Tag: surgical operations

Keith Purino, PA-C: Finding Balance and Growth at AP Health

Posted on April 17, 2025

Keith Purino, PA-C, didn’t take the traditional path to a career in healthcare. With a background in economics and political science, he initially planned to attend law school. But during his senior year of college, everything changed after meeting some athletic trainers through his involvement in sports.

“I liked that they were working with athletes. It was medicine, and I had always been strong in science,” Keith recalls. That interest led him to Temple University in Philadelphia, where he earned a master’s degree in athletic training and worked in the field for almost five years.

While Keith enjoyed his work as a trainer, he began exploring other career paths in healthcare. “The hours were long, and the pay wasn’t great. I started looking into other options, and that’s when someone mentioned PA school. I had no idea what a Physician Assistant was at that point. It was the mid-1990s, and the profession was still relatively new.”

After shadowing a PA in his workplace, Keith applied to PA school “really on a whim” and was accepted into a program in Nashville. He initially thought he would go right back into orthopedics after graduation because of his background in athletic training. However, during his clinical rotations he discovered a passion for family practice and emergency medicine. He worked in those areas for nearly seven years before finding his way back to orthopedics.

A New Opportunity with AP Health

After spending 12 years as a PA in orthopedic practices, Keith was beginning to feel the heavy demands of the job. “I spent three days in clinic and two in the OR each week,” he explains. “Plus, I worked weekends and holidays, had call, did rounds, etc. I had two kids in middle school and felt like all my time was being consumed by my job. I was burned out.”

That’s when Keith was approached about joining AP Health in 2019. “They offered me a surgery-focused role. Once they explained the AP Health business model, I realized it would provide a better work-life balance, so I signed up. That was five years ago.”

Growth and Development at AP Health

Coming from a clinical background where he managed patient care from initial consultation through surgery and recovery, Keith had to adjust to focusing solely on the operating room. He also learned new specialties.

“As a seasoned PA, I was already well-versed in surgery and orthopedics,” he explains. “But joining AP Health was a big change. I went from working closely with just a few orthopedic surgeons, to collaborating with a much larger team of physicians across a variety of specialties. My first year was focused on learning neuro-spine, which really expanded my skill set.”

When Keith joined AP Health’s Nashville team, he was the only PA among a small group of surgical assistants. Since then, he’s witnessed—and helped drive—tremendous growth. “We’ve gone from about 8-10 providers with me being the only PA, to 25 providers with probably three-quarters of those being PAs,” he explains.

Keith’s surgical experience, leadership qualities, and strong interpersonal skills quickly set him apart, paving the way for his growth within the company. Last year, he was asked to assist the recruitment team with helping to interview new providers in addition to him working in the OR.

“We’re now staffing surgeries at more than a dozen facilities, with more growth ahead,” Keith explains. “We’ve been fortunate to build a deep bench of providers to accommodate that growth.”

Recently, Keith was named Director of Clinical Services for the Nashville team, a promotion that takes him out the OR.

“AP Health values promoting from within,” Keith says. “Having a clinical background and understanding what the OR demands of your providers gives me a unique perspective as a team leader. I feel fortunate to be given the opportunity to step into this role.”

Finding the Right Balance

In his new position, Keith oversees a growing team of providers, helps with scheduling, meets with physicians and facilities to understand their needs, and ensures that AP Health maintains its high standards of care.

While he occasionally misses direct patient care and the hands-on aspects of surgery, Keith values the company’s approach to work-life balance and its focus on matching the right providers with the right physicians.

“While managing people is new to me, I like interacting with our providers and making sure we are creating a good environment for them,” he says. “I know it’s been a good one for me.”

