Is anyone else out there considering acute care surgery fellowship after residency? I am finishing my 3rd year of surgical training, and enjoy the clinical and academic features of trauma and critical care. I see the potential benefits of training in an acute care surgery curriculum as outlined by the AAST, but as someone who is thinking about academic trauma/critical care, I am not sure that pursuing this particular fellowship offers more than that provided by a traditional combined trauma/critical care fellowship. Anyone else have any thoughts about this new training paradigm?
Acute Care Surgery vs. Trauma/Critical Care
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I think the surg critical care fellowship is one of the best investment of one year.
you will earn far more than the average gen surgeon and have a much better lifestyle. (the other 2 good 1 yr fellowships being breast and colon-rectal)
most surgical critical care fellows are getting offers between 275-350k/yr with VERY favorable call/work schedules.
Do not be fooled into thinking you will be getting paid to do nothing- you will work hard for your money. you will babysit other surgeons patients and you may not operate that much. even the so called "emergency general" cases are not very fulfilling- appy, gallbladder, ruptured colons- not exactly cases you need alot of skill to deal with.
if you think about it- even the most intense rip-roaring trauma bleeding case you ever see is not that big a deal, since it isnt an elective case. you just do the best you can given the present circumstances.
DO NOT BE FOOLED into going to a 2 year trauma fellowship to do acute care surgery. I think this was designed with good intents, but it has no realistic value. Do you really think you can rod a femur after spending 3 months on an ortho rotation?? what if it the hardware gets infected?? can you deal with the complication?? what about emergency neurosurg- why would you take the risk of putting in an ICP monitor if you cant deal with the complications? 2yr traumafellowships are setting you up for an extra year of indentured servitude to your program
Any well trained general surgeon can do anything any "trauma" surgeon can do in the OR.
you will earn far more than the average gen surgeon and have a much better lifestyle. (the other 2 good 1 yr fellowships being breast and colon-rectal)
most surgical critical care fellows are getting offers between 275-350k/yr with VERY favorable call/work schedules.
Do not be fooled into thinking you will be getting paid to do nothing- you will work hard for your money. you will babysit other surgeons patients and you may not operate that much. even the so called "emergency general" cases are not very fulfilling- appy, gallbladder, ruptured colons- not exactly cases you need alot of skill to deal with.
if you think about it- even the most intense rip-roaring trauma bleeding case you ever see is not that big a deal, since it isnt an elective case. you just do the best you can given the present circumstances.
DO NOT BE FOOLED into going to a 2 year trauma fellowship to do acute care surgery. I think this was designed with good intents, but it has no realistic value. Do you really think you can rod a femur after spending 3 months on an ortho rotation?? what if it the hardware gets infected?? can you deal with the complication?? what about emergency neurosurg- why would you take the risk of putting in an ICP monitor if you cant deal with the complications? 2yr traumafellowships are setting you up for an extra year of indentured servitude to your program
Any well trained general surgeon can do anything any "trauma" surgeon can do in the OR.
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Agreed. The acute care fellowships should probably stick to things covered in the scope of general/trauma surgery.
In an acute care fellowship you will not learn (nor should you) to learn to place IM nails. The AAST has developed a curriculum that has limited scope in orthopaedic procedures. These include:
Amputations, lower extremity (Hip disarticulation, AKA, BKA, Trans-met)
Reducing dislocations
Splinting fractures
Applying femoral/tibial traction (this is listed as desirable, not essential).
Frankly, IMHO, every physician who provides emergency medical care should be able to reduce most simple dislocations, or at the very least be able to stabilize a fracture/dislocation with an external splint. There are very few times when applying femoral or tibial traction is an absolute necessity.
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What are the training requirements for (edit)Trauma Surgery? And what kind of work does it involve? You said the lifestyle is better than a gen-surg, how so?
I checked on the AAMC Careers in Medicine page and didn't find the info I was looking for.
Any links/posts are greatly appreciated 🙂
PS: Sorry for post hijack
I checked on the AAMC Careers in Medicine page and didn't find the info I was looking for.
Any links/posts are greatly appreciated 🙂
PS: Sorry for post hijack
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Most Trauma Surgery is handled by General Surgeons who have completed a minimum of 5 years of residency.
You can complete a Trauma/CC Surgery fellowship after general surgery, which ranges from 1-2 years if you wish additional training.
