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trauma surgeon

1

Becoming a Trauma Surgeon

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trauma surgeon, trauma surgery, surgeon, suture, ER doctor, emergency surgeryStory at a Glance

Is there a difference between an ER doctor and a trauma surgeon? Yes, there is. When becoming a trauma surgeon, you enter a highly specialized field, interacting with patients facing life-threatening injuries. This article reveals:

  • The unique skill sets of a trauma surgeon.
  • A brief history of trauma surgery.
  • The education necessary to become a trauma surgeon.
  • Some career options and advancement opportunities for this surgical specialty.

The other day a billboard for a local emergency room went up in my neighborhood. It has a Waiting Time clock on it. That’s a puzzling concept because if you ever need to go to an emergency room, it may not be when the waiting time is only a few minutes.

Most people feel as if their wait time in an ER is hours. That’s probably because an allied health professional has assessed your ailment and determined it isn’t life-threatening. If it is, you’ll be seen immediately and possibly encounter a trauma surgeon.

Both a trauma surgeon and an ER doctor are vital to the controlled chaos associated with the environment of an emergency room. And both respond to emergencies at hand. But since their skill sets are different, their roles are distinct.

A Trauma Surgeon’s Unique Skill Sets

An ER doctor will treat any patient who enters the emergency room, regardless of their presenting condition. One of their primary skills is to stabilize individuals while making decisions about next steps in their care. The majority of patients who have experienced minor trauma, such as cuts and bruises from a fall will see an ER doctor. Once you’ve been released, or even admitted, you’ll usually be assigned to another doctor and not see the ER physician again.

On the other hand, if you fall into a specific medical category, a trauma surgeon enters the scene. Events necessitating a trauma surgeon can range from a serious car accident to a gunshot wound. They are life-threatening because those injuries could affect internal organs. Immediate treatment is necessary by a doctor specially trained to rapidly assess and make decisions about what to do. Trauma surgeons must have confidence in their decisions since often they work with incomplete information.

Although both trauma surgeons and ER doctors must treat patients with compassion and empathy, a trauma surgeon deals with high levels of emotion as well severe physical injuries.

For example, people in terrible car accidents are frequently panic-stricken and confused. Often they go into shock and could be unable to identify everything that’s wrong with them. It’s possible they may not be able to communicate at all. Depression can enter the emotional mix if they feel responsible for the accident, especially if other people were hurt. As a trauma surgeon applies medical knowledge and experience, he or she must also deliver a high amount of emotional support, which requires extraordinary social skills.

A trauma surgeon must also think linearly. While assessing a patient, the surgeon treats wounds and injuries in a particular order. Bleeding is stopped first. Next, any potential threat of contamination from open wounds is eliminated. Then a decision about surgery has to be made. Is surgery immediately called for, or is the patient stable enough to transport to intensive care for further treatment and observation? The trauma surgeon must treat injuries while simultaneously thinking three or four steps ahead. Saving a life and preventing permanent damage are the primary objectives. A misstep could be costly.

Common surgeries performed by trauma surgeons include:

  • Colon
  • Pancreas
  • Spleen
  • Stomach

The Beginnings of Trauma Surgery

The first trauma surgeon in the United States was Dr. George E. Goodfellow, although he didn’t start out with that in mind. In November 1880, he opened up a general medical practice in Tombstone, which was, at that time, located in what was known as the Arizona Territory.

On July 13, 1881, a miner suffered a gunshot wound that perforated his small and large intestines as well as his bowel. Dr. Goodfellow sutured six holes in his organs. The miner survived due to the quick thinking and immediate surgical intervention by Goodfellow.

Throughout the ensuing years, Goodfellow performed trauma surgery on many notorious outlaws as well as Deputy U.S. Marshall Virgil Earp and his brother, Assistant Deputy U.S. Marshall Morgan Earp, who both suffered gunshot wounds at the O.K. Corral in October of 1881.

Through his many emergency surgical experiences, Goodfellow pioneered the use of sterile techniques in treating gunshot wounds. He ultimately became known as a gunfighter’s surgeon and became the leading authority on managing this type of traumatic injury. His method of what is now known as a laparotomy has become the standard of care associated with penetrating injuries to the abdomen.

Steps to Becoming a Trauma Surgeon

There are multiple steps to becoming a trauma surgeon and you’ll spend 12-15 years in school.

  • Step 1 – Obtain a bachelor’s degree in biology, pre-med or another science-based discipline.
  • Step 2 – Complete a doctor of medicine (MD) program, which includes two years of clinical practice.
  • Step 3 – Enter a medical residency program. If you aspire to become a trauma surgeon, secure one in general surgery so you’re exposed to a variety of surgical procedures. Expect the residency to last 4-5 years.
  • Step 4 – Complete a 1-2 year fellowship program. During this time you’ll focus on trauma surgeries and receive instruction in follow-up care to patients.

Licensing and Certification

Once you have all the necessary education, you must become licensed and certified. A license is required by law. Certification adds value to your degree and license because an independent third-party has assessed, and approved, your skill level.

You want to pass these assessments the first time you face them. So take the time to study and take practice tests. All the practice you had in medical school allows you to have automatic responses in an emergency. Test practicing gives you the same advantage when answering questions and can reduce any anxiety you may have.

  • Step 1 – Take the U.S. Medical Licensing Examination (USMLE). This assessment helps state licensing boards evaluate your skills and knowledge. Check with your state for further details.
  • Step 2 – Although voluntary, you can become certified in General Surgery which requires five years of surgical training before certification is granted by the American Board of Surgery.
  • Step 3 – Once you receive your certification in general surgery, you can also obtain a subspecialty certification from the American Board of Surgery. They offer five subspecialty certificates, but the best one for trauma surgeons is the Surgical Critical Care certificate. A surgeon specifically trained in this area has skills in diagnosing and treating trauma victims with severe infections and organ injuries.

Acute Care Surgery

The American Association for the Surgery of Trauma defines Acute Care Surgery (ACS) as a developing area of medicine consisting of three components – trauma, critical care and emergency surgery. The need for trauma and emergency surgical care has increased over time, requiring improved, formal education covering both areas. As a result, the Trauma and Acute Care Surgical specialty emerged. Your formal trauma education may incorporate this ever-growing concentration.

Continuing Education

trauma surgeon, trauma surgery, surgeon, suture, ER doctor, emergency surgeryIn the field of medicine, continuing education is mandatory. Trauma surgeons must stay abreast of advancements in surgical techniques. The better the methods and tools, the less risk there is to patients. Educational content varies depending on a doctor’s specialty. However, the surgical material is more complicated. Minimal requirements for continuing education are ten hours of participation in an accredited continuing medical education program. The American Medical Association (AMA) is a source of information for CEUs.

Career Advancement

Trauma surgeons are nearly at the top of their field. However, depending on your years of experience and the competency of your skills, you may be asked to participate in research and development. R&D tends to focus on the advancement of surgical procedures and techniques. You may also elect to mentor and teach medical residents just starting out on their career path.

Career Options for Trauma Surgeons

Although you may consider a hospital as the only place that employs trauma surgeons, there is a vital need for them elsewhere. Becoming a member of the military or naval medical staff, are career options. Unfortunately, injuries to soldiers are often traumatic, and skilled surgeons capable of remaining calm and effectively performing in high-stress situations are always needed.

Entering the field of medicine can be a gratifying career. But the role of a trauma surgeon is one where your intervention means the difference between the life, and death, of an individual.

Can you begin your career in trauma surgery today?

Indeed yes!

The Apprentice Doctor® Academy has developed and perfected an Online Course for Future Doctors to assist them towards fulfilling their dreams of becoming great medical professionals. The For Future Doctors Foundation Medical Online Course with accompanying Medical Kit has helped launch the career of thousands of want-to-be doctors!