AP Health and TexAssist Announce Strategic Partnership to Form AP of Dallas, a Leading Surgical Assist Services Provider

Posted on October 21, 2024

Nashville, TN (October 21st, 2024) – New Joint Venture to Deliver Superior Advanced Practice Providers (APP) and Surgical Assistants Across the Dallas-Fort Worth Area

AP Health and TexAssist are pleased to announce their partnership to form a joint venture, AP of Dallas, establishing a market-leading outsourced clinical services platform. This strategic alliance brings together the expertise of both organizations, enabling them to provide highly experienced and top-quality Advanced Practice Providers (APP) and Surgical First Assistants to hospitals and surgical facilities throughout the market.

By combining their clinical excellence, operational strengths, and talented healthcare professionals, AP of Dallas will offer partner hospitals and surgery centers optimized patient outcomes, enhanced operational efficiencies, and cost-effective solutions. The collaboration also sets the stage for the continued delivery of high-quality care while addressing the evolving needs of the healthcare industry.

“This is a milestone moment for AP Health,” said J. Toby Gray, CEO of AP Health. “We have long admired TexAssist’s commitment to clinical excellence, and our shared focus on driving superior patient outcomes, improving efficiencies, and delivering value to all stakeholders makes this partnership a natural fit. By forming AP of Dallas, we will continue to advance health and well-being across the Dallas-Fort Worth community, offering even more robust support to our partner facilities and practitioners.”

AP of Dallas will be majority-owned by AP Health, with both companies maintaining their leadership teams. There will be no changes to the team of practitioners transitioning from TexAssist to the new entity.

C.J. Brock, CEO of TexAssist, added, “We’re extremely proud of the work we have done at TexAssist, and we know that by joining forces with AP Health, we can achieve even more. Together, we are poised to expand access to our exemplary services and continue addressing some of the most critical healthcare challenges in this market, including growing our provider base.”

About AP Health:

AP Health is a national leader in providing healthcare solutions, specializing in the recruitment and placement of Advanced Practice Providers (APPs) and clinical talent. With a focus on quality care, AP Health partners with hospitals and surgical facilities to offer innovative staffing solutions that enhance patient outcomes, reduce costs, and ensure operational efficiency. The company’s commitment to excellence in care delivery and service makes it a trusted partner in the healthcare sector. Learn more at AP Health.

About TexAssist:

TexAssist is a premier provider of surgical assisting services, offering highly skilled Surgical Assistants to healthcare facilities throughout Texas. With a focus on clinical excellence, TexAssist delivers customized solutions that improve surgical efficiency and patient care. The company has built a reputation for providing experienced practitioners who work seamlessly with surgeons and healthcare teams to enhance operational outcomes. Learn more at TexAssist.

Surgical Assistants: Unsung Heroes of the OR

By Billy Williams, SA-C

Posted on November 27, 2023

With nearly three decades of experience in the operating room, I’ve witnessed firsthand what it takes to make surgeries successful. While a skilled surgeon is crucial, surgical assistants play a pivotal role in orchestrating surgeries, from preparing the operating room to closing incisions, all while maintaining effective communication among the surgical team.

Surgical assistants arrive early to help set up the room for each procedure, organize instrumentation, collaborate with nurses to prepare for cases, and coordinate with surgical techs, anesthesiologists, and other essential staff. Their deep understanding of the surgeon’s preferences for equipment and procedures allows the operation to proceed efficiently while closely monitoring the patient’s well-being.

Surgery is a collaborative effort, and while the surgeon takes the lead, it’s the surgical assistant who helps the surgeon facilitate everything. Their role is to make sure everyone is aligned and working for the best possible outcome for the patient.

The Surgeon Relationship is Essential for Success

To orchestrate a successful surgery, the surgical assistant must not only must understand the technical aspects of the operation but also cultivate a strong working relationship with the surgeon. This involves adapting to the surgeon’s style, knowing their preferences for instruments and technology, and anticipating their needs throughout the procedure. In many cases, it means having the suturing skills to close an incision as well as a surgeon could. This is important because the patient may not remember the complexities of the surgery, but they will likely see the incision for some time to come. As a result, the surgical assistant must earn the trust of the surgeon to handle those duties.

