Trauma/Critical Care/Acute Care Surgery

[Norwood-Sano]

I've been hearing more and more about this specialty (specialties?) and how it prepares you to be the true, well-rounded general surgeon that has began disappearing by sub-specializing. Sounds like you play the general surgeon (bread and butter), trauma surgeon (the **** that comes in at 2am that you may have to stabilize or even operate on until the appropriate specialist can jump in) and the SICU intensivist (managing the vents, electrolytes, placing some lines etc.). I would't say a particular interest area of mine or anything but I was curious in hearing more about it since it at least sounds pretty cool.

My understanding is:

Surgery (5-7 years) -> Acute Care Surgery (2 years) leads to all the above

Surgery (5-7 years) -> Surgical Critical Care (1 year) leads to less operating and more SICU?

Thanks from a lowly OMS!

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[deleted547339]

I've been hearing more and more about this specialty (specialties?) and how it prepares you to be the true, well-rounded general surgeon that has began disappearing by sub-specializing. Sounds like you play the general surgeon (bread and butter), trauma surgeon (the **** that comes in at 2am that you may have to stabilize or even operate on until the appropriate specialist can jump in) and the SICU intensivist (managing the vents, electrolytes, placing some lines etc.). I would't say a particular interest area of mine or anything but I was curious in hearing more about it since it at least sounds pretty cool.

My understanding is:

Surgery (5-7 years) -> Acute Care Surgery (2 years) leads to all the above

Surgery (5-7 years) -> Surgical Critical Care (1 year) leads to less operating and more SICU?

Thanks from a lowly OMS!

I’m not a surgeon, but I’m an intensivist and trained with a lot of surgeons.

It depends where you go. There are a few (rare) places that are low volume and let you do trauma/sicu/whatever with just residency.

Surgical critical care is a relatively non competitive 1 year fellowship following residency. It’s ACGME accredited. Some places are more sicu heavy, some more trauma heavy, but none are heavy operatively by design. Various places have different emphasis. The goal is a thinking year, not a doing year, to train you do be an intensivist. Many places will let you do everything after this one year of training.

There is an additional non-acgme year of training that can be done after the scc fellowship that generally focuses more on operative management and trauma. If you do this, you can work wherever.

Build your training (regardless of your specialty) around what you want to do.

Also, many high volume centers will have a different attending on for trauma (operations) and attending in the unit since you can’t be in two places at once with the unit attending only operating when the trauma attending and fellow are already in the OR and it’s hitting the fan.

Again, I’m an intensivist, not a surgeon, but this is what I’ve heard from a lot of surgeons.

 

[AsianPersuasion]

Upcoming surgery resident, but at the place I matched at, they split their time between SICU week, GS and Trauma call. My fiance's practice is similar in set up too. I don't remember his SDN handle but there's one ACS surgeon on board here who's pretty active, I'm sure he'll answer and a lot of this has been discussed in the past too.

 

[Norwood-Sano]

Thanks for the responses! Yes I think the ACS surgeon's handle is actually @ACSurgeon hahah. I would not mind hearing his/her responses!

 

[ACSurgeon]

I've been hearing more and more about this specialty (specialties?) and how it prepares you to be the true, well-rounded general surgeon that has began disappearing by sub-specializing. Sounds like you play the general surgeon (bread and butter), trauma surgeon (the **** that comes in at 2am that you may have to stabilize or even operate on until the appropriate specialist can jump in) and the SICU intensivist (managing the vents, electrolytes, placing some lines etc.). I would't say a particular interest area of mine or anything but I was curious in hearing more about it since it at least sounds pretty cool.

My understanding is:

Surgery (5-7 years) -> Acute Care Surgery (2 years) leads to all the above

Surgery (5-7 years) -> Surgical Critical Care (1 year) leads to less operating and more SICU?

Thanks from a lowly OMS!

Acute care surgery can mean a few things.

At a minimum it’s someone who completed five years of general surgery and finds a job set up to just work as an acute care surgeon.

Ideally (and I’m biased) you’d also have a critical care fellowship and that as part of your job. Critical care is just one year.

I did just that for my training and my job divided into two weeks of surgery and two weeks off during which I do critical care.

At academic centers you can still be just a general surgeon but usually with the critical care fellowship.

At medium to highly academic centers you’d almost certainly have to have some research experience, often in the form of dedicated research years in residency (1-3 years).

Finally ACS fellowships are relatively new and include one year of critical care and one year that’s more of a hodgepodge of things depending where you do it...

 

[Norwood-Sano]

Acute care surgery can mean a few things.

At a minimum it’s someone who completed five years of general surgery and finds a job set up to just work as an acute care surgeon.

Ideally (and I’m biased) you’d also have a critical care fellowship and that as part of your job. Critical care is just one year.

I did just that for my training and my job divided into two weeks of surgery and two weeks off during which I do critical care.

At academic centers you can still be just a general surgeon but usually with the critical care fellowship.

At medium to highly academic centers you’d almost certainly have to have some research experience, often in the form of dedicated research years in residency (1-3 years).

Finally ACS fellowships are relatively new and include one year of critical care and one year that’s more of a hodgepodge of things depending where you do it...

So you did the 1 year SCC fellowship? Do you feel as though that prepared you well for your current practice model? Do you enjoy getting to do “more medicine” than your colleagues? Also does the SCC prepare you more for trauma surgery and management than just going through gen surgery?

Thanks for your informative post!

 

[ACSurgeon]

So you did the 1 year SCC fellowship? Do you feel as though that prepared you well for your current practice model? Do you enjoy getting to do “more medicine” than your colleagues? Also does the SCC prepare you more for trauma surgery and management than just going through gen surgery?

Thanks for your informative post!