The Apprentice Doctor® Suturing Course and Kit is a resource that will teach you how to suture wounds in a couple of hours! If you want to become a Surgeon – why not learn how to suture wounds now?

If you’re interested in medical school and becoming a doctor or surgeon, these articles may be of interest to you:

Is Your High School Curriculum Preparing You for a Medical Career?
Become a Medical Doctor (General Practitioner); A How to Guide
Path to Becoming a Neurologist or Neurosurgeon
How to Become a Surgeon
How to Become a Cardiothoracic Surgeon

medical engineer

0

Using Engineering in Surgery

Become a Doctor, Future of Medicine, Suturing

robotics, stretchable electronics, surgical gloves, medical engineers

Becoming a Surgeon and An Engineer

Article at a Glance

The blending of surgery and engineering isn’t unheard of, although rare. But it’s clear that engineers and surgeons are working together to make miraculous progress in the field of medicine. These advances are making surgeries shorter with less risk to patients.

This article gives you a snapshot of a few engineering advances making positive changes in surgical procedures:

Stretchable electronics.
Electronic surgical gloves and finger sleeves.
Needlescopic surgery.
Robotic surgery.

If you are interested in becoming a medical engineer, you’ll also find information on that fast-growing career.

 

Becoming a surgeon and an engineer so that they blend into a single career is an interesting proposition. The advantages seem clear, but the concept isn’t straightforward. Being a surgeon can enhance medical engineering research and surgical advances. The critical thinking and problem solving skills of an engineer are similar to those needed by a surgeon. Although years of education are required to secure both degrees, the knowledge of one can complement the knowledge of the other. I’m aware of one doctor who holds a degree in electrical engineering as well as in otolaryngology, neurological surgery and urologic surgery.

If you have ever considered a dual title such as medical-surgical engineering, you’ll have to know as much about medicine and medical practice as you will about electronics, biomedical technology and chemical engineering.

When surgeons and engineers work cooperatively, yet independently, here is a snapshot of what they’ve been able to accomplish.

Types of Engineering Technology Used in Surgery

Stretchable Electronics

What they are: Although stretchable electronics can be used in a variety of industries, in the medical industry they perform like adhesive bandages. They can bend, stretch and otherwise mold themselves around multiple surfaces. The sensors embedded in them can send data from the human body back to the surgeon or other healthcare professional.

The initial challenge: To develop “stretchy electronics” so a single surgical instrument could be used in open heart surgery instead of three, reducing the risk to the patient. During open-heart surgery, surgeons often have to utilize multiple balloon catheters with different functions. Because they all have to be inserted sequentially, surgeries are long, complicated and sometimes painful. The longer the surgery, the higher the risk to the patient. Currently three different devices have to be used. The first maps the heart’s signals so the problem area can be identified. The second one controls the positions of therapeutic actuators and their contact with the epicardium. The third is used to burn away damaged tissue.

The initial solution: Development of a multifunctional balloon catheter that stretches up to 300%, inflating or deflating as needed in the surgical procedure. It operates reliably without any changes in properties.

Advantages/Applications:

  • Delivery of high-quality information such as temperature and blood flow to surgeons in real time.
  • Neuroscience research.
  • Performs corrections on heart tissue during surgery through the use of radio signals to heat and kill cells.
  • Physical rehabilitation.
  • Preemie monitoring.
  • Provides fast, high-resolution mapping.
  • Quickly diagnoses and treats the causes of irregular heartbeats.
  • Spinal surgery.
  • Sun exposure monitoring

Future Adaptations:

  • Biodegradable implants to monitor cranial pressure and temperature.
  • Collection of bodily fluids to monitor electrolytes and glucose levels.
  • Monitor the risk of asthma attacks in the lungs.
  • Monitor the stretch and flow of bladder functions.
  • Real-time mapping of electrical activity in the brain during epileptic seizures.

Electronic Surgical Gloves and Finger Sleeves

stretchable electronics
Image: John Rogers/University of Illinois

What they are: Similar to stretchable electronics, semiconductors embedded in soft, flexible surgical gloves allow cardiac surgeons to feel everything they do with their fingertips.

The initial challenge: Reduce the size of current technology, which is large and bulky. There was a need for a simple technology that could measure the stress and strains during surgery through the fingertip(s). With electrotactile simulation surgeons could monitor and detect medical information from the skin.

The initial solution: Integration of ultra-thin and stretchable silicon-based electronics and sensors with artificial skin that can be slipped on hands or fingertips.

Advantages/Applications:

  • Performs ultrasound imaging of tissue upon touch.
  • Performs surgery by heat-induced local ablation.
  • Precisely removes tissue using local ablation.
  • Relays information such as temperature, conductivity, etc. to the skin.
  • Senses the electrical properties of tissue.

Future Adaptations:

  • Application of sensors to flexible surfaces to provide a sense of touch to prosthetic limbs.
  • Measuring motion and temperature.
  • Softer robotic interactions with surroundings.
  • Wrapping the surface of the heart with sensors to diagnose and treat cardiac arrhythmia.

Needlescopic Surgery

What it is: Minimally invasive, needlescopic surgery uses instruments with a diameter 10,000 times thinner than a strand of hair. The incisions can be sealed with surgical tape. Scars are small if they exist at all.

The initial challenge: Reduce the invasiveness of surgeries through the use of needle-sized instruments that current robotic technologies can’t accomplish.

The initial solution: Provide needlescopic surgical instruments that possess more dexterity, thereby broadening potential applications.

Advantages/Applications:

  • Laparoscopic surgery.
  • Less postoperative pain.
  • Minimally invasive surgeries in small areas such as the ears, nose and throat.
  • Shorter hospital stays.
  • Transnasal brain surgery.

Future adaptations:

  • Currently very few surgeons in the world use needlescopic surgery. As more surgeons incorporate it into their practices, future adaptations can be better identified.

Robotic Surgery

What it is: Robotic surgery is another type of minimally invasive surgery. Through the use of miniaturized surgical instruments mounted on one of four robotic arms, it allows surgeons a maximum range of motion and precision.

The initial challenge: Provide surgeons a way to perform complex procedures with more precision, flexibility and control than is possible with conventional techniques.

The initial solution: The creation of a robotic surgical system controlled by surgeons at a computer console near the operating table. The two most well-known systems are the da Vinci and Zeus.

Advantages/Applications:

robotic surgery
Robotic surgical system on a test medical stand
  • Clearer visual field.
  • Fewer complications, such as surgical site infection.
  • Greater flexibility and precision during surgery.
  • Increased mobility without tremors.
  • Less pain and blood loss.
  • Perform surgeries previously too high risk with current techniques.
  • Quicker recovery.
  • Smaller incisions and scarring.

Future Adaptations:

  • Expanded opportunities for teaching and assessment of new surgeons.
  • Integration of new and current technologies used in surgical procedures.
  • Long-distance intraoperative consultation or guidance.
  • Preoperative and intraoperative video image fusion to better guide surgeons in dissection and identifying pathology.
  • Rehearsal of complex procedures before performing them on patients.

Medical Engineers

Blending engineering and surgery into one role is possible, but takes many, many years of schooling. As an alternative, if you want to work in medicine with an engineering degree, you may be interested in becoming a Medical Engineer.

Medical engineers apply engineering principles from technical sources to solve clinical problems. As you have read in this article, they have created medical products that combine anatomy and physiology with technology. The result is higher quality healthcare for surgical patients. Future research shows similar advances in all areas of medicine.

As a medical engineer, you can go in any number of directions. Research, development and quality assurance represent only three areas. The development and evaluation of medical devices is another. You can help hospitals and medical clinics with the latest purchases in biomedical technology by evaluating their needs against what’s available. You can also specialize in nanotechnology, stem cell research, or other areas of cutting-edge medicine. The avenues that combine healthcare with electronics are expanding all the time.

