Trauma Surgery lifestyle?

Q-Optics, surgical ergonomics - redefined
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Blitz2006

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Hey guys,

Final year med student here (IMG from UK), planning to apply for Gen Surg residency next year, doing some electives this summer.

Anyways, I'm keen on a career in Trauma Surg, especially after I did a 2 week elective last winter in a major trauma center, quite enjoyed it.

Few questions about the career choice however,

1) Relative to other sub-specialties in Gen Surg, how are the hours? 70 hour weeks normal? Is it mainly shift work, and if it is, are they 12 hour shifts usually?
Also, if I choose to work only 36 hours/week, is this possible, or am I dreaming?
2) Days off a week? I hear that most Trauma Guys do q4 In-House...true?
3) Whats the average pay? I'm hearing in Major Urban areas, 300K...correct?
4) Average time off a year? 4 weeks?
5) Do I have to do both Trauma & ICU for fellowship, or can I just do Trauma if I want? Not sure if ICU work is up my alley, I just love to operate and fix.
6) I'm hearing stuff that there is not much operative work anymore in trauma...true? If so, I can still do a lot of bread and butter Gen Surg stuff on the side right? (Lap Appys, choleys, Hernia repairs, etc)?
7) Current Job market (I know things will change in 7-8 years), but how is it now? Jobs saturated in Top 20 Urban Areas?
8) Relative competitiveness of Trauma Surg fellowship? Is heavy research/publications crucial (I hear it is not...but correct me if I'm wrong)

Any other feedback would be appreciated about the specialty, thanks!
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1) Relative to other sub-specialties in Gen Surg, how are the hours? 70 hour weeks normal? Is it mainly shift work, and if it is, are they 12 hour shifts usually?

-Depends on the trauma group. 60-70hrs/wk I'm guessing is pretty average. It is shift work. Usually call is 24 hrs.

Also, if I choose to work only 36 hours/week, is this possible, or am I dreaming?
Only if you've been doing the job for 30-40 years.

2) Days off a week? I hear that most Trauma Guys do q4 In-House...true?
Depends on the group. I'd say q5days is pretty average.

3) Whats the average pay? I'm hearing in Major Urban areas, 300K...correct?
Very variable. I've heard of starting salaries in the 400K's

4) Average time off a year? 4 weeks?
Probably start off at 2 wks

5) Do I have to do both Trauma & ICU for fellowship, or can I just do Trauma if I want? Not sure if ICU work is up my alley, I just love to operate and fix.

There aren't many trauma fellowships. Most are Critical Care. You can do trauma without a fellowship. Most trauma jobs will want you to do critical care. If you aren't boarded in critical care, you aren't as marketable.

6) I'm hearing stuff that there is not much operative work anymore in trauma...true? If so, I can still do a lot of bread and butter Gen Surg stuff on the side right? (Lap Appys, choleys, Hernia repairs, etc)?
Trauma is very non-operative. You can do elective general surgery on the side at most institutions.

7) Current Job market (I know things will change in 7-8 years), but how is it now? Jobs saturated in Top 20 Urban Areas?

Very good job market currently.

8) Relative competitiveness of Trauma Surg fellowship? Is heavy research/publications crucial (I hear it is not...but correct me if I'm wrong)

Critical Care is not a very competitive fellowship
 
Hey Ceiling,

Very helpful, thx.

So looks like I should do Critcal Care fellowship as well eh? I'm using this site as a source:

http://www.trauma.org/index.php/resources/fellowships/C65/

and it appears there are a few trauma only fellowships...but I guess I should follow your advice and look into Critical care stuff as well.

The only thing that worries me is that Trauma is very 'non-operative'...hmmm.

I love to operate and I hate clinics/18 hour resections (hence me shying away from stuff like colorectal/surg onc).

I always thought Trauma would be a lot of laparotomies (GSW, stabbings, splenic ruptures, perforations, peritonitis, etc.)...
 
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Blitz2006 said:
Hey Ceiling,

Very helpful, thx.

So looks like I should do Critcal Care fellowship as well eh? I'm using this site as a source:

http://www.trauma.org/index.php/resources/fellowships/C65/

and it appears there are a few trauma only fellowships...but I guess I should follow your advice and look into Critical care stuff as well.

The only thing that worries me is that Trauma is very 'non-operative'...hmmm.

I love to operate and I hate clinics/18 hour resections (hence me shying away from stuff like colorectal/surg onc).

I always thought Trauma would be a lot of laparotomies (GSW, stabbings, splenic ruptures, perforations, peritonitis, etc.)...
Click to expand...

I would focus on getting into residency and experience trauma before you settle on it as a career choice. Typically, trauma is considered non-operative because there is quite a lot of blunt/non-penetrating trauma that does not go to the operating room. Even at a big inner-city Level I center, even at a big name place, the majority of trauma is still non-op. Additionally, the trauma service/attending will frequently be the primary admit for ortho/neuro trauma, even if the trauma service itself does not operate on them.

Typically, "trauma" as a specialty is pretty much indistinguishable from "critical care." In addition, some places have moved to an Acute Care/Trauma model with the same group covering all Emergent General Surgery (more operative) and Trauma. Frequently the schedule will rotate which partner is covering which service; at my particular hospital/program (Level I), the on-call attending covers all EGS and Trauma that comes in. At other institutions, they will divide it out.