Technological Support Improves Surgical Operations

At AP Health, our company collaborates with over 1,000 surgeons across numerous surgical facilities. and Wwe take great pride in the relationships we’ve built with them. We leverage technology to support these relationships, using our LogistiSx platform to schedule surgeons’ preferred surgical assistants for more than 95% of the cases we staff. Additionally, we’ve developed a Surgeon Relationship Management program within our platform which houses a wealth of information about each surgeon, including details about procedures, preferred technology vendors and equipment and surgical techniques. Having this technological support instills confidence in our providers when working with surgeons and brings a sense of calm when interacting with other team members.

Working as a surgical assistant is a high-pressure job, but it is also incredibly rewarding. Many of the surgeries we perform involve spinal and orthopedic procedures, which enable patients to return to activities they once thought were beyond reach, free from pain. Knowing that we play a pivotal role in orchestrating these life-changing surgeries is immensely gratifying, and I wouldn’t trade it for anything in the world.

Flexibility Key to Surgical Operations, Practitioner Retention

By Sarah Calvey PA-C, MMS

Posted on September 15, 2020

Surgical programs typically place a high priority on stability of practitioner staff, especially those with highly specialized procedures. This often leads facilities to hire full-time practitioners to support their programs. However, this reliance on in-house staff often leads to practitioner burnout and high turnover, resulting in less stability of staffing operations. I know this because I have seen it firsthand.

In September 2018, the cardiothoracic surgery team at Holy Cross Health in Ft. Lauderdale, Fla., experienced a staffing challenge. Its two full-time Physician Assistants (PAs) were leaving at the same time and turnover had been an issue with these positions for a while – the demanding schedule of being on call every other night and every other weekend often led to employee exhaustion.

Holy Cross Health called on AP Health since we were already supporting other areas of the hospital. With our deep bench of PAs and our focus on recruiting, we were able to build a team of five cardiac practitioners. Our PAs know the surgeons’ preferences both in the operating room and in the ICU. We also have good flexibility and variety in our work life. These factors have eliminated turnover of surgery staff, which has meant more stability and continuity for the cardiac surgeons.

Pandemic Intensifies Need for Flexibility in Staffing Operations

While the importance of being nimble in surgical staffing has been increasing for years, COVID-19 has intensified that need. At Holy Cross, like many hospitals across the country, non-essential surgeries were stopped in April, and ICUs were converted into COVID ICUs. For many hospitals, that meant furloughing full-time staff in different departments while also ramping up staffing for treating COVID-19 patients.

When the first wave of COVID-19 patients began entering its facility, Holy Cross

administration approached us about helping in the ICU. Because our advanced practice providers were already trained in critical care, we were able to move our staff from other areas of the hospital. In doing so we were able to support the hospital during nights and weekends in the ICU for about two months until COVID patient volumes declined.

Had AP Health not provided advanced practice providers to assist in the care of COVID-19 patients, Holy Cross would have needed to bring in many more MDs at much higher  costs. We were able to provide the hospital with the critical care staff it needed, while also saving them a significant amount of money.

As COVID progressed throughout summer, we continued to adapt to the changing needs of the hospital and its patient volumes. Three of us have helped the infectious disease doctors with a census of 50-60 COVID patients, while others moved to support other areas of the hospital as elective surgeries and other normal duties returned.

As a 15-year PA, I love the variety and flexibility that AP Health provides. I can continue to learn and advance my career while maintaining a good quality of life. I’ve been able to branch out from orthopedics into general surgery, labor and delivery with C-sections and now, cardiac surgery. And, with two young children, I also have the ability to flex my schedule easily because we have so much coverage. And I can do so with the peace of mind of knowing that we’re providing the hospital with the surgical support to provide the best possible care for their patients.

Sarah Calvey is director of Clinical Operations at AP Health.