Thursday, May 05, 2005

Trauma Call With a Twist

Dr. Bard Parker posts an excellent introduction to the idea of "emergency surgeons" today. Basically, this idea comes in response to a few simple realities:

  • Trauma care is poorly reimbursed and time consuming
  • Trauma care is a field in which general surgeons provide evaluation and care for patients who need primarily orthopedic and neurosurgical care
  • As a result, trauma surgeons don't operate very much
  • Sooooo, why not have the trauma surgeons also provide emergent surgical care for the hospital?
The difficulties with trauma call are no less true here; my group does provide all of the trauma call coverage here, but our primary practice is general/vascular surgery. The idea of increasing a trauma surgeon's income and operating experience by adding "emergent surgery" to his responsibilities is hardly a new one. Trauma surgery leaders, such as Dr. Ken Mattox, have for years urged us to pin hips, do emergent craniotomies, etc. I'm afraid that it would be the unusual surgical resident who would choose to pursue that type of practice. I know that if I was told at the beginning of my residency I would have to spend 5 years training to be a general surgeon, only to rarely operate as a trauma surgeon, I would have re-entered the match. I went into surgery because I like to operate; I know of no surgeon who feels differently. To be additionally offered the opportunity to provide all of the emergent surgical care for the hospital would be a bitter pill to swallow --- watching other surgeons doing nice, elective cases in the daytime (which will on average pay better and involve a healthier population) while they never have to take ER call......wait a minute! I'd want that job!

The emergency surgeon idea is certainly the flavor of the day, but I don't think it will stand up to the realities of practice outside training programs and a few urban centers. In the world outside of academia, I still believe the best trauma surgeons are those who operate with great frequency and are comfortable caring for the sickest patients in the hospital.