To be successful in the field of medical engineering, you must be able to give attention to detail, creatively solve problems, and apply analytical thinking. Because you’ll be working with others, you must be able to easily integrate yourself into a team by expressing ideas and listening to others. More often than not you will have to be a leader.

To enter this field you must obtain a bachelor’s degree in engineering, physics or related program. You will need to go on to graduate with a master’s or Ph.D. in medical engineering.

Would you like to start learning surgical skills today? You can!

Would you like to develop the skills used by a surgeon or medical engineer? There’s no need to wait until you get into a post-secondary or graduate program. You can begin right now.

The Apprentice Doctor® Academy has developed and perfected an Online Course for Future Doctors to assist them towards fulfilling their dreams of becoming great medical professionals. The For Future Doctors Foundation Medical Online Course with accompanying Medical Kit has helped launch the career of thousands of want-to-be doctors!

The Apprentice Doctor® Phlebotomy Course and Kit is a resource that will teach you how to confidently perform phlebotomy procedures in a couple of hours! If you want to perfect that skill, why not learn how to perform venipuncture procedures now?

The Apprentice Doctor® Suturing Course and Kit is a resource that will teach you how to suture wounds in a couple of hours! If you think may be drawn to direct-patient care, why not perfect suturing techniques now?

If you’d like information about becoming a surgeon, you may be interested in the following articles:

How to Become a Medical Doctor in the United States.
How to Become a Cardiothoracic Surgeon.
What’s the Difference Between a Neurologist and a Neurosurgeon?

______________________

References
Kim D.-H. et al. Nature Materials advance online publication doi:10.1038/NMAT2971 (2011).
Borghino, D. Electronic Fingertips could lead to smart surgical gloves (2014).
Robotic Surgery Center. What is Robotic Surgery?
Anthony R. Lanfranco, BAS, Andres E. Castellanos, MD, Jaydev P. Desai, PhD, and William C. Meyers, MD Robotic Surgery, A Current Perspective.

surgical specialties

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8 Surgical Specialties for Registered Nurses

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Becoming a Surgical Nurse

surgical nurses, nursing specialties, nursing, registered nurses, nursing careersArticle at a Glance

In our nursing articles you have read about post-secondary degrees in nursing. You have even learned how to improve your application for getting into nursing school. In today’s article you’ll read about 8 surgical specialties you can pursue once you are a licensed registered nurse. For each one you’ll see:

A brief description of the career.

A list of typical duties.

The educational path to follow.

The type of experience to obtain.

Certification and re-certification requirements.

Snapshot of 8 surgical nursing specialties

Below is a chart that lists the eight surgical nursing specialties this article covers. The table provides the name of the position and the type of nursing environment to expect. All of the roles require you to be a licensed, registered nurse.

Specialty Name

 Nursing Environment(s)
Cardiac Cath Lab Nurse – Registered Nurse-Board Certified (RN-BC) Clinical; emergency; surgical
Nurse Anesthetist – Certified Registered Nurse Anesthetist (CRNA) Advanced Practice; surgical
Ophthalmic Nurse – Certified Registered Nurse in Ophthalmology (CRNO) Clinical; surgical
Otorhinolaryngology Nurse – Certified Otorhinolaryngology Nurse (CORLN) Clinical; surgical
Perianesthesia Nurse – Certified Post Anesthesia Nurse (CPAN) and/or Certified Ambulatory Perianesthesia Nurse (CAPA) Surgical
Perioperative (Surgical) Nurse – Clinical Nurse Specialist-Certified Perioperative (CNS-CP) Surgical
Plastic Surgery Nurse – Certified Plastic Surgical Nurse (CPSN) or Certified Aesthetic Nurse Specialist (CANS) Clinical; surgical
Transplant Nurse – Certified Clinical Transplant Nurse (CCTN)

Surgical

As you read details about the positions, you’ll learn the general duties performed, the educational path to follow, and information on the certification process.

To become a type of surgical nurse requires dedication and significant training. However, if you pursue any of these roles, you will find yourself with a gratifying career.

1. Cardiac Cath Lab Nurse – RN-BC

Another name for a cardiac cath lab nurse is a cardiac-vascular nurse. This type of surgical nurse assists surgeons with the insertion of a catheter into a chamber or vessel of the heart. This procedure is used to diagnose or treat heart conditions. It’s possible you’ll also assist with coronary catheterization. These procedures are performed in highly specialized labs using advanced technologies in cardiac care.

Typically a cardiac cath lab nurse will assist in some, if not all of the following types of procedures:

  • Angioplasties.
  • Pacemakers and cardioverter-defibrillators (ICDs) implants.
  • Stent placements.
  • Valvuloplasties.

To become a certified cardiac cath lab nurse, you’ll take the following steps:

  • Obtain an associate or bachelor degree in registered nursing.
  • Pass the NCLEX-RN.
  • Obtain a Cardiac Vascular Nursing Certification (RN-BC) from the American Nurses Credentialing Center (ANCC). As stated on their site, eligibility for this certification is extensive and requires the following:
    • Hold a current, active, unencumbered RN license.
    • Participate in a six-month cardiac cath lab training program run by a hospital.
    • Work two years in an ER, ICU or coronary care unit.
    • Have practiced the equivalent of 2 years full-time as a registered nurse.
    • Have a minimum of 2,000 hours of clinical practice in cardiac-vascular nursing within the last 3 years.
    • Have completed 30 hours of continuing education in cardiac-vascular nursing within the last 3 years.

Once you receive the RN-BC credential, it will have to be renewed every five years.

Because eligibility requirements, fees and continuing education information changes as the industry does, check the ANCC website for details when you’re ready to begin the education process.

You may be interested in watching this video about the cardiac nursing specialty.

2. Nurse Anesthetist – CRNA

As the name implies, a nurse anesthetist gives anesthesia and anesthesia-related care to patients before, during, and after surgery. A CRNA faces a variety of situations and unexpected events during operations. That’s why the path into this field is so intensive. Nurse anesthetists are among the most in-demand, and highest-paid, of all nursing professions.

Some of the responsibilities of a nurse anesthetist include:

  • Assisting with outpatient procedures.
  • Helping patients with pain management.
  • Performing epidurals.
  • Providing operating and emergency room care.

The steps to becoming a nurse anesthetist are:

The Continued Professional Certification (CPC) is their recertification program. It consists of two four-year cycles. The CPC is a relatively new program, so it is always best to check the NBCRNA website for current details. They provide detailed manuals and samples of test questions.

3. Ophthalmic Nurse – CRNO

As you may know, the field of ophthalmology involves eyecare beyond optometry. An ophthalmic nurse cares for individuals faced with severe eye disorders and serves as a vital member of surgical teams.

Some duties of an ophthalmic nurse include:

  • Conducting pre-operative assessments.
  • Helping patients with glaucoma, cataracts and other eye trauma.
  • Positioning patients and verifying surgical sites.
  • Serving as a circulating or scrub nurse during eye surgeries.

To become an ophthalmic nurse, the steps you follow are:

  • Obtain your nursing diploma, associate or bachelor degree in registered nursing.
  • Pass the NCLEX-RN.
  • Work a minimum of two years as a registered nurse in ophthalmic nursing.
  • Pass the Ophthalmic Nursing certification exam administered by the National Certifying Board for Ophthalmic Registered Nurses (NCBORN). As their site states, eligibility requirements to take the test are:
    • Hold a current, active, unencumbered RN license.
    • Have two years of full-time or the equivalent (4,000 hours) experience in ophthalmic registered nursing practice.

Continuing education and recertification is required for a Certified Registered Nurse in Ophthalmology (CRNO) every five years. The certification exam itself is only given twice a year. It is always advisable to check the NCBORN website for current details. You can also download manuals and outlines about requirements and the test itself.

