VOLUME 1 NUMBER 4 JULY/AUGUST 2018 Trauma Models: PAs and NPs Increasingly IN THIS ISSUE... Embedded in Care Teams By Bonnie Darves Trauma Models: Surgery PAs and NPs Increasingly Embedded in Care Teams PAGE 1 dvanced practice clinicians looking career path for PA development, for APCs who for fast-paced, clinically challenging want to pursue expanded roles, Mr. Van Horn Perspectives and gratifying work, and a practice noted. “You won’t likely see the really complex PAGE 4 A environment that typically offers ample patients or deal with the resuscitative stress, opportunities for professional growth are but it’s still a great job for those who prefer 7 Surgical PA Jobs PAGE 4 likely to find both at a Level I . a.m. to 3 p.m. shiftwork and want to practice assistants and nurse practitioners in a hospitalist model,” he said. Communicating After the First Interview: who’ve made their way onto trauma-care In Mr. Van Horn’s program, the trauma-care Timeliness, Professionalism Key teams—or devoted their careers specifically to model is definitely full spectrum. APCs are in PAGE 5 trauma practice—report that the the ER, the OR, the ICU and on the floors. That’s is a good fit for APCs who want to be where the the comprehensive model that many programs Legal Corner PAGE 6 action is and have the energy to manage what around the country are moving toward, if can be a demanding workday. incrementally, he points out, when no barriers Featured Opportunity Physician assistants (PAs) have been a exist in practice-scope limitations, PAGE 7 mainstay in for decades, bylaws or surgery training-program needs. and both nurse practitioners (NPs) and PAs Embedded APC teams are even becoming Surgery PA Events PAGE 7 have a well-established presence in hospital more common at academic medical centers, emergency departments. APCs are relatively which continue to struggle with the 80-hour new on the trauma-care scene, but both their work week and shift-length limitations imposed Surgery PA Market Watch is published bi- monthly by Harlequin Recruiting in Denver, numbers and their clinical responsibilities are on physician training programs, as they Colorado, as a service for physician assistants growing, according to Jon Van Horn, MPAS, PA- accommodate ever-growing patient volumes. and advanced practice clinician candidates C, immediate past president of the American To get a sense of how PAs and NPs are seeking new opportunities. Submissions of articles and perspectives on Association of Surgical PAs (AASPA). functioning on trauma-care teams these days, the PA practice environment and job market “Trauma programs with PAs and NPs are Surgery PA Market Watch obtained a snapshot that may be of interest to readers are wel- comed. Please contact the publisher or editor getting larger because a lot of facilities that do of several programs throughout the country by for more information and guidelines. exclusively trauma, to ensure a good outcome speaking with APCs about their programs and in resuscitative , now have to have a their work. We also asked sources to offer tips PUBLISHER team that’s been in the OR frequently,” said Mr. for new grads and others interested in pursuing Katie Cole Van Horn, who practices trauma and critical care trauma practice. 303.832.1866 | [email protected] at Legacy Emanuel Medical Center in Portland, EDITOR Ore. “We’re now seeing models with embedded Richard Winters, D.H.Sc., PA-C Bonnie Darves PAs and NPs as the backbone of the service and, Lead Advanced Practice Provider, 425.822.7409 | [email protected] frequently, working collaboratively with physician Medical City Plano ART DIRECTOR residents if there’s a training program.” Plano, Texas Annie Harmon, Harmony Design At the other end of the trauma-program At Medical City Plano, part of Envision 720.580.3555 | [email protected] spectrum, PAs and NPs might have far more Healthcare, PAs and NPs are integrated in Surgery PA Market Watch, limited roles, serving primarily as rounders on every trauma care-delivery setting. ACPs work Harlequin Recruiting in the ER and as first assist in the OR, they P.O. Box 102166, Denver CO 80250 the floor and also working in the post-discharge follow and manage patients who end up in the www.harlequinna.com setting. The potential problem with those programs is that there’s not really a defined continued on page 2

