."
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