4. Otorhinolaryngology Nurse – CORLN

Otorhinolaryngology nurses provide care for patients facing illnesses, diseases, or disorders related to the head. Areas include the skin, neck, ears, nose, oral cavities, and cranial nerves.

Some responsibilities of an otorhinolaryngology nurse are:

  • Assisting with radiation treatments.
  • Diagnosing patients.
  • Providing support for patients undergoing medical and surgical procedures.

The steps to becoming an otorhinolaryngology nurse are:

  • Obtain your nursing diploma, associate or bachelor degree in registered nursing.
  • Pass the NCLEX-RN.
  • Work a minimum of three years as a registered nurse.
  • Pass the Certified Otorhinolaryngology Nurse (CORLN) exam facilitated by the Society of Otorhinolaryngology and Head-Neck Nurses (SOHN). As you will note from their site, eligibility requirements are:
    • Hold a current, active, unencumbered RN license.
    • Have at least three years of experience in otorhinolaryngology and head-neck nursing practice.

Upon passing, you will become a Certified Otorhinolaryngology Nurse (CORLN). The test is only offered twice a year, so checking the SOHN website for updated information is always the best practice. Currently, CORLN recertification is required every five years.

5. Perianesthesia Nurse – CPAN and/or CAPA

Perianesthesia nurses, or recovery room nurses, carefully monitor patients as they recover from the effects of anesthesia after surgery. Perianesthesia nurses are well trained on how to handle patients with unexpected reactions upon awakening such as confusion or pain. They often consult with patients before and after surgery, and provide information about ongoing care at home once the patient is discharged.

Typical duties of a perianesthesia nurse include:

  • Caring for patients in recovery.
  • Giving patients recovery tips for home.
  • Prepping patients for surgery.

There are two certifications for a perianesthesia nurse. Each covers a specific phase of anesthesia. The first, the CPAN, certifies a nurse to care for patients in the post-anesthesia phase. The second, CAPA, is more extensive. It certifies a nurse to care for patients in preanesthesia, the day of the surgery, and post-anesthesia and extended care. You can be certified in one or the other, or opt for dual certification.

The educational flow to become a perianesthesia nurse is:

  • Obtain an associate or bachelor degree in registered nursing.
  • Pass the NCLEX-RN.
  • Apply to take your certification through the American Board of Perianesthesia Nursing (ABPANC).
    Per the ABPANC site, eligibility requirements for a Certified Post Anesthesia Nurse (CPAN) are:

    • Hold a current, active, unencumbered RN license.
    • Have 1,800 hours of direct clinical experience caring for patients in post-anesthesia Phase I obtained within the two years prior to applying for initial certification.

Per the ABPANC site, eligibility requirements for the Certified Ambulatory Perianesthesia Nurse (CAPA) are:
Hold a current, active, unencumbered RN license.

  • Have 1,800 hours of direct clinical experience caring for patients in preanesthesia phase, day of surgery/procedure, post-anesthesia Phase II and/or extended care obtained within the two years prior to applying for initial certification.

Per the ABPANC site, eligibility requirements for dual certification:

  • Hold a current, active, unencumbered RN license.
  • Direct clinical experience hours required for both CPAN and CAPA (1,800 hours each).

Because of the complexity of two potential exams and dual certification, and specific testing dates, it is recommended you visit the ABPANC for details and updates to their handbook.

This two-minute video entitled We are Perianesthesia Nurses may be of interest to you.

6. Perioperative (Surgical) Nurse – CNS-CP

Perioperative nurses care for patients during the entire course of their surgical experience. They monitor patients to ensure they are receiving the best quality of care during surgery. They also serve as intermediaries between the surgical team and the patients’ families. They can be seen assisting in the recovery room, and sharing post-operative tips patients should follow when they return home.

Typical duties of perioperative nurses include:

  • Giving patients recovery tips for home.
  • Interviewing and assessing patients for surgery.
  • Maintaining a sterile operating room throughout surgery.
  • Monitoring patients and coordinating care during surgery.

The educational path to becoming a perioperative nurse is:

  • Obtain a bachelor degree in registered nursing.
  • Pass the NCLEX-RN.
  • Gain experience working in critical care and in the ER.
  • Pass the Certified Nurse Operating Room exam (CNOR) through the Competency and Credentialing Institute (CCI). As their site indicates, eligibility requirements are:
    • Hold a current, active, unencumbered RN license.
    • Be currently working full-time or part-time in perioperative nursing an area of nursing education, administration, research or clinical practice.
    • Complete a minimum of 2 years and 2,400 hours of experience in perioperative nursing, with a minimum of 50% (1,200 hours) in an intraoperative setting.

Recertification for a Clinical Nurse Specialist-Certified Perioperative is required every five years. The CCI site contains updated information on initial certification and renewal.

A Day in the Life of a Perioperative Nurse may give you additional insight about this career.

7. Plastic Surgery Nurse – CPSN or CANS

Plastic surgery nurses help patients facing or recovering from plastic surgery procedures. They with procedures that range from small and elective, to more complicated operations like facial reconstruction.

Typical duties of a plastic surgery nurse include:

  • Explaining procedures to patients.
  • Prepping the surgery room.
  • Working with surgeons and other members of a surgical team.

The educational flow for a plastic surgery nurse is:

  • Diploma, associate or bachelor degree in registered nursing.
  • Pass the NCLEX-RN.
  • Work for two years as a registered nurse in surgical nursing with half the hours being in plastic surgery.
  • Pass the Certified Plastic Surgical Nurse (CPSN) exam facilitated by the Plastic Surgical Nursing Certification Board (PSNCB) exam. Their site provides details on the following eligibility requirements:
    • Hold a current, active, unencumbered RN license.
    • Have a minimum of two 2 years of plastic surgery nursing experience as a registered nurse in a general staff, administrative, teaching, or research capacity within 3 years prior to application.
    • Have a minimum of 1,000 practice hours in plastic surgery nursing during 2 of the preceding three 3 years before making application.

There is also a Certified Aesthetic Nurse Specialist (CANS) certification exam, also facilitated by the PSNCB. Details on the following eligibility requirements can be located on their site:

  • Hold a current, active, unencumbered RN license.
  • Work in collaboration or in a practice with a physician that is Board Certified within one of the following core specialties: Plastic/Aesthetic Surgery, Ophthalmology, Dermatology, or Facial Plastic Surgery (ENT).
  • Have a minimum of 2 years of nursing experience as a registered nurse within one of the listed core specialties above in a general staff, administrative, teaching, or research capacity within 3 years prior to application.
  • Have spent at least 1,000 practice hours within the core specialties during the preceding 2 years before making application.

Recertification for either credential is every three years. Because there are two exams with different eligibility requirements, and the tests are given only during certain times of the year, it’s best to check the PSNCB website.

You may want to view this short video on What is a Plastic Surgery Nurse?

8. Transplant Nurse – CCTN

Transplant nurses work with patients who donate and receive organs. These nurses are highly skilled at preparing living donors for transplant operations, including any risks involved in the donation. They perform similar services for patients receiving transplant organs from deceased individuals. Transplant nurses assist medical teams during surgery and work in post-operative care. They carefully monitor patients for post-transplant complications like organ rejection.

Typical duties of a transplant nurse include:

  • Clearing patients and donors for surgery.
  • Monitoring patients’ vital signs after surgery.
  • Ordering lab tests to confirm an organ match.
  • Taking medical histories.

