title: Physician Assistants Improve Efficiency and Decrease Costs in Outpatient Oral and Maxillofacial Surgery.
abstract: OBJECTIVE
  To determine the effects on time, cost, and complication rates of integrating physician assistants (PAs) into the procedural components of an outpatient oral and maxillofacial surgery practice.
  
  
  METHODS
  This is a prospective cohort study of patients from the Department of Plastic and Oral Surgery at Boston Children's Hospital who underwent removal of 4 impacted third molars with intravenous sedation in our outpatient facility. Patients were separated into the "no PA group" and PA group. Process maps were created to capture all activities from room preparation to patient discharge, and all activities were timed for each case. A time-driven activity-based costing method was used to calculate the average times and costs from the provider's perspective for each group. Complication rates were calculated during the periods for both groups. Descriptive statistics were calculated, and significance was set at P < .05.
  
  
  RESULTS
  The total process time did not differ significantly between groups, but the average total procedure cost decreased by $75.08 after the introduction of PAs (P < .001). The time that the oral and maxillofacial surgeon was directly involved in the procedure decreased by an average of 19.2 minutes after the introduction of PAs (P < .001). No significant differences in postoperative complications were found.
  
  
  CONCLUSIONS
  The addition of PAs into the procedural components of an outpatient oral and maxillofacial surgery practice resulted in decreased costs whereas complication rates remained constant. The increased availability of the oral and maxillofacial surgeon after the incorporation of PAs allows for more patients to be seen during a clinic session, which has the potential to further increase efficiency and revenue.
authors.affiliation: Instructor, Harvard School of Dental Medicine; Attending Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. Electronic address: Cory.Resnick@childrens.harvard.edu.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Resnick
authors.affiliation: Research Data Manager, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Daniels
authors.affiliation: Quality Improvement Specialist, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Flath-Sporn
authors.affiliation: Research Study Assistant, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Doyle
authors.affiliation: Department Director, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Heald
authors.affiliation: Associate Professor, Harvard School of Dental Medicine; Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Padwa
mesh_terms: D001900:Boston / Q000453:epidemiology; D003363:Cost Control; D004526:Efficiency; D005260:Female; D006801:Humans; D008297:Male; D008964:Molar, Third / Q000601:surgery*; D061646:Operative Time; D019647:Oral Surgical Procedures / Q000191:economics*; D010823:Physician Assistants / Q000191:economics*; D011183:Postoperative Complications / Q000453:epidemiology; D024382:Professional Role; D011446:Prospective Studies; D058996:Quality Improvement; D012456:Salaries and Fringe Benefits / Q000191:economics; D014095:Tooth, Impacted / Q000601:surgery*