Few people (in surgery) love clinic... but there is always clinic. My particular program doesn't have a trauma-specific clinic but trauma clinic (where it exists) can be particularly painful due to the high rate of no-shows/lost-to-follow-up/show-up after being missing for months with a terrible wound infection from drains they never had taken out, etc. All my attendings do a couple half days of clinic a week at least.

Again, you need to experience trauma as a resident (ie for more than 2 weeks as a student) before you mentally commit yourself. Based on your post, I don't think you were able to get a clear idea of what Trauma/Critical Care really is.

As an IMG, your first battle will be to secure a residency. Worry about your fellowship after you've landed a categorical spot.
 
Hey Ceiling,

Very helpful, thx.

So looks like I should do Critcal Care fellowship as well eh? I'm using this site as a source:

http://www.trauma.org/index.php/reso...llowships/C65/

and it appears there are a few trauma only fellowships...but I guess I should follow your advice and look into Critical care stuff as well.

The only thing that worries me is that Trauma is very 'non-operative'...hmmm.

I love to operate and I hate clinics/18 hour resections (hence me shying away from stuff like colorectal/surg onc).

I always thought Trauma would be a lot of laparotomies (GSW, stabbings, splenic ruptures, perforations, peritonitis, etc.)...


No problem. I do agree with LucidSplash that you shouldn't completely focus on Trauma. A lot of it is babysitting pts for other services (Ortho, ENT, Neuro surg, etc) and a lot of social work. There is a lot of medicine (eg. Critical Care).

Most of the operating is Trach & PEGs, Abdominal washouts, skin Grafts. There are the occasional interesting surgeries (Clamshell Thoracotomies, Splenectomies, etc.), but they aren't a regular occurrence.

Many of the residents who rotate on the service hate it. However, I know more than a few who go into the field. So, don't let me completely discourage you from the field.

Right now, I'd focus on getting a categorical general surgery position and then see if you like trauma during your residency.
 
Hey,

Thx LucidSplash, informative as well.

Yeah, I'm a British-Canadian dual citizen, so I'm planning on applying to Canada for Gen Surg. I actually had 3 interviews in Canada (and there are only 4 schools in Canada that take IMGs) this past year for Gen Surg, but I didn't match (cause I didn't do my electives in Canada). So I have 8 weeks of electives in the Great White North lined up in Gen Surg, so should stand a good chance for 2013 match. I did 2 months of Gen Surg in U.S last summer, UMass and Mt. Sinai NYC, but both program directors said I need >240 on both steps and 3-5 publications to lock up a categorical spot (since I'm a Non-US citizen IMG). And I unfortunately don't have these stats. And I have no desire to entire the prelim jungle, hence me trying the Canada route for surg.

Anyways, this is why I'm starting to look into potential fellowships. But I agree with you, I'm sure as a resident I will have a better idea. But I kinda want to know what it takes to get into certain fellowships, especially if I want to go to a place like Miami Ryder or Baltimore Shock Center...
 
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Sounds good Ceiling,

So which sub-specialities allows you to operate the most?

I've done electives in:

1) Transplant
2) Colorectal
3) Surg Onc
4) Trauma/CC
5) Thoracic

Transplant was cool, very rewarding. But it just seems so repetitive...

Again, I admit I"m just a naive final year medical student, but from my experience, at least with Trauma/CC I get to spend everyday in the SICU/OR, whilst all other specialities is only 1-2 days a week max in the OR...
 
celling said:
1) Relative to other sub-specialties in Gen Surg, how are the hours? 70 hour weeks normal? Is it mainly shift work, and if it is, are they 12 hour shifts usually?

-Depends on the trauma group. 60-70hrs/wk I'm guessing is pretty average. It is shift work. Usually call is 24 hrs.

Also, if I choose to work only 36 hours/week, is this possible, or am I dreaming?
Only if you've been doing the job for 30-40 years.
Click to expand...

This interview seems to suggest that trauma/CC is moving toward better hours and lifestyle... is this just a sales pitch or an accurate portrayal of the specialty?

http://www.youtube.com/watch?v=rZy0tsJxdbg
 
Sounds good Ceiling,

So which sub-specialities allows you to operate the most?

I've done electives in:

1) Transplant
2) Colorectal
3) Surg Onc
4) Trauma/CC
5) Thoracic

Transplant was cool, very rewarding. But it just seems so repetitive...

Again, I admit I"m just a naive final year medical student, but from my experience, at least with Trauma/CC I get to spend everyday in the SICU/OR, whilst all other specialities is only 1-2 days a week max in the OR...


Transplant is very hit or miss operatively. When it's busy, it's busy. Overall, the lifestyle sucks. The pts are very complicated and there is a lot of intensive care medicine, immunosupressive adjustments, evaluation of rejection/ atypical infections, etc.

Colorectal is very operative heavy. It's not the easiest fellowship to get into but the job market is very good, the pts aren't too complicated, and the lifestyle is pretty good.