The path to becoming a transplant nurse is:

  • Get diploma, associate or bachelor degree in registered nursing.
  • Pass the NCLEX-RN.
  • Get a few years experience in critical care, intensive care or medical-surgical nursing.
  • Pass the Transplant Nurse certification exam through the American Board for Transplant Certification (ABTC). Their site outlines the following eligibility requirements:
    • 24 months general experience as a registered nurse.
    • 12 months experience while working as a transplant nurse, which can occur concurrently with RN experience.

Recertification for a Certified Clinical Transplant Nurse (CCTN) is every five years. Check the ABTC website for updated information when you are prepared to embark on this career path.

Exam Preparation

As you have read, all of these specialties require experience in the field before you are eligible to take the exam. It is essential to understand that practical field experiences do not adequately prepare you to pass any of the certification tests.

You have invested substantial time and financial resources for your education, so it is recommended that you take a preparatory course for your selected exam. You should also use the review materials and practice tests provided to you on each site. Most successful candidates spend two to three months consistently studying before attempting their exam. Since there are fees involved, you want to pass your exam the first time. So, create a study routine and follow it faithfully.

It can also be helpful for you to join a professional organization associated with the surgical specialty that most interests you. In some cases, the organization can offer you reduced exam fees and special training materials.

No matter what surgical specialty you prefer, you will have to obtain a degree in registered nursing and gain practical experience in the field. If you dedicate yourself to becoming a surgical nurse, you will find more career opportunities open to you.

Still interested?

If any of these nursing specialties has sparked an interest in a nursing career, you can get started today with one of two kits from The Apprentice Doctor. There’s no need to wait until you are in an official nursing program, or even in college. Either kit enables you to practice skills you’ll need in any nursing career.

The Apprentice Doctor® Suturing Course and Kit is a resource that teaches you how to suture wounds in a short period of time. As a nurse, you’ll use this skill almost daily. The kit contains everything you need to get started. Take a look at the following video for a closer view of the contents of the kit.

The Apprentice Doctor® Phlebotomy Course and Kit is another handy resource at your fingertips. This program teaches you how to confidently perform phlebotomy procedures. Drawing blood is a skill nurses perform frequently – and they have to be very good at it to minimize any discomfort for the patient. If you want to start your education being a great nurse, why not begin phlebotomy training right away? Take a quick look at the following video for an introduction to the kit.

If you are interested in the education you need to get started in registered nursing, the following articles will be of interest to you:

Associate Degree versus a Bachelor Degree in Registered Nursing
5 Reasons Your Application Gets Rejected by Nursing Schools

For an podcast interview with a surgical nurse, click here.

application gets rejected by nursing schools

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5 Reasons Your Application Gets Rejected by Nursing Schools

All, Become a Doctor, Featured Articles, Nurses

Story at a Glance

Do you want to become a nurse, but can’t get into a program? There are 5 probable reasons your application gets rejected by nursing schools.

Do your nursing school applications contain any of the following weaknesses?

You haven’t completed the pre-requisites (or you may not know what they are).

Your grade point average is too low.

Your test scores don’t meet the minimum admissions criteria.

Your preferred school won’t accept you (but perhaps another one does).

The lack of acceptance has made you frustrated and discouraged.

If even one reason is true for you, read on. If you’re serious about becoming a nurse, learn the ways to overcome these difficulties.

 5 Reasons Your Application Gets Rejected by Nursing Schools; and how you can overcome them.

 

We read a lot about why students stay in nursing school and the reasons they drop out. Lots of articles and FAQ sheets tell you what to expect in nursing school. They also go over the licensing exam and details about the career. But few review the reasons an application gets rejected by nursing schools or what to do about it.

If your dream is to become a nurse, but you can’t get accepted, read on. Listed below are the top 5 reasons this may be the case and what you can do to overcome each one.

1 – You haven’t completed the prerequisites

application gets rejected by nursing schools, you haven't completed the prequisitesNursing schools prefer their students to have some foundational knowledge when they begin training. They don’t expect you to know about nursing. But they do want you to have completed courses in the sciences. They scan your transcript for curriculum like anatomy and physiology, chemistry, nutrition, and microbiology. They also expect to see general education courses such as English, sociology, and psychology. Without them, your application is probably rejected by nursing schools.

If you are serious about entering a nurse training program, talk with an admissions representative about prerequisites. Once you have a list, review the courses you have and then make a dedicated effort to complete the rest.You can pick up most, if not all the necessary classes at a community college or online. But before taking this step, talk to your intended nursing school to make sure the credits will transfer into their program. Always keep in mind that transfer of credit, also known as TOC, is still at the discretion of the receiving institution.

2 – Your grade point average is too low

grade point average too low

Like medical school, nursing school is very competitive. If your grade point average in high school, or college, was lower than a 3.0, admissions committees will probably pass over your application. Sometimes they will consider you if you demonstrate an improved grade trend. But there are enough applicants with consistently high grades that they don’t have to. So don’t count on that.

If you haven’t taken any pre-requisites, you can probably overcome a low grade point average. As you complete the necessary courses and do well, your grade point average will rise. If you already have the pre-requisites, don’t give up. Bolster your application with letters of recommendations, a snappy admissions essay or even community work in a hospital or clinic. Reference those right away in your cover letter and make sure you include them in your application package.

3 – Your test scores don’t meet the minimum admissions criteria

test scores don't meet the minimum admissioins criteria

As you investigate nursing schools, you’ll discover they want you to pass the Test of Essential Academic Skills (TEAS), which assesses your skills in reading, math, science, English and language use. The scores predict your chances of doing well in nursing school. Or they may require the Health Education Systems, Inc. (HESI) A2 exam. Your score on this exam assesses the likelihood of your passing the National Council Licensure Examination (NCLEX). A license is essential because without it, you can’t practice in the field. No school wants you expending your time and financial resources if you’re not going to be successful. Plus, you don’t want to take on debt and have nothing to show for it at the end of the line. It’s a protective type of step.

Both the HESI and the TEAS are standardized tests scored by independent third parties, so the accuracy of their predictive ability is very high. If you’ve taken one of these tests and not reached a school’s minimum threshold score, you need to study more.

You can’t avoid facing one of the two tests. Without a high score, an application gets rejected by nursing schools. So prepare yourself to do well. There are many live review courses for these exams as well as study materials and practice tests. A small investment in your future now may earn you big rewards with a satisfying, rewarding career later.

4 – Your preferred school won’t accept you

As you’ve gathered by now, nursing schools are very selective. You might have a school preference, but don’t limit yourself to only one. That specific school may not see you as a good match for their training program. If that happens and you don’t have a pool of other schools to choose from, where does that leave you?

Ask yourself what’s more important to you – going to your dream school or becoming a nurse? If you complete a nurse training program and pass your licensing exam, you are a nurse no matter what school you attended. So keep your options open.

5 – The lack of acceptance has left you frustrated and discouraged

lack of acceptance has left you frustrated

No matter what anyone says, if a nursing school declines your application, your feelings will be hurt. If you have everything you need and are still not accepted, remember that it probably isn’t personal.The need for nurses is high. But the number of nursing schools and qualified instructors can’t meet the demand. So schools can only accept so many students. Sometimes it’s a numbers game. That works in your favor. If you apply enough times and to enough schools, your chances of being accepted improve. So even if you feel discouraged and want to give up, submit applications anyway. One day you may be pleasantly surprised.

Your next steps

SMART goals

Overcoming some of these obstacles requires perseverance, time and planning. To achieve your dream, establish SMART goals. Doing so keeps things manageable for you and will help you reach your dream. They also allow you to weave your objective naturally into the busy life you have. But what are SMART goals?

SMART is an acronym for the following:

Specific or Simple – Your overall goal of “getting into nursing school,” is too general and too big. Keep your steps to tiny specifics, like making one phone to one nurse to interview her about school. When you keep things simple, you won’t get overwhelmed.

Measurable – Measurable refers to numbers, or quantities such as one phone call, two classes, three applications. When you hit the number, you know you’ve accomplished the step.

