Lesson 9
Surgical Technologists and Perfusionists
WORK DESCRIPTION OF SURGICAL TECHNOLOGISTS
The term operating room conjures up the image of two principal characters: the surgeon and the patient. Most operations involve more people than this, however, and during a major procedure such as open-heart surgery, the operating room may be crowded with as many as 20 doctors, nurses, and technicians. Among these are surgical or operating room technicians. Surgical technicians work with, and under the supervision of, surgeons or registered nurses. They help set up the operating room with surgical instruments, equipment, sterile linens, and fluids such as saline (a salt solution), or glucose (a sugar solution). Surgical technicians may prepare patients for surgery by washing, shaving, and disinfecting the body area where the surgeon may operate. They may transport patients to the operating room and help drape them and position them on the operating table. During surgery, they pass instruments and other sterile supplies to the surgeons and the surgeon's assistants. They may hold retractors, cut sutures, and help count the sponges, needles, supplies, and instruments used during the operation. Surgical technicians help prepare, care for, and dispose of specimens taken for laboratory analysis during the operation of diagnostic equipment.
WORKING CONDITIONS
Surgical technicians work in clean, well lighted, cool environments. They need stamina to be on their feet the whole time they are on duty and must pay close attention to detail during operations. Most surgery is performed during the day, but some workplaces, such as an emergency surgical unit, require 24-hour coverage. A 40-hour, 5-day workweek is normal for surgical technicians, although many are required at times to be on call.
EMPLOYMENT OPPORTUNITIES
Surgical technicians hold about 57,000 jobs. In some regions of the country, technicians known as private scrubs are employed directly by surgeons. Most, however, are employed by hospitals and other places that have operating rooms, delivery rooms, and emergency room facilities.
TRAINING, OTHER QUALIFICATIONS, AND ADVANCEMENT
Nearly all technicians receive their training in formal programs offered by community and junior colleges, vocational technical schools, or hospitals. There are approximately 650 training programs for surgical technicians, of which 450 are accredited by the Committee on Allied Health Education and Accreditation of the American Medical Association. High school graduation normally is required for admission. Although most programs last from nine to 10 months, some community college programs last two years and lead to an associate degree.
Accredited programs provide classroom training as well as supervised clinical experience. Required courses include anatomy, physiology, and microbiology. Other courses cover such topics as the care and safety of patients during surgery, proper use of anesthesia, and surgical care procedures. Students learn how to sterilize instruments, prevent and control infection, and handle special drugs, solutions, supplies, and equipment.
Some surgical technicians receive their training in hospital-based programs that last from six months to one year, depending on the program's admission requirements. The shorter programs are designed for licensed practical nurses that already have some background in anatomy, physiology, and clinical practice. The longer programs, from nine months to a year, are for individuals with no background in health care.
Some surgical technicians are trained in the armed forces. Regardless of where they are educated and trained, surgical technicians are expected to keep abreast of new developments in the field. With additional training, they can work with new equipment such as is used in open-heart surgery.
Obtaining professional credentials for this occupation is voluntary; the Liaison Council on Certification certifies technicians who demonstrate entry-level knowledge by successfully passing a national certification examination. Continuing education or reexamination is required to maintain certification, which must be renewed every six years.
Manual dexterity is a necessity for surgical technicians because they must handle instruments quickly; often having to anticipate which instrument is needed. They must be conscientious, orderly, and emotionally stable. In surgery there is little margin for error. High school students interested in careers in this occupation are advised to take courses in health, biology, chemistry, and mathematics.
Technologists may advance by specializing in a particular area of surgery, such as neurosurgery or open heart surgery. They may also work as circulating technologists. A circulating technologist is the person during the procedure that monitors the patient's circulatory function. They interview the patient before surgery; keep a written account of the surgical procedure; and answer the surgeon's questions about the patient during the surgery. With additional training, some technologists advance to first assistants who help with retracting, sponging, suturing, cauterizing bleeders, and closing and treating wounds.
Career advancement for surgical technicians often involves leaving the occupation in order to take sales, consumer relations, or management positions with insurance companies, sterile supply services, or operating equipment firms. Some technicians advance by becoming instructors in surgical technology training programs.