01 Trauma Models (continued from Page 1)

ICU, and also participate in discharge planning few trauma centers in the middle of urban Aaron Pugh, PA-C and seeing patients in the follow-up clinic. areas have advanced practitioners who Trauma Center Physician Assistant, “We’re involved in every aspect of trauma practice at top of license like we do,” Mr. Intermountain Medical Center patients’ care here,” said Mr. Winters, who is Messing explains. “Part of that is because we Murray, Utah also director of clinical services for Envision are six blocks from White House and a few As team lead for of all trauma Surgical Services. “Our model is to engage PAs blocks from State Department, so don’t get patients at a high-volume center with high- and NPs in all facets of care, and to enable us the volume some urban centers get, but we do acuity patients and a 24/7 service staffed by to practice at the top of our license.” get a good variety and high-acuity patients.” seven , Mr. Pugh and his nine APC That means that PAs and NPs have APCs are encouraged by the trauma center’s colleagues function at a breakneck pace in a numerous opportunities to work in the ER director, Babak Sarani, MD, to function as highly collaborative environment. They do all the and the OR, Mr. Winters explained, “unlike in close to fellow status as possible—and Dr. bedside procedures except open thoracotomy, some and large academic centers.” Sarani provides the requisite training. “He and they’re involved at every juncture of care He previously worked in trauma practice in an sees us as the continuity in the service, and from the OR to the ICU and the floors, through academic center in Alabama where the PA role as educators. From a clinical standpoint, discharge. They also train emergency was extremely limited clinically. In addition, we just go where we’re most needed on any residents in certain procedures. Texas has a decidedly unrestrictive regulatory given day,” said Mr. Messing, who also co- “It’s a very busy practice, and because trauma environment for PAs, he added, which allows directs the hospital’s advanced practitioner service has been growing at 2.5% annually over the program leeway to train PAs to broaden program. past decade, our daily census during our busiest their procedure skills. On a typical day, the three APCs first assist time of year runs between 30 and 50 patients,” TIPS in OR, do trauma activation and consults, Mr. Pugh said. “Basically, I don’t ask my attending • If you’re considering a move, ask about and perform numerous procedures, see patients if I can do something; I ask for help if I need it.” understand the state laws governing what PAs in the ICU, and work collaboratively with the The practice has evolved substantially in and APCs are permitted to do in that state. physician residents. “We can run the service recent years to continually broaden APCs’ Also ask at the hospital level if there are as needed, which sends a positive message roles, thanks to a visionary , Mark restrictions on practice in the OR or in terms to the PA and NP students who rotate on Stevens, MD. “He had the idea that if you give of procedures you would be allowed to do. our service,” he said. “It’s a fast-paced field, PAs and NPs access to the ‘fun stuff,’ they’ll • It’s also important to understand the and because we care for a very vulnerable stay,” said Mr. Pugh, who frequently speaks on employment model—whether it’s hospital population, it requires a lot of discipline and PA career paths and leadership, and trauma or physician group employment. If it’s a dedication. And it’s gratifying—anything you APC program development. “And it has worked. hospital, roles for PAs tend to be more well do for these patients will help, and there’s so We have a very APC-friendly environment, and defined and specific vs. a physician group, much opportunity to grow as a clinician.” people rarely leave unless it’s because of a where PAs are more like righthand clinicians TIPS life change.” The Utah laws recently changed to surgeons and have a broader clinical role. • If you want to go into trauma, a so that PAs now have a more collaborative fellowship isn’t needed, but some practice with surgeons, not a strictly supervised Jonathan Messing, NP surgical experience is always desired. If one—and surgeons can now oversee six PAs. Advanced Practitioner Trauma Surgery Lead, you don’t have that, and The medical center also operates a thriving The George Washington University Hospital critical care are great fields to get some trauma APC fellowship program, which Mr. Washington, D.C. experience and set you up for moving Pugh helped to develop and implement, and The trauma program at The George into trauma practice later on. whose graduates have gone on to several high- Washington University is unusual in many • Many trauma physician societies openly profile programs throughout the country. respects. It’s a relatively small urban medical welcome APCs, and if you want to find TIPS center (350 beds), in the middle of the a surgeon to mentor you, you’ll have no • If you’re looking at opportunities, ask a nation’s capital and therefore geographically difficulty doing so. There’s just a great lot of questions. You want to know exactly constrained. “We’re somewhat unique in that community culture in trauma. how the service is run, and all the details

