Trauma Center

[rotty1021]

Hey, all. What's the reality of landing an EM job, after residency, at a trauma center (any level), or an ER that sees more than 40,000 pts. a year? I like the adrenaline rush and diversity of a big ER, and may get bored in a little ER on Main Street, USA. Thanks.

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[edinOH]

You must be a pre-med.

Most "trauma centers" or the level I tertiary facilities which receive the worst of the trauma are located in academic centers associated with medical schools. There are still many that are only indirectly tied to an academic institution, but usually by definition inorder to be classified as a level one, you need an active research and the teaching service that goes along with it.

Hence, most "trauma center" jobs will be directly or indirectly combined with academic positions within the medical school they are associated with. As a residency trained EM physician, you will be qualified for these positions. Many times it is best to obtain fellowship training in a certain area to make yourself more marketable for these types of positions. Since longevity in this area is often times directly tied to academic promotion, publishing and research are also useful if not required.

As I progress through training, more and more I'm finding the adrenalin rush of a big, bloody trauma to be closely related to a big pain in my ass!

Suburbs, here I come!

 

[rotty1021]

South Florida has two three trauma centers, I believe, and two aren't affiliated with any med schools. I believe one's part of a private system. Once you hit the suburbs, though, you'll be seeing a gamut of problems, from babies to old ones, no?

 

[Apollyon]

Most "trauma centers" or the level I tertiary facilities which receive the worst of the trauma are located in academic centers associated with medical schools.

Out of 6000 hospitals in the US, I was told ~500 are "Level I trauma centers", whereas there are ~135 EM programs. (If I was motivated, I would check with the ACS-COT.) I don't think there are 500 academic centers in the US.

 

[aliraja]

There's 146 AAMC and AACOM-affiliated medical schools in the country. Sure, there's a bunch of hostpials that are affiliated with medical schools but I'd bet that only places directly linked to medical schools can be academic medical centers... so it looks like there's ~350 non-academic medical center level I trauma centers.

Why I bothered to look that up at 11:20 on a Tuesday night, I don't know.

 

[edinOH]

If I remember correctly when the University of Oklahoma gained their level one accrediation a couple of years ago, one of the major stipulations to that status is active trauma research as well as some component regarding resident education.

I'm not familiar with every facility in the country obviously, but in my experience, even the otherwise private level one centers I've encountered or read about participated in resident education on some level. Thus the indirect or direct affiliation with a medical school, which most residencies have.

 

[southerndoc]

There's 146 AAMC and AACOM-affiliated medical schools in the country. Sure, there's a bunch of hostpials that are affiliated with medical schools but I'd bet that only places directly linked to medical schools can be academic medical centers... so it looks like there's ~350 non-academic medical center level I trauma centers.

Why I bothered to look that up at 11:20 on a Tuesday night, I don't know.

Any program that has a residency is technically classified by the government as an academic medical center.

Now, how many Level I trauma centers do not have a residency?

 

[supercut]

Actually, the criteria for being designated a Level 1 trauma center pertain to staffing issues (eg must have a 24 hour in house trauma surgeon, with subspecialties such as ortho, neurosurg, etc.) There is no requirement that the center be "academic", or do research.

Reality dictates, however, that there be residents around to provide the staffing, and the rules allow for the trauma surgeon, for example, to be a surgery chief. (esp since there is no board certification for trauma surgery)

At least one of the busiest level one trauma centers does not have a EM program...Memphis. I'm in the process of reseraching them all so if I find others, I'll try to remember to post here.

 

[hakksar]

Actually, the criteria for being designated a Level 1 trauma center pertain to staffing issues (eg must have a 24 hour in house trauma surgeon, with subspecialties such as ortho, neurosurg, etc.) There is no requirement that the center be "academic", or do research.

Reality dictates, however, that there be residents around to provide the staffing, and the rules allow for the trauma surgeon, for example, to be a surgery chief. (esp since there is no board certification for trauma surgery)

At least one of the busiest level one trauma centers does not have a EM program...Memphis. I'm in the process of reseraching them all so if I find others, I'll try to remember to post here.

Well put! I realize I am still a premed but I am quite familiar with the situation in Denver (9 years EMS experience and my fiance is a Trauma-Surgical ICU Nurse). In the Denver metro area there are 3 level 1 trauma centers (Denver Health, St. Anthony Central, and Swedish). Denver Health is a sort of an academic center with an EM Residency Program (it is a County Hospital closely affiliated with CU med school). Swedish and St. A's are at best extremely loosely affilitated with CU med school and I wouldn't call them academic centers (St. A's has a Family Practice Residency independant of CU's FP Residency, not sure about Swedish). All three educate Pre-hospital care providers (EMT-P's etc). However, I know St. A's no longer has any Surgical Residents (they used to have CU's Surg Residents but not anymore). Not sure about research but I would suspect not much outside of Denver Health. Thus, there is definetly EM spots at a level 1 center outside of academia in Colorado. In addition, there are countless more level 2 centers in Colorado that provide nearly the same level of care (and see similar trauma patients) that are not academic.