Surg Onc is a very difficult fellowship to get. You operate a lot, but the operations are crazy complex and the pts have lots of complications (infections, fistulas, anastomotic leaks, etc.)

Trauma/ CC- See my previous post

Thoracic- I'm biased because I'm going into it, but I really like how the field is evolving. The operations overall have been increasing over the last 5 years and the job market at the same time has been getting better. The lifestyle is tough. The operations are long. The stress level is high. However, the cases are amazing.
 
This interview seems to suggest that trauma/CC is moving toward better hours and lifestyle... is this just a sales pitch or an accurate portrayal of the specialty?

I'd say that it's not the norm for the profession. You might luck out and join a big group that shares call and you only take 4 calls a month. However, this would be highly unlikely. Usually, you join a 5-6 doctor group and you are the junior attending. Therefore, you take a higher percentage of the calls. Therefore, the hours would be worse early in your career.
 
celling said:
Sounds good Ceiling,

So which sub-specialities allows you to operate the most?

I've done electives in:

1) Transplant
2) Colorectal
3) Surg Onc
4) Trauma/CC
5) Thoracic

Transplant was cool, very rewarding. But it just seems so repetitive...

Again, I admit I"m just a naive final year medical student, but from my experience, at least with Trauma/CC I get to spend everyday in the SICU/OR, whilst all other specialities is only 1-2 days a week max in the OR...


Transplant is very hit or miss operatively. When it's busy, it's busy. Overall, the lifestyle sucks. The pts are very complicated and there is a lot of intensive care medicine, immunosupressive adjustments, evaluation of rejection/ atypical infections, etc.

Colorectal is very operative heavy. It's not the easiest fellowship to get into but the job market is very good, the pts aren't too complicated, and the lifestyle is pretty good.

Surg Onc is a very difficult fellowship to get. You operate a lot, but the operations are crazy complex and the pts have lots of complications (infections, fistulas, anastomotic leaks, etc.)

Trauma/ CC- See my previous post

Thoracic- I'm biased because I'm going into it, but I really like how the field is evolving. The operations overall have been increasing over the last 5 years and the job market at the same time has been getting better. The lifestyle is tough. The operations are long. The stress level is high. However, the cases are amazing.
Click to expand...


Nice, very informative once again.

I might be PMing you in the next few months if I have any other questions.

Cheers,
 
Oh yeah, I haven't had much exposure, but your 2 cents on:

1) HPB
2) Endocrine
3) Breast

I heard Endocrine/Breast are best lifestyle...true?
 
Oh yeah, I haven't had much exposure, but your 2 cents on:

1) HPB
2) Endocrine
3) Breast

I heard Endocrine/Breast are best lifestyle...true?

NPB- Cases can be very complex. Lifestyle is better than transplant, if you are in an academic center. However, if go into provate practice, you'll probably need to do general surgery cases as well. Fellowship is easier to get than surg-onc.

Endocrine- Don't have a lot of exposure to pure endocrine surgeons. Most do a lot of general surgery and do a higher % of thyroids/parathyroids. For these guys, the lifestyle is the same as general surgeons.

Breast- Great lifestyle. Money is decent. Pt's aren't very sick. Minimal to no ICU pts. Some people who go into field tend to some general surgery on the side, but not all. Fellowships are currently competitive, but not the most competitive. However, this can change. It seems that the majority of medical students these days are going after the "good lifestyle" residencies. Therefore, Breast surgery could easily become a very competitive fellowship in the future.
 
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Definitely keep your mind open as you proceed through residency. What seems like very exciting "trauma surgery" as a med student may change when you see how non-operative trauma actually us (the vast majority of cases get done by NSGY/Ortho).
 
Buzz Me said:
Definitely keep your mind open as you proceed through residency. What seems like very exciting "trauma surgery" as a med student may change when you see how non-operative trauma actually us (the vast majority of cases get done by NSGY/Ortho).
Click to expand...

Hmmm, thx buzz me, appreciate the words of wisdom as always.

Yeah, I'm getting that vibe that trauma is quite non-operative. Bit of a shame. Its also a downer cause I'm not really into Critical Care stuff, just like to operate.

BTW, newbie question: whats the difference between acute care surgery and critical care?
 
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celling said:
Breast- Great lifestyle. Money is decent. Pt's aren't very sick. Minimal to no ICU pts. Some people who go into field tend to some general surgery on the side, but not all. Fellowships are currently competitive, but not the most competitive. However, this can change. It seems that the majority of medical students these days are going after the "good lifestyle" residencies. Therefore, Breast surgery could easily become a very competitive fellowship in the future.
Click to expand...

And the best part is that most of your colleagues don't want to work hard so it doesn't take much to be busy and successful. :laugh:

(FYI: The SSO/ASBS tells us that the vast majority of fellowship trained breast surgeons practice 100% breast and no general surgery).
 
Blitz2006 said:
Hmmm, thx buzz me, appreciate the words of wisdom as always.

Yeah, I'm getting that vibe that trauma is quite non-operative. Bit of a shame. Its also a downer cause I'm not really into Critical Care stuff, just like to operate.

