Taking Trauma Call as Community ENT

[CTU Surgeon]

Hi,

I'm a junior ENT resident. I have enjoyed a lot of the trauma cases I've been involved with so far in residency. I was hoping to hear about the experiences of otolaryngologists out there who have taken trauma call in the community while being a generalist during the day. As I move along, I feel like I will be comfortable with a lot of the surgeries by the end of training. However, whenever we get a self-inflicted GSW, or something where the face is barely recognizable, not sure that I'd wanna be the one first at bat for those reconstructions without sub-specialty focus. I'm assuming in the community for trauma call you could do as much as you're comfortable with and refer the rest though? Also, if you take trauma call and need to operate on patients, do you tend to just try and get an OR at the end of a clinic day, or try and add it on at the end of an OR day where you have block time? I'm sure that's easier said than done. I'm trying to envision what I would do if I am fortunate to have a decently full clinical schedule in the community and then get a few operative mandibles or ZMCs during the week through consults. Anyhow, I would appreciate any thoughts!

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[HighPriest]

For the most part, you’re going to be able to do what you want to do - some trauma, no trauma, all of the trauma. The limitation will be your hospital’s capability. You’re probably not going to keep that GSW to the mouth without neurosurgery support. So if you don’t have a neurosurgeon or a neuro-capable ICU, that’s not going to be your case, short of possibly establishing an airway.
Some practices have historically done a lot of trauma, and if you join that practice you’ll probably be expected to do it too. (I suppose if they never asked you and you later said you didn’t want to do it, maybe there’s an argument to be made to not do it, but they probably wouldn’t be happy about it.) So it’s a good question to ask while interviewing.
Conversely, some practices historically do no trauma (or only soft tissue trauma like lacs and dog bites) and you could probably still do trauma in that setting, but you would be the ONLY trauma guy, and that can suck real fast. Keep in mind that in most of the communities in which I’ve worked, no one else is willing to do trauma, not OMFS, not PRS.
It also would depend to an extent upon how close the nearest tertiary referral center is. If it’s an hour down the road, they’re going to eat up most of your trauma anyway. Ambulances may just pass you by with a GSW.
If the nearest place is a 2 hour flight, then you’re back to “what can your hospital manage?”

The reason no one likes trauma (ok, not “no one”. Lots of people) is that there isn’t a good time to do it. You’re stuffing it in at the end of your OR day, or on the weekends or after hours. You’re working in off/block time with a B or C team, and the patients are usually (not always, I understand sometimes it’s a line drive to the face) flaky. There is no such thing as having OR time available when you’re done with clinic. You finish clinic and then sit around waiting for Ortho to finish their cases, and then that perfed appy bumps you, and then they get to your case at 8pm. And then, unless you’re employed, Medicaid pays for $1.27 for the surgery and follow up care. Or maybe the patient has no insurance and they just don’t pay you at all.

 

[CTU Surgeon]

I have heard that some people will get significant bumps up in their salary just for adding a certain amount of trauma call to their schedule. Is it ever the case that even though you might no get well compensated for many of the surgeries, and salary boost from adding that call to your contract makes it somewhat worth it if you like the work?

I have heard that compensation can be quite handsome for "complex lac repair" and other soft tissue stuff of the face. Anyone know how compensation is, roughly, for if you do a mandibular or ZMC ORIF for a patient with insurance?

 

[HighPriest]

If you get paid for trauma call, then yes, potentially.

Insurance generally pays well for most trauma. The problem is that if you have a mandible fracture there’s a pretty good chance you don’t have good insurance. Yes, car accidents happen, but not as often as bar fights in my experience. People with good jobs and good insurance tend to stay away from fistfights, somehow.

 

[Pikevillemedstudent]

Only thing I would add is that trauma has a much higher malpractice risk. Probably not worth it in private practice. If hospital employed, you better ask for a significantly higher salary. The going rate for facial trauma coverage is very significant. I know a few that solely perform facial trauma coverage (no general ENT) for level I and II trauma centers and their income is significantly higher than some of the busiest community ENT's. But they say no to nothing, GSW to the face particularly.