JOB OUTLOOK
Employment in this field is expected to grow faster than the average for all occupations through the year 2010. As in other occupations, most job openings will result from the need to replace experienced workers who transfer to other occupations or stop working all together. The volume of surgery, surgical practice patterns, and the availability of operating room nurses will affect future prospects for surgical technicians. The number of surgical procedures is expected to rise due to projected changes in the size and age structure of the population, technological advances that permit surgical intervention for more conditions than ever before, and widespread insurance coverage for surgical care.
The rate of surgery has climbed steadily among persons 65 years of age and above. Elderly patients typically undergo surgery for cataracts, hip replacements, hernia repair, or prostate removal, for example. As new procedures and improvement in technology continue to make surgery less risky and more successful, the potential benefits to elderly patients increasingly outweigh the risks. Rapid growth of the 65-and-older population in the years ahead is certain to sustain a high level of demand for surgery.
Surgical practice patterns are changing, however; the dominant trend is a shift to outpatient or ambulatory surgery. Advances in anesthesia, fiber optics, and laser technology have made it possible for many procedures to be performed on an outpatient basis, and cost-control considerations furnish a powerful stimulus for choosing outpatient rather than inpatient surgery. Some health insurance plans cover the full cost of outpatient surgery but only pay part of the cost if the same procedure entails a hospital stay.
The growing popularity of outpatient surgery is especially evident in the hospital sector. Explosive growth is occurring in the number of surgical procedures performed in hospital outpatient departments, which employ surgical technicians as assistants. If hospitals continue to dominate the rapidly expanding outpatient surgery market, demand for surgical technicians is likely to remain strong. Nonetheless, the shift to outpatient or ambulatory surgery will create faster growth for technologists in offices and clinics of physicians, including surgicenter.
Shortages or surpluses in the supply of operating room nurses are quite likely to affect demand for surgical technicians, however. Hospitals unable to locate sufficient numbers of suitably trained surgical nurses may alter operation room staffing patterns, increasing their utilization of surgical technicians. Thus, in areas experiencing a nursing shortage, opportunities for surgical technicians should be even more favorable.
Because so many factors are at work, the job market for surgical technicians will vary from one community to another, depending on local hiring needs and the supply of qualified applicants.
Employment prospects for top graduates of accredited programs in surgical technology are expected to be very good, overall. Employers tend to view graduates of accredited training programs more favorably than those without such preparation--with the important exception of applicants with very strong clinical backgrounds such as foreign medical school graduates who have not yet passed the licensing examination that is necessary to enter residency training.
EARNINGS
The average starting salary for surgical technicians is $21,741 a year, according to a national survey by the University of Texas Medical Branch. Experienced technicians earn an average annual salary of $30,540. Surgical technicians employed by the Federal government are classified as nursing assistants. Their starting salaries range from about $18,885 to $29,740, depending on education and experience.
Salaries vary widely by geographic location, with those on the East and West Coasts generally higher. Surgical technicians employed by surgeons tend to earn more than those employed by hospitals and similar institutions.
Questions:
Describe what Surgical Technologists do in a surgical unit.
How do Surgical Technologists receive their training?
What are the requirements to get into a Surgical Technologist program?
What are the physical requirements for becoming a Surgical Technologist?
What is the job outlook for a Surgical Technologist?
What is the average starting salary for a Surgical Technologist?
RELATED OCCUPATIONS
Other workers who perform medical activities under supervision are chiropractor assistants, dental assistants, electrocardiograph technicians, electroencephalographic technologists, licensed practical nurses, medical assistants, nursing assistants, occupational therapy assistants, orderlies, and physical therapy aides.
ADDITIONAL INFORMATION
Additional information on a career as a surgical technician, on training schools for the occupation, and on certification is available from: American Medical Association, Division of Allied Health Education and Accreditation, 535 N. Dearborn St., Chicago, IL 60610.
Perfusionists
WORK DESCRIPTION OF PERFUSIONISTS
A perfusionist is a skilled person, qualified by academic and clinical education, who operates extra corporeal circulation and auto transfusion equipment during any medical situation where it is necessary to support or temporarily replace the patient's circulatory or respiratory function. The perfusionist is knowledgeable concerning the variety of equipment available to perform extra corporeal circulations functions and is responsible, in consultation with the physician, for selecting the appropriate equipment and techniques to be used.