BTW, newbie question: whats the difference between acute care surgery and critical care?
Click to expand...
Critical care = manage the SICU

Acute care = do general surgery, but usually with the implication that it's shift-based, hospital-based, without an outpatient practice component. You would see patients with acute cholecystitis, bowel perforations, strangulated hernias, diverticulitis, perirectal abscesses, bowel obstructions, appendicitis, etc. You would not be doing elective cases (breast, thyroid, elective hernias/GBs, etc).
 
TheProwler said:
Critical care = manage the SICU

Acute care = do general surgery, but usually with the implication that it's shift-based, hospital-based, without an outpatient practice component. You would see patients with acute cholecystitis, bowel perforations, strangulated hernias, diverticulitis, perirectal abscesses, bowel obstructions, appendicitis, etc. You would not be doing elective cases (breast, thyroid, elective hernias/GBs, etc).
Click to expand...

Thx for clarification

Acute Care Surgery sounds like my cup of tea.

So now for dumb question #2, can I purely be an "Acute Care Surgeon", and does this require having to do a Trauma & CC fellowship?
 
TheProwler said:
Critical care = manage the SICU

Acute care = do general surgery, but usually with the implication that it's shift-based, hospital-based, without an outpatient practice component. You would see patients with acute cholecystitis, bowel perforations, strangulated hernias, diverticulitis, perirectal abscesses, bowel obstructions, appendicitis, etc. You would not be doing elective cases (breast, thyroid, elective hernias/GBs, etc).
Click to expand...

Well yes, but these areas of practice are not always mutually exclusive. I'm at an institution where there is complete overlap. There are 5 surgeons in the group that cover all these areas. They rotate weekly as the rounding attending on either trauma (floor), ICU (all surgical critical care consults and all trauma ICU patients), or acute care surgery. Their arrangement has the trauma floor attending as the admitting/consulting attending for all three services during the day and the call attending as the admitting/consulting attending at night.

Additionally, each has some elective general surgery patients.

I'm not saying this model is the same everywhere, but this institution is not the only place where it exists. There will be places where you do pure acute care surgery or pure trauma/critical care, or various other models, but there is considerable overlap in many places.
 
LucidSplash said:
Well yes, but these areas of practice are not always mutually exclusive. I'm at an institution where there is complete overlap. There are 5 surgeons in the group that cover all these areas. They rotate weekly as the rounding attending on either trauma (floor), ICU (all surgical critical care consults and all trauma ICU patients), or acute care surgery. Their arrangement has the trauma floor attending as the admitting/consulting attending for all three services during the day and the call attending as the admitting/consulting attending at night.

Additionally, each has some elective general surgery patients.

I'm not saying this model is the same everywhere, but this institution is not the only place where it exists. There will be places where you do pure acute care surgery or pure trauma/critical care, or various other models, but there is considerable overlap in many places.
Click to expand...


So would do a fellowship only in Acute Care Surgery, like this one: http://www.brighamandwomens.org/Dep...ma/Medical/Acute_Care_Surgery_Fellowship.aspx

be a bad idea?

As in, would you reccomend doing CC fellowships as well to open up job opportunities?

I don't think I would really enjoy being in the SICU...ACS sounds more for me.
 
Blitz2006 said:
So would do a fellowship only in Acute Care Surgery, like this one: http://www.brighamandwomens.org/Dep...ma/Medical/Acute_Care_Surgery_Fellowship.aspx

be a bad idea?

As in, would you reccomend doing CC fellowships as well to open up job opportunities?

I don't think I would really enjoy being in the SICU...ACS sounds more for me.
Click to expand...

My experience has been that hospitalist surgeons (i.e. following the ACS model) are still expected to see their patients who end up in the SICU, manage them etc. You cannot avoid the SICU as a surgeon.

I think most of us would recommend waiting until you're a PGY-3 to make such decisions as interests often change radically.

**And I just posted so I could show off my new avatar.**
 
Blitz2006 said:
So would do a fellowship only in Acute Care Surgery, like this one: http://www.brighamandwomens.org/Dep...ma/Medical/Acute_Care_Surgery_Fellowship.aspx

be a bad idea?

As in, would you reccomend doing CC fellowships as well to open up job opportunities?

I don't think I would really enjoy being in the SICU...ACS sounds more for me.
Click to expand...

Well if you read the description on the BWH fellowship page, you will see that an ACS fellowship includes a year of critical care.

You may want to read here for more information on the area of ACS. In short, its a bit of a new concept and the current approved sites all have existingcritical care fellowships. The ACS curriculum includes a year of critical care and meets the requirements for a standalone critical care fellowship in addition to having an extra year of training in "acute general surgery." There is some controversy on the model and it has been discussed in these forums previously and you should do a search.

What you are describing as your anticipated career preference sounds, to me, more like general surgery with call responsibilities that will include coverage of emergent cases; at my program these attendings take call for the smaller, non-academic, more privately-oriented hospitals in town. You do not need to do a fellowship to practice in this area. I have several general surgery attendings who fit under this category and routinely consult pulmonary critical care to manage their ICU patients. You should be cautioned that this does not mean, in my experience, that my attendings are totally hands off on the management of their patients admitted to the ICU (and in fact this would be a terrible idea IMHO). Additionally, they all have at least two half-days of clinic weekly.
 