As the name implies, you cover trauma. However, because most hospitals in the US do not have enough volume to employ you full-time doing ONLY trauma you are also likely to cover the ICU and perhaps take general surgery/acute care surgery call (especially as a junior faculty member).
Some will work shifts, some take frequent over night call in the hospital. There are multiple schemas for a Trauma surgeon.
Not sure who said that, but if you are in a shift work environment you may have a better lifestyle than the general surgeon who takes call and then stays all the next day to finish his cases, cover clinic, etc. There is no hard and fast rules about this, though. I know some trauma surgeons with good lifestyles and some with pretty dismal ones.
Because they don't tend to cover fellowships and subspecialties much.
Check http://www.trauma.org
http://www.east.org
for more info.
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Agreed.
I would agree that many things can be safely initially stabilized until an orthopod is available to place a pin. However, there are many injuries in which traction is essential until definitive treatment.
I don't think many orthopaedists are concerned about trauma attendings being trained in reducing fractures/dislocations and stabilizing them with splints. The concern comes when you begin talking about things like placing external fixation frames or traction pins. These devices have to be placed taking into account how the fracture is going to be definitively fixed. For example, if you put your pin right where I want to put the intramedullary nail, then I am going to have to take the pin out first. Now I can't use that pin for traction during the case. And external fixation while seemingly simple is definitely an art form, especially with complex fractures.
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Well said.
There is a belief out there that all orthopods do is straight forward and simple (partially self propagated). Within the last 3 weeks I had 3 separate people (2 non surgery interns and 4th year student) that were surprised that ortho was as long of a residency as gen surg. Their "theory" was that since we weren't learning to manage "complex" medical problems like gen surg then we shouldn't have to be in residency as long (which would be nice🙂. One of the interns as also lamenting that our decision making was "erratic." They didn't like that sometimes we let the hip fractures walk immediately and sometimes kept them NWB for months at a time (making their lives more difficult in terms of medical management and potential complications). I certainly think the nuances of orthopaedics are lost on non orthopods.
Well, this thread has gone in a direction I had never envisioned when I started it. As someone who plans on an academic career in trauma/critical care (or acute care surgery, if you will), I don't have any intention of setting fractures or putting bolts in people's heads. My understanding of the AAST curriculum is that there is very little emphasis on things like orthopedics and neurosurgery (although these things were featured more prominently in the beginning stages of curriculum development).
The more valuable aspects that I see in the acute care surgery fellowship concept were hinted at a bit by the comment made ESU_MD referring to the ability of a well-trained general surgeon to manage trauma. While I fully agree that a well-trained general surgeon CAN manage most trauma and do it well, I have to say that I question my own preparedness to manage things like severe thoracic trauma having performed only 17 elective thoracotomies (plus whatever thoracic trauma I will manage in my chief resident years) as a general surgery resident.
On one hand, I want to believe that I will be ready for anything on completion of my general surgery training and that with a year of critical care training, I will be supremely well prepared; but on the other hand, spending time gaining additional exposure to fields less covered during my general surgery training, like CT or hepatobiliary, seems like it might not be a bad idea. I think that the ACS curriculum might offer this in a different way than the traditional trauma-critical care combination, in which the focus seems to be on covering trauma and doesn't offer those organized experiences. I can see pros and cons to either 2 years of ACS or trauma-critical care, and the pros and cons to do neither and simply spend a year doing critical care. This three-way split is what is really at the heart of my dilemma.
The more valuable aspects that I see in the acute care surgery fellowship concept were hinted at a bit by the comment made ESU_MD referring to the ability of a well-trained general surgeon to manage trauma. While I fully agree that a well-trained general surgeon CAN manage most trauma and do it well, I have to say that I question my own preparedness to manage things like severe thoracic trauma having performed only 17 elective thoracotomies (plus whatever thoracic trauma I will manage in my chief resident years) as a general surgery resident.
On one hand, I want to believe that I will be ready for anything on completion of my general surgery training and that with a year of critical care training, I will be supremely well prepared; but on the other hand, spending time gaining additional exposure to fields less covered during my general surgery training, like CT or hepatobiliary, seems like it might not be a bad idea. I think that the ACS curriculum might offer this in a different way than the traditional trauma-critical care combination, in which the focus seems to be on covering trauma and doesn't offer those organized experiences. I can see pros and cons to either 2 years of ACS or trauma-critical care, and the pros and cons to do neither and simply spend a year doing critical care. This three-way split is what is really at the heart of my dilemma.
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