The main benefit of a critical care fellowship is the certificate. It makes you able to cover the icu as an intensivist. Some general surgeons finish training with theoretically enough knowledge and skills to be in the icu but can’t because of the formal training and certification.

No doubt the fellowship makes you better at managing ventilators, pressors, among other things. It might make you better at managing a trauma patient, but doesn’t make you operate any better.

 

[Dr.LeoSpaceman]

It seems from observation of the 2-year ACS/Trauma fellowship at my prior residency that the 2nd year is basically a "transition to practice" year. If you came from a high-volume program that saw quite a bit of complex general surgery, it's actual training value seemed questionable. The other potential benefit is additional time to build/start a research portfolio, which could make you more attractive to academic jobs.

 

[Smurfette]

It seems from observation of the 2-year ACS/Trauma fellowship at my prior residency that the 2nd year is basically a "transition to practice" year. If you came from a high-volume program that saw quite a bit of complex general surgery, it's actual training value seemed questionable. The other potential benefit is additional time to build/start a research portfolio, which could make you more attractive to academic jobs.

Yeah, my understanding of the TTP years is basically to boost confidence in those who want to do GS (there are places that do just a 1 yr TTP "fellowship" and not "ACS" fellowship). Good for those who didn't get a lot of autonomy in their residency programs.

 

[Dr.LeoSpaceman]

Yeah, my understanding of the TTP years is basically to boost confidence in those who want to do GS (there are places that do just a 1 yr TTP "fellowship" and not "ACS" fellowship). Good for those who didn't get a lot of autonomy in their residency programs.

I'm pretty sure the program liked it since it was an extra body in the call/rounding pool that is paid a fellow's wage, but can still bill as an attending.

 

[deleted547339]

No doubt the fellowship makes you better at managing ventilators, predators, among other things.

I’m pretty sure the only thing that can mange a predator is an alien, but it’s been a long time since I’ve brushed up on it.

 

[ACSurgeon]

I’m pretty sure the only thing that can mange a predator is an alien, but it’s been a long time since I’ve brushed up on it.

Haha. Typo

 

[Norwood-Sano]

The main benefit of a critical care fellowship is the certificate. It makes you able to cover the icu as an intensivist. Some general surgeons finish training with theoretically enough knowledge and skills to be in the icu but can’t because of the formal training and certification.

No doubt the fellowship makes you better at managing ventilators, pressors, among other things. It might make you better at managing a trauma patient, but doesn’t make you operate any better.

I must say this model is interesting me more. I have always liked the idea of being an intensivist but my love is for surgery. This model seems to be a great fit for that!

 

[deleted547339]

I must say this model is interesting me more. I have always liked the idea of being an intensivist but my love is for surgery. This model seems to be a great fit for that!

Yea, one of my buddies does a week of trauma, a week of icu, then a week of acute care surgery. Seems to be reasonably attainable.

 

[ACSurgeon]

Yea, one of my buddies does a week of trauma, a week of icu, then a week of acute care surgery. Seems to be reasonably attainable.

In the community you should be able to get a job doing 2-3 weeks on with 1-2 weeks off. Has to be a busy enough hospital to support that...

 

[Norwood-Sano]

Yea, one of my buddies does a week of trauma, a week of icu, then a week of acute care surgery. Seems to be reasonably attainable.

In the community you should be able to get a job doing 2-3 weeks on with 1-2 weeks off. Has to be a busy enough hospital to support that...

Sounds like a great gig with plenty of variety! Just for notes, how competitive is it coming from DO?

 

[kemper6036]

It seems from observation of the 2-year ACS/Trauma fellowship at my prior residency that the 2nd year is basically a "transition to practice" year. If you came from a high-volume program that saw quite a bit of complex general surgery, it's actual training value seemed questionable. The other potential benefit is additional time to build/start a research portfolio, which could make you more attractive to academic jobs.

Or in other words, do attending work with trainee pay. I agree with your comments. There are some folks whose training was seriously impacted by too many fellows or whatever who legitimately need this extra year. If you came from a place that didn't see a lot of penetrating/operative trauma, it may have a role. Also if you are looking for an academic job and need to buff up your CV, it might help.

 

[deleted547339]

Or in other words, do attending work with trainee pay. I agree with your comments. There are some folks whose training was seriously impacted by too many fellows or whatever who legitimately need this extra year. If you came from a place that didn't see a lot of penetrating/operative trauma, it may have a role. Also if you are looking for an academic job and need to buff up your CV, it might help.

Yea. I know someone who is doing a second year because he wants to work at a high level trauma center and is training somewhere widely respected for its trauma program. I know someone else who was essentially required to do a second year for lack of clinical competence.

 

[kemper6036]

one of my junior residents is going to be an ACS fellow next year. the place we trained at was a pretty violent center with 30% penetrating trauma so we were in the OR quite often, cracking chests often as well as operating on the neck and peripheral vessels. despite this, she feels she needs more, and the bottom line is that is what it comes down to. if you think you're ready, you are. i kind of tried to talk her out of it, because the opportunity cost is huge. $$$

 

[Norwood-Sano]

The general consensus appears to to be that being properly trained in general surgery followed by the SCC fellowship year is sufficient to do trauma, general surgery and critical care from a skill standpoint. While ACS fellowship is more about the buffing up your CV while unfortunately being used as cheap labor.

 

[ACSurgeon]

The general consensus appears to to be that being properly trained in general surgery followed by the SCC fellowship year is sufficient to do trauma, general surgery and critical care from a skill standpoint. While ACS fellowship is more about the buffing up your CV while unfortunately being used as cheap labor.

To put things in perspective, it’s not uncommon for general surgery residents to waste 2-3 or more years doing research and other academic things... so an extra clinical year that makes you better in the OR isn’t necessarily all bad.