Thx Lucid/WS.

Well, I believe BWH says that the 2nd year is optional, so you can only do ACS:

"(This non-ACGME fellowship year is also available as a one-year fellowship.) "

http://www.hopkinsmedicine.org/surgery/education/Fellowships.html#Acute_Care

Hopkins seems to have a sweet ACS fellowship as well.

*edit: i just saw your link, thx, lists all the ACS fellowship -> http://www.aast.org/AcuteCareSurgery/ApprovedSites.aspx

I agree, I am obv jumping the gun, I need to get into Gen Surg residency first! But I've wanted to do Gen Surg since Grade 12, and I'm fairly certain that Trauma/ACS is what I want to sub-specialize in...hence me asking the newbie questions.

"What you are describing as your anticipated career preference sounds, to me, more like general surgery with call responsibilities that will include coverage of emergent cases; at my program these attendings take call for the smaller, non-academic, more privately-oriented hospitals in town. You do not need to do a fellowship to practice in this area."

Yep, you kinda nailed it. But I am under the impression (correct me if I'm wrong) that if I want to do Trauma/ACS in a larger urban area (where jobs are more saturated), doing a Trauma/ACS fellowship will be beneficial for me?

Or am I talking nonsense like a typical final year med student?

P.S. - Is doing a fellowship that is not ACGME accredited, taboo? Like this one -> http://www.aast.org/AcuteCareSurgery/ApprovedSites.aspx
 
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Blitz2006 said:
Yep, you kinda nailed it. But I am under the impression (correct me if I'm wrong) that if I want to do Trauma/ACS in a larger urban area (where jobs are more saturated), doing a Trauma/ACS fellowship will be beneficial for me?

Or am I talking nonsense like a typical final year med student?
Click to expand...

While my experience is obviously limited to my educational training sites and those of my friends, my opinion here is that it will be difficult to find a Trauma/ACS job in a major urban center without associated ICU/critical care responsibilities.

Much of the controversy around the idea of an "ACS fellowship" is that many believe you should be fully capable of handling emergent general surgery cases following residency. If you have no interest in critical care at all I don't think you need to pursue an "ACS" fellowship. But if you want to practice Trauma/ACS in a major urban center, you're probably going to need to be critical care board eligible to be competitive as most major urban centers will want you to carry ICU responsibilities.
 
LucidSplash said:
While my experience is obviously limited to my educational training sites and those of my friends, my opinion here is that it will be difficult to find a Trauma/ACS job in a major urban center without associated ICU/critical care responsibilities.

Much of the controversy around the idea of an "ACS fellowship" is that many believe you should be fully capable of handling emergent general surgery cases following residency. If you have no interest in critical care at all I don't think you need to pursue an "ACS" fellowship. But if you want to practice Trauma/ACS in a major urban center, you're probably going to need to be critical care board eligible to be competitive as most major urban centers will want you to carry ICU responsibilities.
Click to expand...

Well said. thx.
 
Winged Scapula said:
My experience has been that hospitalist surgeons (i.e. following the ACS model) are still expected to see their patients who end up in the SICU, manage them etc. You cannot avoid the SICU as a surgeon.

I think most of us would recommend waiting until you're a PGY-3 to make such decisions as interests often change radically.

**And I just posted so I could show off my new avatar.**
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Hey WS,

Don't get me wrong, I def enjoy being in the SICU, I'm not trying to avoid it at all. But my impression (and obv due to lack of experience) is that trauma fellowships, particularly those that contain 1 year of CC, is 100% SICU and almost non-operative....(which may be my own ignorance).

So yeah, I'm sure as a PGY-3 I'll have a better idea of the ins and outs of this stuff..
 
Blitz2006 said:
Hey WS,

Don't get me wrong, I def enjoy being in the SICU, I'm not trying to avoid it at all. But my impression (and obv due to lack of experience) is that trauma fellowships, particularly those that contain 1 year of CC, is 100% SICU and almost non-operative....(which may be my own ignorance).

So yeah, I'm sure as a PGY-3 I'll have a better idea of the ins and outs of this stuff..
Click to expand...

There is no board-certification for "trauma," only for critical care. So PURE trauma fellowships are not that common as most trauma is linked to critical care responsibilities; additionally, the ability to manage operative trauma is another area that many feel is adequately addressed in general surgery residency. Critical care fellowships (and therefore all accredited trauma/critical care fellowships) must have a minimum of 9 months of critical care.

One of my trauma attendings told me that, while exciting to the newly-initiated, the operative portion of penetrating trauma is actually one of the least complex parts of his job. Its the associated post-operative management and acute care surgery portions where the decision tree gets more challenging. Obviously this is just one person's opinion, and I'm still a junior resident, but based on my own experience and observations, this makes sense to me.
 
LucidSplash said:
There is no board-certification for "trauma," only for critical care. So PURE trauma fellowships are not that common as most trauma is linked to critical care responsibilities; additionally, the ability to manage operative trauma is another area that many feel is adequately addressed in general surgery residency. Critical care fellowships (and therefore all accredited trauma/critical care fellowships) must have a minimum of 9 months of critical care.