02 VOLUME 1 NUMBER 4 JULY/AUGUST 2018

of what PAs or NPs are permitted to do. It’s department, says he found his niche in his It’s the diversity of both the clinical practice important to find out what kind of career current position because of the clinical and the patients that drew Mr. Privitera to growth opportunities are available. diversity. “This is a true multidisciplinary academic PA trauma practice two years ago. “I • Ideally, you’re looking for a program where service, so we also see a lot of brain and enjoyed the idea of an unknown work day,” he the surgeons have the concept of working spinal-cord . We’re involved in a lot said. “As a trauma APC, it could be an ordinary collaboratively with APCs in their DNA.” of success stories, so it’s very gratifying,” work day and then three traumas roll in, and we he said. The medical center also serves as have to be prepared to act fast and efficiently.” Marialice Gulledge, ACNP a tele-trauma support service for outlying He appreciates the challenge that an Tyler Cook, PA Level II and III trauma centers, adding further academic center provides to treat complex Carolinas Medical Center—Atrium Health service complexity. patients who have multiple medical Charlotte, North Carolina As it has expanded, the Carolinas comorbidities who became injured, and At Carolinas Medical Center, the region’s program—which has become a model for the opportunity to work closely with several only Level I trauma center, to say that the ACP other programs—has sought candidates with different types of . “The gratitude service is busy is an understatement. The 16 surgery or experience, or and appreciation we receive from our patients ACPs—currently a 50/50 mix of PAs and NPs— NPs and PAs who’ve completed a fellowship. is the best feeling an APC could ask for,” he assist with 5,100 trauma code activations The interview process is a daylong affair that said. “I enjoy working with multiple specialists annually and handle more than 4,700 adult includes an interview with all attendings and to help save lives and change lives, daily.” admissions—qualifying the center, with 29 the entire ACP team. “I think it’s important At Strong Memorial, APCs also play a key role trauma beds, as the country’s sixth largest. for NPs and PAs interested in trauma to in educating residents—and the trauma division “Most people don’t realize how busy this place do rotations at places like ours, or shadow specifically looks for versatile APCs who can be is until they get here—it just doesn’t stop!” colleagues, so that they can see what it’s really interchangeable with surgical residents and said Ms. Gulledge, the lead NP and chief of like on a daily basis,” Ms. Gulledge said. who have a strong procedural and surgical the service. TIP foundation. “It’s vital that our APCs are able to The APCs’ scope is defined by their privileges, • During the interview, ask specifically how identify a patient who is crashing and initiate per state laws, and for some procedures ACPs emergencies are handled and ACPs’ roles resuscitative efforts,” Mr. Privitera said. must be proctored. Overall, however, the in those situations, because you want to be TIPS team’s practice is fairly broad and the pace able to practice at the top of your license. If • A new PA looking at trauma should ask is fast, because of the high patient volumes you don’t sense that there’s good physician several key questions: What service model and the fact that they support 13 surgeons. support for the PAs and NPs, walk away. does your trauma center use (service based “We’re primarily working on the floors and in vs. physician based)? What is the APC’s the ICU, and only occasionally in the OR, and Jacob Privitera, PA-C role in the trauma bay during activations? all but two of our ACPs are cross trained to Trauma and Acute Care Surgery PA, Strong What does a typical day look like? Will work in the ICU,” said Ms. Gulledge, a former Memorial Hospital there be opportunities to assist in the OR? flight nurse who also once served in an Army Rochester, New York Will the APC be in charge of treatment MASH hospital. At Strong Memorial Hospital, part of the plans and disposition planning? One interesting design component of University of Rochester, the five APCs primarily • Red flags to be aware of are a high rate of the Carolinas program is its approach to manage acute care surgery and trauma APC turnover, poorly defined orientation scheduling, which has evolved over time to patients admitted to the hospital floor, working goals and schedule, an undefined service reflect, as Ms. Gulledge puts it, “what really in a nearly one-to-one ratio with the facility’s model or a lack of policy protocols—for happens.” ACPs working in the trauma ICU do six trauma surgeons. They respond to trauma chest tube protocol or trauma admission 13.5-hour shifts to allow for sufficient overlap alerts in the ED and serve as OR first and criteria, for example. when transferring care. second assists one to two days a week. APCs Mr. Cook, who came to trauma practice also provide care in the outpatient setting by Ms. Darves is an independent healthcare writer based in at Carolinas via a stint in a busy emergency seeing patients in follow-up clinic. the Seattle area and editor of Surgery PA Market Watch.

