PHYSICIAN/PA TEAM: TOBY GRAY PA-C AND DR. MARTIN ROCHE
By Toby Gray PA-C

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When I first began my surgical career, the unknown of the operating room was unnerving. Fortunately, my first encounter with a surgeon as a Certified Physician Assistant was with Martin Roche, Chief of Orthopaedics at Holy Cross Hospital. Dr. Roche, who I still work with today, is the ideal surgeon for a PA to be teamed up with. At the beginning of our relationship, he was demanding but patient. I was either going to keep up and challenge him or I was going to be left behind. He did not want a PA that was going to sit back and hold retractors. He has been one of the guiding influences for me in setting up Surgical Assist, Inc. today.

My first job was with Holy Cross Hospital and I was the first physician assistant they hired. Holy Cross was not able to collect very well for my services and I figured a way to create an independent company, giving birth to Surgical Assist, Inc. Today, Surgical Assist, employs 10 physician assistants within Surgical Assist and all of our subsidiary companies.

Dr. Roche challenged me to get quicker in suturing, to understand the complexities of a total joint replacement and to understand reimbursement issues for the physician assistant. In my beginning years he was always telling me, “you need to know everything about reimbursement and about your rules and regulations”.

My relationship with Dr. Roche has allowed him to be able to be more efficient within the operating room. He has grown his practice from doing 1 or 2 cases a day to performing up to 12 cases a day. Our total joint cases are well synchronized surgeries, consisting of a well trained team of Surgeon, PA, scrub technician, and circulating nurse. Over the years we have taken on new procedures from unilateral knee replacements to cartilage transplants to recently being the first in the U.S. doing robotic assisted unilateral knee replacements. We dove into these new procedures together and, with time, we have grown to be very efficient in all of these new procedures. One key to our success is after each case, Dr. Roche and I will sit down and discuss what was good about the case and also what we would do differently. These issues were fresh on our minds and enabled us to make a plan the next time for greater success.

I have clearly understood my role as a physician assistant from the beginning. Many PAs make the mistake of trying to be or thinking they are the primary surgeon. From the beginning, I have tried to be as humble as I can be and a facilitator to the surgeon. I feel this attitude has allowed me to assume greater responsibilities. Today, Dr. Roche depends on me to recognize any potential problems from my side of the table, ie if the knee is flexed and the tibia is rotated properly. Everyday working in the operating room is fun and I have a strong sense of purpose. Being a physician assistant has been very fulfilling.