One of my trauma attendings told me that, while exciting to the newly-initiated, the operative portion of penetrating trauma is actually one of the least complex parts of his job. Its the associated post-operative management and acute care surgery portions where the decision tree gets more challenging. Obviously this is just one person's opinion, and I'm still a junior resident, but based on my own experience and observations, this makes sense to me.
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Interesting.

Well the one fellowship that seems to check off all the boxes for me: http://www.east.org/professional-development/fellowship-details/20

As you can probably tell, I like having a goal in the future, since it motivates me to work towards it...

Def learnt a lot on this thread today,
 
Blitz2006 said:
But my impression (and obv due to lack of experience) is that trauma fellowships, particularly those that contain 1 year of CC, is 100% SICU and almost non-operative....(which may be my own ignorance).
Click to expand...

It depends on where you do your fellowship.

My ex-SO did his at Shock Trauma. And while there was a great deal of SICU time, when his team was on call, they covered the traumas as well, including any operative trauma (of which there was a lot). In addition, they always operated on the patients they admitted, even if not on call, even if post call, so he was in the OR a lot.

But Lucid Splash is correct in everything she has written above, so listen/read to what she says.
 
Blitz2006 said:
Interesting.

Well the one fellowship that seems to check off all the boxes for me: http://www.east.org/professional-development/fellowship-details/20

As you can probably tell, I like having a goal in the future, since it motivates me to work towards it...

Def learnt a lot on this thread today,
Click to expand...

A 400 bed hospital with only 20 unit beds? For an SCC fellowship/level I center, I feel like something doesn't quite add up unless that's only in their sicu/trauma unit.

neb
 
Winged Scapula said:
Well you should look at that twice.

UCSD is 80% blunt. That means a LOT of SICU time, non-op management and babysitting other people's patients.
Click to expand...

Hmmm, thx.

Guess I got my research cut out for me.
 
neb85 said:
A 400 bed hospital with only 20 unit beds? For an SCC fellowship/level I center, I feel like something doesn't quite add up unless that's only in their sicu/trauma unit.

neb
Click to expand...

Probably doesn't include Pediatrics. The average number of ICU beds, even for Level 1 trauma centers, is generally between 5-10% of total hospital beds.

By way of example, we had 500 licensed beds, 30 SICU beds, I think around 15 MICU beds, and about 12 PICU beds.

For hospitals that do a lot of blunt trauma, the CC bed census tends to be lower (which is the case for UCSD).

Finally, East.org (the origin of the data on UCSD) is notoriously out of date and incorrect. However, UCSD's website does list 20 SICU beds so it is perhaps correct here.
 
Also, for some open or mixed ICU models, patients can be placed in any ICU bed, even if its not a designated SICU/TICU bed.

My institution technically has 12 TICU beds and 12 SICU beds. But in addition, there are 8 Neuro ICU, 12 MICU, 12 Med-Surg ICU, 8 Cardiac Surgery ICU, and 8 Cardiac Care Unit beds. All of these count as adult ICU beds; obviously we try to keep surgical patients to TICU or SICU beds, or MSICU as a third choice, but when we are out of beds, I've had trauma and non-trauma surgical patients everywhere. Its less than ideal to have them in some of those units who are not as accustomed to surgical patients but they still count as a bed. Even so, I've seen advertisements for our institution that leave out these "extra" ICU beds... probably because its too complicated to explain in advertisement blurb form.
 
Hey WS,

I just checked Maryland Shock Trauma, and only 15% is Penetrating.....and I thought Baltimore Shock was #1 for Penetrating?

http://www.east.org/professional-development/fellowship-details/77

or is this site horribly wrong?


Also, I saw this job posting:

http://www.east.org/professional-development/jobs-details/206

" A current ATLS certificate is required with instructor preferred. Acute care surgeons work 14 12-hour shifts during each 28-day segment with two thirds being day shifts and one-third night shifts. The base salary is $288,000 and can reach $360,000 based on easily measured performance metrics."

Is this standard?
 
Last edited:
Blitz2006 said:
Hey WS,

I just checked Maryland Shock Trauma, and only 15% is Penetrating.....and I thought Baltimore Shock was #1 for Penetrating?

http://www.east.org/professional-development/fellowship-details/77

or is this site horribly wrong?
Click to expand...

Ok, listen. I am not trying to be mean but you are missing the point that many people have made: the vast majority of trauma, even at the "Big" places, is blunt trauma. Overwhelmingly. The percentages don't change all that much between institutions of similar size in similar demographic areas. If you find a place with 30% penetrating, that would be a lot and I might be skeptical of the figures.

Now, for the actual numbers you have to consider the overall volume of admissions. STC sees a huge number of admissions every year, >7500. By comparison, my own institution (a busy Level 1 center with a large catchment area) gets about 2400. We also get about 15% penetrating. So by percentage its the same as STC but the volume there is 3x ours. Plenty of people are stabbing and shooting each other in Baltimore - but there are also a ton of car accidents, drunk people trying to ride horses, ATV accidents, and the perennial favorite "Old Person On Blood Thinners Fall Down and Hit Head." The trauma system in Maryland is unique and has some specific peculiarities that actually increase the amount of blunt trauma seen at the institution - for example, by reqs, every patient in an MVC rollover in the entire state gets transported to STC if deemed to need evaluation.