03 PERSPECTIVES Pursuing Optimal Team Practice: Q&A with AAPA’s Gail Curtis, MPAS, PA-C

In its efforts to promote practice with PAs. The policy also calls for laws What’s happened to date with this initiative, greater flexibility nationally authorizing PAs to be directly reimbursed by all and what are the next steps? in how physician assistants public and private insurers. State laws determine PA practice, so each (PAs) practice to better The PA profession celebrated its 50th state PA chapter will decide how and when to reflect the realities of the anniversary last year. But since its inception, advocate OTP. Since the policy was adopted, current health services healthcare has continued to evolve. AAPA is more than 20 states have become active on delivery environment, the American Association pursuing these changes because many of the OTP in some way. For some, that means they’ve of Physician Assistants is promoting a new oversight provisions included in early PA state laws formed task forces, surveyed members, reached model called Optimal Team Practice (OTP). to assure quality are antiquated and unnecessary. out to stakeholders, educated members, or AAPA President L. Gail Curtis, MPAS, PA-C, who OTP aims to enable PAs to practice at the top of published articles about the new policy. Half of chairs the Department of PA Studies at Wake their experience and education, which is what’s these 20 states are planning to pursue elements Forest University School of Medicine, talks best for patients and their physician colleagues. of OTP in legislation in 2019. about the rationale for OTP and what it might For example, as more physicians and PAs are mean for surgical PAs. practicing in groups, the requirement for PAs to have an agreement with a specific physician If OTP moves forward nationally, what might is increasingly difficult to manage. It also puts it mean for practicing PAs—and surgical PAs What is OTP and why is AAPA pursuing it? all providers involved at risk of disciplinary in particular? Optimal Team Practice is a new policy adopted action for administrative infractions that are We anticipate that the role of PAs— by AAPA in 2017 that calls for laws and regulations unrelated to patient care or outcomes. and specifically the role of PAs in surgical that emphasize PAs’ commitment to team The pursuit of OTP does not mean PAs want practices—will remain unchanged. However, practice; and authorize PAs to practice without independent practice. PAs value a sustained there are a few ways that all PAs—including an agreement with a specific physician—enabling partnership with physicians, have great respect surgical PAs—might benefit from more practice-level decisions about collaboration. OTP for the depth of physician training, and rely on modernized PA-practice laws. regulations would enable creation of separate the PA-physician team in clinical practice. This is First, it will help level the playing field with majority-PA boards to regulate PAs or give that especially true in surgery, where the role of the nurse practitioners. In a 2017 survey, 45% of authority to healing arts or medical boards that surgeon and others involved in caring for patients, PAs said they have personally experienced NPs have as members both PAs and physicians who like PAs, are well-defined and profession-specific. being hired over PAs due to the administrative continued on next page

SURGICAL PA JOBS

Farmington, NM: Hospital Employed-General Surgery Greenville, NC: Hospital Employed: Orthopedic Trauma Surgery Reno, NV: Private Practice- Fresno, CA: Priva-demic-Neurosurgery Pinehurst, NC: Hospital Employed: Neurosurgery Greenville, NC: Hospital Employed-Functional Neurosurgery San Antonio, TX: Academic-Neuro-ICU Las Vegas, NV: Private Practice-Neurosurgery Long Island, NY: Private Practice-Neurosurgery Salina, KS: Hospital Employed-Orthopedic Surgery Raleigh, NC: Academic-Neurosurgery Trenton, NJ: Hospital Employed-Lead PA/ NP Job for Neuro-ICU Greenville, NC: Hospital Employed: Trauma Surgery Greenville, NC: Hospital Employed: Macon, GA: Private Practice-Neurosurgery Reno, NV: Private Practice-PM&R position Farmington, NM: Hospital Employed-Neurosurgery

04 VOLUME 1 NUMBER 4 JULY/AUGUST 2018

Communicating After the First Interview: Timeliness, Professionalism Key By Katie Cole