Achievable – This is related to simple and specific. In other words, only do what you can do. Try not to take on everything at once. If your test scores are too low, don’t make your first goal passing the test. That may not be achievable. Plus, it’s too general of a target. What you can do is find a practice test. Or sign up for a review course. Each one of those tasks is achievable. When you have a series of achievable steps, you will feel successful all the time. That has the added benefit of reducing your frustration.

Realistic – If you need five pre-requisite courses, it might not be practical to take all five at once. It’s better to take more time by completing one class at a time than it is to do all five and possibly fail, or drop out.

Timely, or Time Limited – You may have heard the cliche that goals are dreams with deadlines. Without a firm deadline for each task, it probably won’t get done because other elements of life will overtake you. When they do, you’ll be tempted to push your deadline farther down the road. So set timeframes for each task, and hold yourself to them.

Establishing your SMART goals is simpler than you think. Here are a few examples:

  • Call one nursing school admissions office and make an appointment – By May 2.
  • Make a list of questions for the admissions appointment – By May 4.
  • Attend my appointment – May 10.

Imagine you discovered you need four pre-requisite courses. The next set of SMART goals would look something like this:

  • Investigate online schools or community colleges – By May 15.
  • Sign up for at least one course – By May 29.
  • Take the course – a start date and end date for classes are built in for you by the college. You can then create the rest of these goals based on the school’s calendar.

You can continue your list from here putting in the tasks that you need to submit a competitive application. The critical factor is staying on track. Time slips away faster than you realize. More than any other reason contained in this article, failing to take the steps you need to get into school may be the top reason you don’t get into a program. But since you have total control over your activities, it’s a straightforward challenge to master. If necessary, ask friend or family member to keep you on task.

If you need a little more motivation, find some pictures of nurses. Hang one on your computer, in your car, or even on your refrigerator. Every time you glance at one, say, “That’s going to be me.” It may sound a little silly, but over time, it improves your perspective and keeps you going.

If you can stick with your plan and draw upon the courage and dedication it takes to be accepted into nursing school; then you can be confident you have the characteristics you need to become a licensed registered nurse.

Thank you for stopping by today.

If you want to become a nurse, you may be interested in the following nursing articles:
OR Nurses; A Podcast Interview
Associate Degree versus a Bachelor Degree in Registered Nursing

In the alternative, you may want to learn about these alternative allied health careers:
Becoming a Certified Phlebotomist
Becoming a Certified Surgical Technologist

Want to beef up your nursing school application? Why not take a suturing or phlebotomy course from The Apprentice Doctor! It’s a fun and inexpensive way to demonstrate you have some of the practical skills used by nurses every day.

The Apprentice Doctor® Suturing Course and Kit is a resource that teaches you how to suture wounds. As a nurse, you’ll use this skill, so why not get started now? The kit contains everything you need to get started. Take a look at the video for a closer view of kit items.

The Apprentice Doctor® Phlebotomy Course and Kit is another handy resource at your fingertips. This kit teaches you how to confidently perform phlebotomy procedures. Drawing blood is another skill nurses use – and they have to be very good at it if they are to minimize discomfort to the patient. If you want to start your education in nursing, why not begin phlebotomy training right away? Take a quick look at the video to see all the items contained in the kit.

technology put your health at risk

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Does Technology Put Your Health at Risk?

All, Become a Doctor, Medical Care

Story at a Glance

  • Does technology put your health at risk? There are seven ways it could be.
  • Light from your devices could impact your sleep and make you more hungry when you normally wouldn’t be.
  • Eye strain, neck, and shoulder pain are common complaints of people who use computers for long hours.
  • Use of social media and spending time surfing the net can create depression and anxiety in some people.
  • Headsets, as great as they are, can contribute to hearing loss.
  • The good news is that there are simple, inexpensive hacks to combat each of these problems so you can continue to use and benefit from all your technology.

Can technology really put your health at risk?

In the early 60s, The Jetsons, a space-aged cartoon pulled kids to television sets on Saturday mornings. The futurist gadgets the family used inspired wonder and possibilities. Today many technologies shown in the animation exist. Most of us own them and use them. They are a natural part of our lives. But does technology put your health at risk? Research seems to indicate it does.

Listed are 7 ways digital technology may destroy your health. All 7 lead to rising costs of healthcare. But we’re giving you 7 easy prevention hacks, too. Implementing all of them can safeguard your physical well-being.

1. Sleep Deprivation

Being fully present during your waking hours means nabbing at least eight hours of sleep. However, many of us only grab six hours or less. The presence of digital technology in almost every room of the house discourages sleep. Bright light interrupts sleep patterns because it reduces the amount of melatonin the body produces. Without melatonin, you remain alert. In turn, this shifts your body’s natural sleep rhythms, keeping you tossing and turning.

Night-lights, television light, or the glow emitted from your digital clock all contribute to sleep deprivation.[1] Using a night mask is an excellent way to block sleep-impairing light. If you don’t like anything covering your eyes, try leaving your phone or laptop in another room at bedtime. Make your bedroom a device-free zone. Turn off the television before burrowing under the covers. Both actions are quick, no-cost steps you can take to catch an extra hour or two of sleep.

2. Weight Gain

The same light that disrupts sleep also makes you hungry. So when working on digital devices, there’s a tendency to snack. Eating while sitting at a computer may cause you to snack more, especially if you’re looking at pictures of food.[2] In 2014 Stanford University conducted a National and Nutritional Examination Survey. Researchers found that the percentage of inactive women in American rose from 19.1 to 51.7 between the years of 1994 and 2010. During that same time, the rate of inactive American men rose from 11.4 to 43.5 percent.[3] With the increase in device use, that number could get higher.

Not even today’s technology has found a way to burn excess calories without exercise. Sitting more and moving less almost always results in weight gain.

Flip your technology into a healthcare benefit. Hundreds of exercise routine apps are available on smartphones. Finding one that fits your personality and activity preferences, even if you travel a lot, is easy. The routine doesn’t have to be difficult or take hours of time. Thirty minutes a day can make improve your cardiovascular health more than you think. Through trial and error, you can find a favorite exercise app at zero to no cost. By offsetting some of your screen time with movement, you’ll be able to lose, or at least stabilize your weight.

3. Eye Strain

Most people spend five or more hours a day viewing digital screens. Did you know you forget to blink when working at a computer for extended periods? Research studies reveal blinking occurs ten technology put your health at risk with eye straintimes less than usual when sitting at a computer display. Lack of blinking deprives your eyes of necessary moisture.

Almost 7 out of 10 Americans who routinely use computers complain of eye irritations. Signs of strain include dry eye, burning, itching, and even blurred vision. Although most symptoms are temporary, they are uncomfortable and can lead to headaches.

Try these quick fixes. Adopt a 20/20/20 system. Set your smartphone for a 20-minute time block. When it buzzes, look away from your computer. Focus on something 20 feet across the room for 20 seconds. Then return to work and repeat the cycle. Another helpful activity is intentional blinking. Train yourself to blink, using your breathing pattern as a reminder. Blinking goes a long way toward keeping your eyes moist and pain-free.

4. Neck and Shoulder Pain

Most of us know leaning over laptops, smartphones or tablets for extended periods tightens the muscles between the shoulders. Even something as simple as tilting your head pulls tendons and ligaments in your back and neck.

An average adult head weighs anywhere from 10 to 12 pounds. When tilted toward a computer even 15 degrees, that weight increases to 27 pounds. If you bend it at a 30-degree angle, your back and neck support 40 pounds. Multiply that by five or more hours a day, and it’s not surprising many people go to the doctor for neck, back, and shoulder pain.