 

[ERMudPhud]

Swedish has an independent FP residency program and some clinical research. The FP residency's beginnings coincided with Swedish's application for level 1 status. St A's has the FP residency, some clinical research and last I checked critical care fellows rotating through their ICU's so both Level 1's qualify as "academic centers" Denver Health has its own ED residency and residents from every other specialty at the University of Colorado rotating through as well as med students and some shared faculty

 

[hakksar]

I can guarantee there are not critical care fellows rotating through St. A's (that would be nice for my fiance since there was only one attending critical care doc on last night and they got hammered . . . the poor guy was run ragged . . . definitely not enough crit care coverage). Yeah, I knew they did some research at St. A's but definitely not like Denver Health. They do have a few fellows rotate through in other areas (recently there was a Pulmonology Fellow that rotated through St. A's). I was just pointing out that you do not have to be a "Academic Center" to be a level 1 trauma center since I do not consider having just a FP Residency as an Academic Center (if that was true then Mercy Hospital in Grand Junction and Poudre Valley Hospital in Ft. Collins would be "Academic Centers")..

 

[Gleevec]

Is there a masterlist of Level 1 Trauma Centers in the US?

 

[southerndoc]

Many hospitals with level I trauma centers might not have a residency itself, but instead is affiliated with a hospital that has a residency. One such example used to be Inova Fairfax Hospital in Fairfax, VA (outside of DC). Until last year they didn't have a surgery residency, but residents from Georgetown rotated there. It's a level I trauma center.

I'm not aware of any other hospitals with level I trauma centers that do not have residencies, but I'm sure there are a few.

 

[Sessamoid]

Arizona is flush with level I trauma centers, due to a peculiarity in funding of trauma in that state. I did my trauma rotation at one of the Phoenix hospitals, and trauma is a big payer, unlike most states, since the state gov't basically pays for all level 1 traumas. Most probably have some sort of residency associated with them, though I'm not sure that they all have surgery residents rotating through.

 

[ERMudPhud]

I can guarantee there are not critical care fellows ...(recently there was a Pulmonology Fellow that rotated through St. A's).

That would be the critical care fellow I was referring to and no they aren't there all the time or every night. The academic requirements for Level 1 designation appear to have changed and been relaxed recently (see www.facs.org). Although a community hospital with an FP residency isn't what we would consider to be an academic center in the eyes of the government or ACS they are.

For a list of current level 1 centers and requirements go to facs.org. However, you'll notice that many of your favorite trauma centers are not on the list. That is because it is up to the individual states to designate their level one centers and those centers may or may not have been evaluated and certified by ACS. As an example, when Swedish wanted level one status they had to apply to the state for approval and most of the battle over their upgrade was fought at the state level. It appears from the ACS website that they have yet to receive their ACS certification. There are other states where the trauma centers don't even bother to apply for ACS certification. (Having recently gone through our certification I can state that it is a pain in the butt)

 

[hakksar]

That would be the critical care fellow I was referring to and no they aren't there all the time or every night. The academic requirements for Level 1 designation appear to have changed and been relaxed recently (see www.facs.org). Although a community hospital with an FP residency isn't what we would consider to be an academic center in the eyes of the government or ACS they are.

OK, I can see that there may be many ways to define an "Academic Center." However, that is besides the point. I was responding to edinOH statement to the op that

You must be a pre-med.

Most "trauma centers" or the level I tertiary facilities which receive the worst of the trauma are located in academic centers associated with medical schools. There are still many that are only indirectly tied to an academic institution, but usually by definition inorder to be classified as a level one, you need an active research and the teaching service that goes along with it.

Hence, most "trauma center" jobs will be directly or indirectly combined with academic positions within the medical school they are associated with. As a residency trained EM physician, you will be qualified for these positions. Many times it is best to obtain fellowship training in a certain area to make yourself more marketable for these types of positions. Since longevity in this area is often times directly tied to academic promotion, publishing and research are also useful if not required.

Since neither Swedish or St. A's are affiliated with a medical school and the EM Physicians at both of those hospitals do not hold academic positions at a medical school I thought supercut's statement was a good one. In addition, in regards to the FP Residency education, I am unfamiliar with how much of this will be related to the severe trauma that level 1 centers see. I do know that the FP residents are rarely seen in the SICU or PCU (the ICU and step down where trauma pts at St. A's go). The surgeons or ER docs might be involved in Family Practice Resident education in other units (I really don't know but do not see how this makes a hospital better prepared to handle trauma anyway, I DO see how crit care, EM, or surgery resident education aids in trauma care, just not FP). As for research there is the ACS requirement that there be 10 papers for all trauma related services every 3 years. However, this need not be from particular disciplines (this is recently changed in the ACS FAQ site). Therefore, if you were an EM doc that wanted to work at a level 1 trauma center, have minimal teaching and research requirements, it can be found. I would think that both St. A's and Swedish would be a good place for this type of doc. In addition, I stand by my comment about level 2 facilities in Colorado. I think Poudre Valley, the level 2 facility in Colo Springs (Memorial????), Mercy in Grand Junction, Aurora South etc all would have enough trauma to keep the op happy. I really wasn't trying to get into a debate about "Academic Centers" or Crit Care Fellows, just trying to point out to the op that he can work as an EM doc at a level 1 center without being medical school faculty.