Perfusion (extra corporeal circulation) procedures involve specialized instrumentation and/or advanced life-support techniques and may include a variety of related functions. During a cardiopulmonary bypass, the perfusionist may administer blood products, anesthetic agents, or drugs through the extra corporeal circuit on prescription and/or appropriate protocol. The perfusionist is responsible for the monitoring of blood gasses and the adequate anticoagulation of the patient, induction of hypothermia, hemodilution, and other duties, when prescribed. Perfusionists may be administratively responsible for purchasing supplies and equipment, as well as for personnel and departmental management. Final medical responsibility for extra corporeal perfusion rests with the surgeon-in-charge.
EMPLOYMENT OPPORTUNITIES
Perfusionists may be employed in hospitals, by surgeons, and as employees of a group practice. They typically work during the week and are frequently on call for emergency procedures on weekends and nights. They may work in an on-call system, depending on the number of perfusionists employed by the institution.
TRAINING, OTHER QUALIFICATION, AND ADVANCEMENT
Programs are generally one to four years in length, depending on the program design, objectives, prerequisites, and student qualifications. Certificate programs require that applicants have a bachelor's degree. Prerequisites vary depending on the length and design of the program. Most programs require college-level science and mathematics. A background in medical terminology, respiratory therapy, or nursing is suggested for some programs.
Curricula of accredited programs include courses covering heart-lung bypass for adult, pediatric, and infant patients undergoing heart surgery; long-term supportive extra corporeal circulation; monitoring of the patient undergoing extra corporeal circulation; auto transfusion; and special applications of technology. Curricula include clinical experience that incorporates and requires performance of an adequate number and variety of circulation procedures.
Standards are minimum educational standards adopted by the AACP, AATS, ABCP, AMA, AmSECT, Perfusion Program Directors Council, Society of Cardiovascular Anesthesiologists, Society of Thoracic Surgeons, and Commission on Accreditation of Allied Health Education Programs. Each new program is assessed in accordance with the Standards, and accredited programs are periodically reviewed to determine whether they remain in substantial compliance. The Standards and Guidelines are available on written request from the AC-PE.
EARNINGS
According to the AmSECT, the average base salary for a recently graduated perfusionist is about $50,000; for a certified perfusionist with two to five years experience, $55,000 to $69,000; 5 to 10 years experience, $65,000 to $72,000; and chief perfusionist, $70,000 to $90,000.
Questions:
What does a Perfusionist do?
How do Perfusionists receive their training?
The minimum education standards for Perfusionists are adopted by what agencies?
What are the starting salaries for Perfusionists?
ADDITIONAL INFORMATION
For inquiries regarding accreditation, contact:
Accreditation Committee Perfusion Education, 7108-C S. Alton Way, Englewood, CO 80112-2106
Careers/Curriculum, AmSECT National Office, 503 Carlisle Dr., Herdon, VA 20170
American Academy of Cardiovascular Perfusion, P.O. Box 468, Pell City, AL, 35125
Certification, American Board of Cardiovascular Perfusion, 207 N. 25th Ave., Hattiesburg, MS, 39401
Medical Assistants
WORK DESCRIPTION
Medical Assistants assist physicians in their offices or other medical settings, performing administrative and/or clinical duties delegated by the physician in relation to the degree of training and in accordance with respective State laws governing such actions and activities. Medical assistants have a wide range of duties in many aspects of the physician's practice.
Business administrative duties include scheduling and receiving patients; obtaining patients' data; maintaining medical records; typing medical transcriptions; handling telephone calls, correspondence, reports, and manuscripts; and assuming responsibility for office care, insurance matters, office accounts, fees, and collections. Clinical duties include preparing the patient for examinations, obtaining vital signs, taking medical histories, assisting with examinations and treatments, performing routine office laboratory procedures, such as, electrocardiograms, sterilizing instruments and equipment for office procedures, and instructing patients in preparation for x-ray and laboratory examinations.
Both administrative and clinical duties involve purchasing and maintain supplies and equipment. A medical assistant who is sufficiently qualified by education and/or experience may be responsible for personnel and office management.
WORKING CONDITIONS
Medical assistants are usually employed in physicians' offices where they work in pleasant, well lighted, surroundings. They constantly interact with other people, and may have to handle several responsibilities at once. A 5-day, 40-hour workweek is normal, although some physicians may require some work evenings and weekends. Their responsibilities and hours will vary depending on whether they work in a clinic, hospital, large group practice, or private office.