You can combat any pain, and even any poor posture working at a computer creates. When walking, pull back your shoulders and stand as straight as possible. Or, when you’re taking a vision break, shrug your shoulders. Moving your muscles in a different direction keeps you flexible and loose. Lastly, stretch your muscles by tiptoeing the fingers of each arm as far as you can slowly up a door jam. Do the same on the other side. The stretch feels amazing.

5. Depression

Does digital technology cause depression? Some research indicates it does. Other research suggests people who are lonely and possibly depressed, use digital technology more. In this case, digital technology primarily refers to social media outlets.

If you suspect your online time lowers your mood, ask yourself some simple questions. Do you feel sad, annoyed or even angry after reading postings? Does your body feel sluggish or tired when you’re interacting with sites? Do the lives of other people seem better than yours? If your answers are positive, they may suggest the amount of time you spend engaging in social media negatively impacts your mood.

The fix is little digital detox. Reduce the amount of time you spend reading posts. Another way is to “unfollow” people who are consistently negative. Avoid videos seeped in anger and other negative emotions. Verbal aggression, even on screen, can pull down your mood. The good news is that you have 100% control over your screen time and what you read or watch. By absorbing less, your outlook could improve. And you may find you have more energy and time to do other things that interest you.

6. Anxiety

Although the Internet provides a lot of useful information, can it put your health at risk? It can, especially if you are self-diagnosing suspected medical problems.

If you suspect something is amiss within yourself, a family member, friend, or pet, avoid rushing to the computer to look up symptoms. Researching medical difficulties is rarely a good idea for two reasons. The first is, if you don’t find the symptom(s), you may assume you’re fine. That could be true, but what if you’re not? On the other hand, what you learn could lead you to believe something is very wrong – even if you’re fine. Your stress and anxiety will increase because the human tendency is to conclude the worst.

If you think you are ill, take two simple actions to prevent excessive anxiety and possible panic. The first is: don’t research your symptoms. The second is: call your primary care provider and make an appointment for a proper diagnosis.

 

technology put your health at risk with hearing7. Loss of Hearing

The number one cause of hearing loss in America is excessive noise. According to the Hearing Health Foundation, the number of Americans experiencing hearing loss doubled between the years of 2000-2015. Sixteen percent of our teens complain about hearing loss.

Too much noise directly into your ears can cause damage to tiny hair cells inside the inner ear. These hair cells do not repair themselves, creating an irreversible hearing loss. Headphones are the primary culprits. Headsets for your computers, phones, and tablets direct all noise (no matter how much we enjoy the content) straight into your ears. They amplify sounds up to and above 85 decibels, which deteriorates your hearing.[4]

The prevention hack here is “noise-canceling” headsets. Simple earbuds can’t drown out sounds around you. So there’s an inclination to crank it up. From a healthcare standpoint, that means it’s probably too loud. Older, earmuff style models block out background noises and lower the volume. They may be big and a bit cumbersome, but they protect your hearing better.

Regardless of the headset you use, ensure your volume is set to a reasonable level. And take regular breaks from your headphones.

Don’t let technology put your health at risk. Protect your health from these 7 digital challenges with a few simple healthcare hacks. Then enjoy your technology without sacrificing your well-being.

Interested in becoming a healthcare professional who treats some of these digital technology side effects? Perhaps an orthopedic doctor, ENT (otolaryngologist) or audiologist. What about an ophthalmologist? Read How to Become a Medical Doctor (General Practitioner). If surgical technology sparks your interest, read Becoming a Certified Surgical Technologist.

 

Why not start your medical career right away?

Future doctors kit


The Apprentice Doctor® Academy has developed and perfected an Online Course for Future Doctors to assist them towards fulfilling their dreams of becoming great medical professionals. The For Future Doctors Foundation Medical Online Course with accompanying Medical Kit has helped launch the career of thousands of want-to-be doctors!

Launch your medical career today!

For those of you who’ve decided the healthcare field is right for you, enhance your skills with one of these kits.

The Apprentice Doctor® Suturing Course and Kit is a resource that will teach you How to Suture Wounds in a couple of hours! If you want to become a Surgeon or other medical professional – why not learn how to suture wounds now?

Suturing kit

 

____________

References:
[1] Grandner MA; Gallagher RAL; Gooneratne NS. The use of technology at night: impact on sleep and health. J Clin Sleep Med 2013;9(12):1301-1302. www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29250
[2] Spence C; Okajima K; Check AD; Petit O; Michael C; 2016, Brain and Cognition, Volume 110, pos. 53-63, Eating with our eyes: From visual hunger to digital satiation. www.sciencedirect.com/science/article/pii/S0278262615300178
[3] Bach, Becky, Stanford Medicine, 2017, lack of exercise, not diet, linked to rise in obseity, Stanford research shows, https://med.stanford.edu/news/all-news/2014/07/lack-of-exercise–not-diet–linked-to-rise-in-obesity–stanford-.html
[4] Noise-Induce Hearing Loss, National Institute on Deafness and Other Communication Disorders (NIDCD) NIH Publication NO. 14-4233, 2/7/2017 https://www.nidcd.nih.gov/health/noise-induced-hearing-loss

 

value based care

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Value-Based Medicine: healthcare’s future

Become a Doctor, Future of Medicine, Medical Care

 

Story-at-a-glance

  • Value-based medicine is an upcoming healthcare delivery system centered on the patient, and patient outcomes.
  • The goals, gender, age, and even culture of the individual are taken into account.
  • Volume-based care, our current system of fee for services rendered, will be replaced over time.
  • Five factors drive value-based medicine. A primary one is the demand by patients to be more involved in the decisions affecting their health and wellness.
  • It’s expected that value-based care will result in better healthcare at lower costs.
  • The shift to value-based medicine has already started. For example, by 2018 the Department of Health and Human services plans on moving 50% of traditional Medicare payments to value-based models.
  • Implementation of value-based care will require a shift in how we think about and approach healthcare.

 

Value-based medicine is changing the landscape of the healthcare delivery system. It focuses on the goals of the patient and their perception of the value of care they receive. Payment to providers is based on how well they adhere to delivering value to the patient. As value-based healthcare takes root, medical professionals will be expected to provide evidence of outcomes before being paid.

Why change to value-based medicine?

In the United States and in many countries across the world, the value of the healthcare delivery system is proving inadequate to meets the needs of its primary constituency – the patients. This inadequacy is not malicious or intentional. Instead, it’s because over time, layers and layers of outdated systems have lagged behind trends and an ever-growing population. Even obsolete technology plays a factor. The result is skyrocketing costs for patients, healthcare professionals and medical organizations.

Currently, we operate in a volume-based healthcare system. In other words, we pay for individual services. For every visit, test, medication, and treatment we receive, we are charged. It is a reactive system centered on illness rather than wellness. Little attention is paid to outcome measures. Payment is made regardless of how the patient perceives or experiences the outcome.

What does volume-based healthcare look like? A case study

Let’s review an actual case study. In 2017 Sally went to her primary care physician for her annual physical. The sequence of events that followed was not only expensive, but kept her on the sidelines.

After a panel of blood work, Sally’s physician was concerned about a sluggish thyroid. To rule it out, or confirm it, he referred her to an endocrinologist.

The endocrinologist reviewed Sally’s blood work and dismissed the thyroid condition. But he noted she had low salt, something Sally had lived with her entire life without negative impact. The endocrinologist believed one of her medications was the cause. Over the next 21 days he switched her prescription three times. Over the same period of time the symptoms the original medication controlled all returned.

The continued changes in medication overloaded Sally’s body and landed her in the hospital for a 24-hour stay. When she was released, the hospital doctor put her back on her original pharmaceutical with the following advice, “Don’t fix what isn’t broken.”