You’ve narrowed down The practice will almost always require will work together to make the ultimate your options and identified references from you, either the names of three hiring decision. This process can take time. a position that fits what surgeons or other advanced practice clinicians Checking in weekly if you haven’t received you’re looking for, and (APCs) you have personally worked with, or any developments, or after the date they you’ve met the team at alternatively, letters of reference from current mentioned that interviews would conclude, the practice. Regardless of or past employers. It is good to have these on would be suitable depending on the timeline whether you have interest in moving forward hand before you go to the interview. If the topic for filling the position. One good way to check with this practice opportunity, what is your came up during your visit, you might consider in if you haven’t heard anything for more than a next step? sending those reference letters along with your week is to simply ask when the practice needs If this interview is a serious contender for thank-you email if you didn’t provide them then. to fill the position and if they have concluded your new job opportunity, communication If the hospital or practice provided any other interviews. is key in moving things forward. An emailed paperwork that you need to complete, fill this If, after you leave the interview, you feel the thank you letter is the ideal way to show you in and return it quickly. Sometimes a hospital practice wouldn’t be a good fit for you, it is appreciate the time the practice took to meet requires pre-screening paperwork to be still important to send a thank-you email and with you. It is sufficient to write the email to completed prior to generating an offer letter. to maintain a professional relationship with the main contact person you worked with who If you haven’t received feedback from the individuals you met. There are many positions initiated the interview, but you might also recruiter or practice within a week of your for surgery PAs, of course, but keep in mind that choose to include the others you met during interview, checking in would be appropriate. healthcare environment is still a small world— the site visit as well. You don’t want to pressure them, but at the you never know when you might encounter A single email usually suffices, as opposed same time, it’s also important to reinforce your or even work with someone you met on that to writing separate emails to everyone interest in the opportunity. It can be a fine line interview. Being professional, courteous, and you met. One exception might be if there determining how often to get in touch, but you receptive will help ensure that you find the ideal was a surgeon you had a particularly good should have a better idea of what’s appropriate position while also laying the groundwork for exchange with and that surgeon is the person if they respond to your first follow-up inquiry. making connections for future opportunities. you would ultimately be working for if you More often than not, there are other took the job. That merits an individualized interviews scheduled, and usually, multiple Ms. Cole is a Denver resident and publisher of Surgery thank-you email. individuals in both administration and surgery PA Market Watch and Neurosurgery Market Watch.

Perspectives (continued from Page 4) burdens imposed on employers and physicians or which charts must be co-signed. Those and physicians who work with PAs as members requiring that PAs have an agreement with a decisions should be made at the practice level of a medical or healing arts board—this should specific physician. As OTP starts to take hold in where the care is being provided. be determined on a state-by-state basis. Some states, this will be less of a challenge for PAs. Third, PAs will have more meaningful input states already have PA boards, but in most Second, it will strengthen healthcare teams into the regulation of their profession. PAs states, PAs are regulated by the medical boards. by reducing administrative burdens and want what physicians and nurses already have: At its core, OTP is about improving patient allowing them to practice more efficiently. regulatory boards that have current knowledge access and removing barriers so that PAs State laws should not dictate to physicians of their profession. Whether that requires a can provide high-quality care as members of how many PAs they may collaborate with separate PA board—or just the addition of PAs medical and surgical teams.

05 LEGAL CORNER Liability Risks for PAs: Oversight, Identification and Charting Are Key Areas By Bonnie Darves

In this new column, current regulations and is willing to provide a PA, “Can you just finish up for me?” Even in Surgery PA Market Watch a detailed explanation of how oversight is the interest of saving time, PAs should never speaks with health lawyers handled in the clinical setting. enter information in a chart under anyone about legal issues affecting physician assistants and other advanced practice “PAs should ensure that everything they do in the chart is under Michael clinicians (APCs). This Sacopulos, JD article, the first in a their name, not someone else’s, and that there’s no possibility two-part series, features Michael Sacopulos, JD, a partner in the Terre Haute, Ind., law that anyone’s work will be misconstrued as theirs.” firm Sacopulos, Johnson & Sacopulos who specializes in physician and provider medical malpractice liability and associated legal issues. Identification. This might sound basic— else’s password to comply with a request or He discusses basic issues that PAs starting out that PAs should always make their position avoid the hassle of logging out and logging or contemplating a move should understand and role clear to patients and their families— back in again. about the liability environment. but it doesn’t always happen. The risk is At a minimum, PAs should ensure that As physician assistants (PAs) start exploring that PAs might be misidentified, through everything they do in the chart is under practice opportunities or accept a new no fault of their own, as physicians, and their password, not someone else’s, and position, what are the chief issues they later be targeted as having misrepresented that there’s no possibility that anyone else’s should keep in mind to mitigate potential himself (even if that’s not the case) or work will be misconstrued as theirs. EHR malpractice and related risks? potentially blamed for a faulty care plan or a systems produce an audit trail by date, time, Oversight. Physician oversight requirements complication of care. and password. These trails can be pulled and arrangements is a big one. You should The way to mitigate this risk in the hospital and audited anytime by risk managers or, thoroughly review and understand the setting is pretty simple: wear a badge that potentially, by plaintiff’s attorneys, so the last regulations in the state where you’ll practice in clearly identifies who you are. Take the time to thing you want is to be deemed responsible terms of not only the ratio of physician to PA introduce yourself as the physician assistant for someone else’s work. but also what constitutes adequate oversight. who works with Dr. X or X surgical group. Cyber-security coverage. With ransomware There’s considerable variation among states, and Studies have found that hospitalized patients and other cyber-attacks on the rise in even though there’s movement toward making are not good at knowing or remembering healthcare—such events have increased oversight regulations less restrictive generally, who their healthcare providers are, so PAs dramatically in just the last year—PAs should PAs need to familiarize themselves with the can help reduce confusion about roles and ensure that there’s coverage in place to protect current laws of the state where they practice. responsibilities by identifying themselves and them or consider purchasing it themselves. For example, what does the definition of their role within the care team. This is a serious emerging risk area for all “oversight” actually mean? Must the overseeing Charting. This is another area where healthcare providers and clinicians, should physician be physically present in the facility? risks can arise for PAs. If information gets patients’ information be released after a How available must the physician be to answer entered into a patient’s chart and there’s any system is hacked. What we’re seeing is that the clinical questions or address concerns that a ambiguity about who entered what or who majority of organizations do not have sufficient PA might have about a patient’s care? Once ordered what, trouble may follow. There are coverage for that. you understand this, make sure that any facility situations, for example, when a patient’s chart where you’re considering practicing adheres to is open and the physician in a hurry might ask

