Acute Care Surgery?

[DeadCactus]

---

Members don't see this ad.

So what's the deal with this? It's one of those terms I seem to come across a lot, but is it something you can actually center your career around? If so, how does it work? Do you take a shift and handle any surgical emergencies that come up? Do you just take call x number of days per week?

 

[45408]

My exposure to it has been in conjunction with trauma surgery - both at my med school and my residency program. It can be arranged different ways (and both systems had all kinds of weird variations), but the trauma guys are covering anything that walks in through the ED. They're working in shifts anyway, so they just take shift call for acute care surgery.

I think that if you wanted your career to center around it, you'd have to work at a pretty big hospital. At my hospital, they do lots of trauma (mostly blunt) and a little acute care. If you were at a big hospital that wasn't the regional trauma center, you could probably do mostly acute care if there were enough appies/choles/SBOs/etc that walked into the ED.

 

[LucidSplash]

The trauma guys at my program are essentially already doing ACS. Here (reasonably-sized academically-affiliated Level-I trauma and tertiary referral center in a small city in the southeast) the trauma staff (currently consisting of 5 attendings) take general surgery call. When they are on call, they cover both trauma and our emergency general surgery services.

For rounding responsibilities they rotate: in a given week one is responsible for trauma floor rounds, one for critical care rounds, and one for EGS. Weekdays 8-5, the one responsible for critical care rounds is the one who takes all incoming trauma and EGS admits/consults. At night and weekends, it is whoever is on call.

I've seen other arrangements too, this is just the one I'm most familiar with. Grace Rozycki recent gave Grand Rounds here and detailed a lot of changes going on with ACS - its a developing field and some critical care fellowships are developing themselves to be "acute care fellowships," expanding to two years for this purpose.

 

[DeadCactus]

Thank you all for the responses so far.

I also meant to ask about the surgical hospitalist model in my original post. I'm under the impression this a model of Acute Care Surgery that is being implemented in some hospitals. Correct?

Is this a growing trend or just a fad? Or is it too early to tell? I can imagine a lot of disdain for the idea from the surgery community...

 

[Thanatos]

Thank you all for the responses so far.

I also meant to ask about the surgical hospitalist model in my original post. I'm under the impression this a model of Acute Care Surgery that is being implemented in some hospitals. Correct?

Is this a growing trend or just a fad? Or is it too early to tell? I can imagine a lot of disdain for the idea from the surgery community...

We're kicking around the surgical hospitalist idea where I'm at now. Historically, the idea of someone working a night shift and not following people long term would lead to you being shot in the town square.

Everything changes though, and even my older attendings have been bitching about getting phone calls at night, coming in for cases, etc on a regular basis. I think the concept of ACS with an in house attending overnight (hospitalist or whatever) will be the way of the future. Its such an easy sell to most people...no coming in overnight plus more oversight when the quality control gestapo starts basing reimbursement on outcome and so on.....

 

[45408]

some critical care fellowships are developing themselves to be "acute care fellowships," expanding to two years for this purpose.

That doesn't make much sense to me. What are they going to teach you about ACS that you shouldn't have already learned in five years of general surgery?

 

[LucidSplash]

That doesn't make much sense to me. What are they going to teach you about ACS that you shouldn't have already learned in five years of general surgery?

They're considered symbiotic. The AAST-approved ACS fellowships are generally 2-year fellowships: the first year is the ACGME-approved CC year and the second in highly operative trauma and non-trauma EGS rotations with elective time in areas that are thought to augment the skill set they are looking to develop.

From an employment standpoint, the ACS model (vs the pure trauma/cc model) is seen as a way to add variety and increased operative volume to the practice of someone who would have traditionally done trauma/cc (low on operative volume overall). From a skillset standpoint, its a way for people to do "general surgery" in a time/place when many feel they have to specialize to be viable. Sure, in theory, someone graduating from a GS residency should feel ready to tackle that kind of breadth; but there are probably a lot of people coming from some programs (many very academic/research-driven programs) who may not.

See the AAST website on the subject to hear it from the horse's mouth: http://www.aast.org/acutecaresurgery.aspx

 

[maxheadroom]

The ACS service at large higher-acuity hospitals totally makes sense, especially when it is coupled with a Trauma/CC service. It keeps the other General Surgeons who have a strong elective practice from having to shoehorn in the unscheduled cases that can be a major disruption in their schedule.

I really don't understand what an ACS fellowship would be, though. I understand Critical Care fellowships. I kind of understand Trauma fellowships (especially for folks who didn't train at a penetrating trauma-heavy program). I just don't understand a fellowship that focuses on appys, choles, perf'd viscouses, and the like. Those are all things that a Chief Resident should be taking a junior resident through.