From start to finish, Sally waded through 19 different services and seven different care providers. None of the medical professionals in Sally’s case intended the ineffective outcome. Each believed they were doing what was best for Sally. The real culprit was the disjointed care. No one person knew what the other was doing and Sally trusted that each step was necessary.

If the professionals had interacted with one another, Sally’s $10,000 hospital stay might have been avoided. Multiply that cost by thousands of people across the health care system experiencing the same type of disconnected care and you’ll end up with a staggering number. That’s the cost of volume-based case. In other words, each additional service anyone receives from allied health professions increases the amount, or volume of care, and the price tag.

Sally is not alone. The core of the healthcare delivery structure is not negligence. It is working within, and navigating a broken system built on lack of coordinated, patient-centered care.

How does value-based medicine differ from volume-based medicine?

Let’s continue with Sally’s scenario. In value-based care, Sally would have gone to her physical and had the lab work done. She may have been referred to an endocrinologist. However, at that point rather than paying for each service separately, Sally may have been quoted a bundled or an episode-payment. This is an all-inclusive reimbursement model where the initial visit, the services, and any subsequent visits would have been one fee. Complications resulting from a decision to switch out her medications three times would have been absorbed by him – not Sally and her insurance company.

Let’s take a look at a more straightforward scenario. If an orthopedic surgeon determines a patient needs a knee replacement, in value-based medicine, a single fee for all the services associated with the knee replacement is quoted to the patient. The cost pays for the surgery, the pre- and post-operative visits, the physical therapy, hospital stay, tests, etc. If something happens and the patient has to be readmitted (within a specific and reasonable length of time), the additional cost is on the provider – not on the patient. Payment is not based on each service, but instead upon ensuring the patient is well and returned to the best state of health possible. The health of the individual is the evidence-based outcome measure, which has high value, especially to the patient. The individual gets the best health care at the lowest cost. When the focus is on the individual and their needs rather than on multiple services, patient satisfaction increases and outcomes improve. Costs decrease.

The shift to value-based medicine is driving both public and private payers to redesign payment models. There are several options under review, but all stress accountability for high quality care and lower healthcare costs.

The Boston Consulting Group created an engaging, five-minute video presenting what healthcare looks like now and compares it to the value-based care of the future. Take a look here: Value in Healthcare – A Case for Change.

What is driving value-based medicine?

Five factors are contributing to the shift into value-based medicine.

  • Advocacy – Patients want to be more involved in managing their healthcare. Healthcare specialists must take time to listen to their patients and respond to them with all the information available.
  • Demographics – There is an increase in the number of people 65 and older (baby boomers) who need healthcare.
  • Diseases – An increase in chronic diseases and conditions around the world requires better delivery of healthcare.
  • Resources – Lack of resources, or inadequate resources drive up costs while pressure is applied to keep them down. Overall there is a shortage of skills and healthcare staff such as nurses.
  • Trust – Currently patients trust their healthcare professionals less and less. Fewer and fewer patients are willing to follow instructions blindly. As adults, and the ones footing some of the bills, they want rationale.

What does value-based medicine mean for patients?value-based medicine patient focus

Although no system is perfect, the current system can improve. Value-based healthcare is seen as a step in the right direction. A more patient-centric approach will result in:

  • Better healthcare for you and your family.
  • Clear and more transparent communication with you.
  • Closer attention to you as an individual. Consideration is given to your culture, gender and age. Healthcare is no longer one-size-fits-all.
  • Focused insistence on proper nutrition. Better nutrition leads to healthier lifestyles, generating improved health outcomes.
  • Healthcare teams managed by coordinators. You’ll no longer have to coordinate everything yourself.
  • Lower costs for everyone.
  • Partnerships between you and your healthcare provider(s).
  • Technology that connects your medical records with other allied health professions involved in your care.

Can value-based care be delivered in a volume-based system?

Medical professionals, and patients, can achieve a measure of value-based care in today’s service-rich system. High-value care can be delivered without fixing the entire system.

For physicians, focusing on the patient requires thoughtful intention. Although there are many ways a patient-centered approach can be accomplished, here are three.

  1. Include the patient in the standard of care – Involve the individual in decisions. Listen to what she or he has to say. Take into consideration gender, culture, and even personal preferences.
  2. Coordinate medical services centrally – Help patients navigate the system by assisting them with the coordination of multiple services and care providers. An integrated effort facilitated by someone in the medical system improves the quality of care. It also may return patients to the best level of health possible in less time.
  3. Be transparent – Many times patients feel they don’t have all the information. Provide honest, clear communication on their status, progress, and prognosis. Promote prevention when possible.

Thoughtful intention is also required by patients. Here are four ways individuals can help.

  1. Be ready with your questions – Be specific when possible.
  2. Ensure you have your answers – Leaving a doctor’s office without them creates unnecessary frustration and may result in additional visits.
  3. Move on with your day – Once you know your next steps, it’s important to exit. It may be tempting to socialize, but you’re partnering with your doctor in a professional capacity, not as a close friend.
  4. Follow through – Embrace wellness by following through with medical advice and recommendations. You’ll feel better and may need to see a medical professional less.

Value-based medicine is a partnership. Physicians and patients have to work together as a team toward the common goal of better outcomes. With better outcomes, everyone wins.

value-based medicine patient outcomeWhat does value-based medicine mean for next-generation doctors?

Value-based medicine will change the future of healthcare. It is likely that future doctors will work in some kind of value-based medical system. For example, by 2018 the Department of Health and Human Services plans to move 50% of traditional Medicare payments to value-based models.[1] By 2020 Aetna plans on having more than 75% of their reimbursements going to doctors and hospitals practicing value-based care [2]. Even medical education will train both students and faculty in quality and safety improvements as well as the broader implications of value-based medical management. Future doctors will need to:

  • Act with the highest levels of integrity, keeping the patient in the picture.
  • Communicate with transparency to the patient and the patient’s family.
  • Embrace the use of technology and analytics.
  • Encourage innovation and keep striving for it.
  • Expect higher levels of accountability for outcomes. Doctors will sign off on results rather than number of services.
  • Form improved and more effective partnerships between the public and private sectors. Consider retailers, and financial and IT organizations as viable healthcare partners.
  • Improve upon the value, cost and quality of healthcare.
  • Lead cross-disciplinary teams.
  • Promote wellness and prevention, including a stronger focus on nutrition as prevention.
  • Seek additional education to keep up with skills, technology and other advances in medicine.
  • Try new ideas.
  • View continued education as a way to genuinely improve skills rather than CEU boxes to be checked.

To see how an IT entrant into the field of medicine is approaching value-based healthcare through technology, take a look at Forward in Silicon Valley. The levels of individual, patient-centric care they achieve through the use of high tech may surprise you.

Where does value-based medicine go from here?

Value-based care is not bad news. It merely means that the primary focus of healthcare shifts to high quality and wellness care, including prevention, rather than illness. It also redefines the use of medical technology outside hospitals. Acceptance of new players into the healthcare field is a must.

Perhaps the first step and one today’s doctors can take immediately includes gaining the cooperation of the patient. By establishing bona fide partnerships with each individual in their care, physicians can improve what is now fading trust. Trust is one of the primary pillars of strong healthcare values.

If you’d like to see how a hospital organization transformed their system from volume-based care into value-based care, take a look at what Sweden’s Karolinska University Hospital did. Karolinska’s New Operating Model – Value-based care.

Do you want to become an allied health professional? But you don’t know if your current high school curriculum is preparing you, read Is Your High School Curriculum Preparing You for a Career in the Medical Field?

Can you begin your career to becoming a value-based medicine health professional today?

Indeed yes!

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References:
[1] What are value-based programs? November 9, 2017 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html.

[2] Value-based care: A new, patient-centered approach to health care, October 11, 2017 https://news.aetna.com/2017/10/value-based-care-new-patient-centered-approach-health-care/.