06 VOLUME 1 NUMBER 4 JULY/AUGUST 2018 FEATURED OPPORTUNITY Neurosurgery Physician Assistant or Nurse Practitioner Job in Texas

A department of neurosurgery in San APC. The hours will be general office hours with The neurosurgery department has 17-plus Antonio is seeking a neurosurgery physician no night or call obligations. The incoming APC neurosurgery residents, so the incoming APC assistant or nurse practitioner to join its will have a clinic-focused practice, and there is will be mostly clinically based. department. The incoming advanced practice limited OR time, likely just once a week. Knowledge and experience in neurosurgery clinician will provide consultation and advice Working in an academic center, the and/or neuro-critical care is preferred, as well to patients and support staff. The department incoming PA or NP will be exposed to all as knowledge of health education focused in will consider both PAs and NPs, and prefers at types of neurosurgery cases, including spine, neuroscience. The department will provide a least one year of experience. cranial, functional and neuro-. The competitive compensation package including Neurosurgery residents take call, so there department’s neurosurgery PAs/NPs typically salary, a benefit package second to none, PTO, will be no OR or in-house call for the incoming practice primarily in and on the floor. relocation and retirement.

SURGERY PA EVENTS

23rd Annual Challenges in Critical Care Skin, Bones, Hearts, & Private Parts 2018 Fundamental Critical Care Support o August 24 o September 11-14 o October 11-12 Hershey, Pennsylvania Orlando, Florida Lake Buena Vista, Florida

2018 UCHealth Trauma, Critical Care Advanced Practice Providers 2018 AASPA CME Meeting & Surgical Update and EMS Symposium Oncology Summit o October 11-14 o o August 24-25 September 14-15 Orlando, Florida Colorado Springs, Colorado Greenwood Village, Colorado AASPA Winter Weekend 2019 2018: Restoring Emergency and Trauma o January 19, 2019 Neurological Function Outreach Symposium Orlando, Florida o September 5-6 o September 28 Cleveland, Ohio Scottsbluff, Nebraska APACVS 38th Annual Meeting o Association of Neurosurgical April 4-7, 2019 Arthroplasty for the Modern Surgeon: Miami, Florida Hip, Knee and Health Innovation Physician Assistants Technology 2018 o October 7 AAPA 2019 o September 6-7 Houston, Texas o Sonoma, California May 18-22, 2019 Denver, Colorado

CONTRIBUTIONS WELCOMED! Help shape Surgery PA Market Watch by contributing opinion articles that address issues affecting surgical APC practice or that provide guidance on career matters. We also seek ideas for articles on topics of potential interest to our readers. To discuss an idea or to propose a coverage topic, please contact Surgery PA Market Watch editor Bonnie Darves at 425-822-7409 or [email protected] or publisher Katie Cole at 303-832-1866 or [email protected].

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