Realistically speaking, you'll be able to get a critical care fellowship if you want one (a full third of available positions went unfilled last year). But the premier programs/places in any given field are competitive and at this time most programs that include a trauma or acute care designation are among the top programs.

But first you have to figure out if you like critical care - and it can not be over-emphasized that so so much of trauma is critical care in the vast majority of places and certainly in large urban centers. Right now, you like the idea of being a trauma/acute care surgeon and you think it is for you but your posts show that you know very little about the real nuts and bolts of most surgical specialties, let alone "trauma." Having a goal is fine, but don't you think its better to pick a goal after you have a reasonable idea of what options you're choosing from? That won't happen until you've spent time "boots on the ground" as a resident. Your goals (after landing a residency spot) should be to be a kick-ass resident (check the NRMP website for the stats of Canadians applying to and matching into US fellowships), to be open to learning about the different areas in surgery, and being willing to have a very loose hold on your pre-conceived notions of what a given specialty is like until you experience it for yourself.
 
Last edited:
Blitz2006 said:
Also, I saw this job posting:

http://www.east.org/professional-development/jobs-details/206

" A current ATLS certificate is required with instructor preferred. Acute care surgeons work 14 12-hour shifts during each 28-day segment with two thirds being day shifts and one-third night shifts. The base salary is $288,000 and can reach $360,000 based on easily measured performance metrics."

Is this standard?
Click to expand...

This seems about right for a Level II facility in this area, in this type of location and the shift-schedule is one model that is employed though there are several models so I wouldn't call it "standard." Winchester is about 2 hours from Baltimore, 1.5 hours from DC, and about 2 hours from some decent (for East Coast) skiing in Western Maryland.
 
Winged Scapula said:
**And I just posted so I could show off my new avatar.**
Click to expand...

Boo -- I miss the kitty. Seemed so much more friendly -- your husky (?) seems much more standoffish, ha.

On topic: thanks to everyone who replied to this. There's not a ton of good information out there on trauma/CC for those of us interested, so it's super helpful to get some feedback from those actually in the field. :thumbup:
 
LucidSplash said:
Now, for the actual numbers you have to consider the overall volume of admissions. STC sees a huge number of admissions every year, >7500.
Click to expand...

And actually, I think the volume data on the EAST website is a bit older, as more recent data cites >8300 admissions in 2010.

Volume, volume, volume.
 
LucidSplash said:
Ok, listen. I am not trying to be mean but you are missing the point that many people have made: the vast majority of trauma, even at the "Big" places, is blunt trauma. Overwhelmingly. The percentages don't change all that much between institutions of similar size in similar demographic areas. If you find a place with 30% penetrating, that would be a lot and I might be skeptical of the figures.

Now, for the actual numbers you have to consider the overall volume of admissions. STC sees a huge number of admissions every year, >7500. By comparison, my own institution (a busy Level 1 center with a large catchment area) gets about 2400. We also get about 15% penetrating. So by percentage its the same as STC but the volume there is 3x ours. Plenty of people are stabbing and shooting each other in Baltimore - but there are also a ton of car accidents, drunk people trying to ride horses, ATV accidents, and the perennial favorite "Old Person On Blood Thinners Fall Down and Hit Head." The trauma system in Maryland is unique and has some specific peculiarities that actually increase the amount of blunt trauma seen at the institution - for example, by reqs, every patient in an MVC rollover in the entire state gets transported to STC if deemed to need evaluation.

Realistically speaking, you'll be able to get a critical care fellowship if you want one (a full third of available positions went unfilled last year). But the premier programs/places in any given field are competitive and at this time most programs that include a trauma or acute care designation are among the top programs.

But first you have to figure out if you like critical care - and it can not be over-emphasized that so so much of trauma is critical care in the vast majority of places and certainly in large urban centers. Right now, you like the idea of being a trauma/acute care surgeon and you think it is for you but your posts show that you know very little about the real nuts and bolts of most surgical specialties, let alone "trauma." Having a goal is fine, but don't you think its better to pick a goal after you have a reasonable idea of what options you're choosing from? That won't happen until you've spent time "boots on the ground" as a resident. Your goals (after landing a residency spot) should be to be a kick-ass resident (check the NRMP website for the stats of Canadians applying to and matching into US fellowships), to be open to learning about the different areas in surgery, and being willing to have a very loose hold on your pre-conceived notions of what a given specialty is like until you experience it for yourself.
Click to expand...


Great post, I don't think you're being mean at all. This is the reason I post on SDN, to learn.

Cheers,
 
sanityonleave said:
Boo -- I miss the kitty. Seemed so much more friendly -- your husky (?) seems much more standoffish, ha.

On topic: thanks to everyone who replied to this. There's not a ton of good information out there on trauma/CC for those of us interested, so it's super helpful to get some feedback from those actually in the field. :thumbup:
Click to expand...

Agreed, this thread has been very informative. thx to the 'wise' ones,
 
LucidSplash said:
but there are also a ton of car accidents, drunk people trying to ride horses, ATV accidents, and the perennial favorite "Old Person On Blood Thinners Fall Down and Hit Head."
Click to expand...
I narrowly avoided being barfed on by a drunk guy who fell off a horse at 10pm and came in as a trauma. Good times.
 
LucidSplash said:
Now, for the actual numbers you have to consider the overall volume of admissions. STC sees a huge number of admissions every year, >7500. By comparison, my own institution (a busy Level 1 center with a large catchment area) gets about 2400. We also get about 15% penetrating. So by percentage its the same as STC but the volume there is 3x ours. Plenty of people are stabbing and shooting each other in Baltimore - but there are also a ton of car accidents, drunk people trying to ride horses, ATV accidents, and the perennial favorite "Old Person On Blood Thinners Fall Down and Hit Head." The trauma system in Maryland is unique and has some specific peculiarities that actually increase the amount of blunt trauma seen at the institution - for example, by reqs, every patient in an MVC rollover in the entire state gets transported to STC if deemed to need evaluation.
Click to expand...

So when San Fran Gen says it gets 75% Penetrating...I take it thats a typo....

http://www.east.org/professional-development/fellowship-details/22
 
Blitz2006 said:
So when San Fran Gen says it gets 75% Penetrating...I take it thats a typo....

http://www.east.org/professional-development/fellowship-details/22
Click to expand...

Must be. This is old data (2000) but it states 77% blunt mechanisms: http://www.sfdph.org/dph/files/reports/AirMedAcs/appdxc.pdf

More recently, although it is the EM residency program, states in 2006 71% of trauma activations were blunt at SFGH: http://www.emresidency.ucsf.edu/the-program/hospitals

The highest percentage of penetrating I"ve seen hovers around 30%, at Ryder as I recall. As LucidSplash points out, trauma is highly non-operative, becoming increasingly so, and even at the "Knife and Gun Clubs" you are going to be doing a lot of non-op CC management. Even stuff in the OR can be mundane things like changing dressings, removing packing, etc. :yawn:
 
Winged Scapula said:
Must be. This is old data (2000) but it states 77% blunt mechanisms: http://www.sfdph.org/dph/files/reports/AirMedAcs/appdxc.pdf

More recently, although it is the EM residency program, states in 2006 71% of trauma activations were blunt at SFGH: http://www.emresidency.ucsf.edu/the-program/hospitals

The highest percentage of penetrating I"ve seen hovers around 30%, at Ryder as I recall. As LucidSplash points out, trauma is highly non-operative, becoming increasingly so, and even at the "Knife and Gun Clubs" you are going to be doing a lot of non-op CC management. Even stuff in the OR can be mundane things like changing dressings, removing packing, etc. :yawn:
Click to expand...

True, not as exciting as lumpectomies and mastectomies ;)

jk :)


But yeah, I've been doing some reading last few days, realizing it is highly non-operative. Hence me wanting to dip into ACS on the side...
 
Blitz2006 said:
True, not as exciting as lumpectomies and mastectomies ;)

jk :)
Click to expand...

Touche (although I would venture that the management of breast cancer is not as straight forward as many seem to think it is, seeing how badly its done sometimes).

But yeah, I've been doing some reading last few days, realizing it is highly non-operative. Hence me wanting to dip into ACS on the side...
Click to expand...

I think that many trauma jobs will *require* you to do some ACS "on the side", as there are fewer general surgeons who are willing to do so.
 
Winged Scapula said:
Touche (although I would venture that the management of breast cancer is not as straight forward as many seem to think it is, seeing how badly its done sometimes).



I think that many trauma jobs will *require* you to do some ACS "on the side", as there are fewer general surgeons who are willing to do so.
Click to expand...


Oh I know its not straightforward, I was just messing around. Trust me, I would love to be in your shoes, attending surgeon in Arizona. 40 degree heat and cacti >> snowy cold Canada/rainy UK.


Regarding your 2nd point, if general surgeons aren't even willing to do ACS, what exactly do general surgeons do? (the ones that don't do fellowship training).

I assumed General surgeons primarily did ACS....

And yes, I realize my newbiness is being badly exposed on this thread, but whatever
 
Blitz2006 said:
if general surgeons aren't even willing to do ACS, what exactly do general surgeons do?
Click to expand...

Elective gallbladders, lumps and bumps, hernias, sigmoids, some breast, and the occasional hemicolectomy. One of the community guys I worked with also had a steady referral of thyroids. With that said though about 30-40% of their patient load was acute GS (typically perfed tics and SBO). These guys run the only general surgery show at that hospital though so everything goes through them.

As an aside, this inevitably led to the private FPs dumping a crap ton of "acute care surgery", AKA "we just want you on board"/"I didn't want to come in to see my new pt with abdominal pain so I'll call the surgical resident in house to work it up" consults onto the service daily. I understand now that this is a pretty common nationwide occurrence but it was totally new for me as a resident and extremely aggravating as it basically cost them nothing to call in the CYA consult but ended up doubling our workload.

At our university hospital, trauma does all the acute general surgery and little elective. From everything that everyone else has posted that seems to be more and more the trend these days. This was the same at my medical school - we had relatively little trauma but all the acute general surgery stuff that rolled in through the ER and r/o acute abdomen consults kept that service hopping.

neb
 
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