Trauma specialities

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SadGiraffe

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Okay so I’m an MS3 at a US school, Decent step 1 score and interested in anything related to trauma.

I was just wondering what exactly are the specialities that deal with trauma. I know emergency med, trauma surgery and perhaps ortho or neurosurgery.

Any other specialities? even if they dealt with it indirectly. Listing them would help me keep an eye out for them so I can decide on a future speciality.

I’m an INTJ if that helps.
I appreciate any opinions or advice.

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General surgery will generally be at the head of trauma management. However this doesn’t mean that they will always be at the head of any operative trauma, though they’ll still continue to manage or co-manage the patient if another service operates on them. They’ll generally be the ones doing the secondary and teritiary surveys, and occasionally primary. They’ll also likely be involved in calling other services.

Ortho is involved in a lot of trauma, and will be called upon to manage things like broken extremities (closed reduction vs operation vs both), pelvic fractures (after they’ve been stabilized with a binder), compartment syndrome, and spine trauma.

Neurosurgery will be involves with any head/neck/spine trauma. Skull fractures, any blood inside the skull, spine trauma (similar to ortho, though neurosurgery does way more spine overall), etc all of these will go to neurosurgery and a lot of it is operative.

EM will often receive the patient and do the primary survey and occasionally secondary depending on the institution or situation. They’ll get trauma surgery involved very early and then help stabilize and get other services involved too but don’t participate in long term trauma management after initial stabilization.

Anesthesia is involved in anything trauma related that requires an operation and will sometimes co-staff trauma ICUs with trauma surgeons.

Urology, OMFS, and ENT can be peripherally involved with trauma depending on injuries to their systems (ENT for airway issue, ENT or OMFS for facial stuff, and urology for bladder/urethral injuries) but will almost never be primary on trauma patients.

Plastics will sometimes be called for hand or facial trauma depending on the institution, but will be a consultant more than anything and generally less involved than OMFS or ortho.

Neurology will staff neurocritical care units that neurosurgery trauma patients may end up in and will see TBI patients on follow up, but otherwise won’t have too much direct involvement.

PM&R will see long term follow up trauma patients that require rehabilitation but are not involved in initial management.

So basically if you like initial trauma management, I would go with one of the following:

EM: immediate stabilization, non-operative, quick handoff
General surgery: immediate stabilization, operative and non-operative, management throughout hospital stay
Neurosurgery: operative and non-operative management after immediate stabilization by one of the two above with rapid initial evaluation for brain/spine trauma
Ortho: operative and non-operative management after immediate stabilization by the above with rapid initial eval for MSK/spine trauma
Anesthesia: periop and critical care management as well as airway and potentially initial stabilization (ABCDEs) in some cases
 
General surgery will generally be at the head of trauma management. However this doesn’t mean that they will always be at the head of any operative trauma, though they’ll still continue to manage or co-manage the patient if another service operates on them. They’ll generally be the ones doing the secondary and teritiary surveys, and occasionally primary. They’ll also likely be involved in calling other services.

Ortho is involved in a lot of trauma, and will be called upon to manage things like broken extremities (closed reduction vs operation vs both), pelvic fractures (after they’ve been stabilized with a binder), compartment syndrome, and spine trauma.

Neurosurgery will be involves with any head/neck/spine trauma. Skull fractures, any blood inside the skull, spine trauma (similar to ortho, though neurosurgery does way more spine overall), etc all of these will go to neurosurgery and a lot of it is operative.

EM will often receive the patient and do the primary survey and occasionally secondary depending on the institution or situation. They’ll get trauma surgery involved very early and then help stabilize and get other services involved too but don’t participate in long term trauma management after initial stabilization.

Anesthesia is involved in anything trauma related that requires an operation and will sometimes co-staff trauma ICUs with trauma surgeons.

Urology, OMFS, and ENT can be peripherally involved with trauma depending on injuries to their systems (ENT for airway issue, ENT or OMFS for facial stuff, and urology for bladder/urethral injuries) but will almost never be primary on trauma patients.

Plastics will sometimes be called for hand or facial trauma depending on the institution, but will be a consultant more than anything and generally less involved than OMFS or ortho.

Neurology will staff neurocritical care units that neurosurgery trauma patients may end up in and will see TBI patients on follow up, but otherwise won’t have too much direct involvement.

PM&R will see long term follow up trauma patients that require rehabilitation but are not involved in initial management.

So basically if you like initial trauma management, I would go with one of the following:

EM: immediate stabilization, non-operative, quick handoff
General surgery: immediate stabilization, operative and non-operative, management throughout hospital stay
Neurosurgery: operative and non-operative management after immediate stabilization by one of the two above with rapid initial evaluation for brain/spine trauma
Ortho: operative and non-operative management after immediate stabilization by the above with rapid initial eval for MSK/spine trauma
Anesthesia: periop and critical care management as well as airway and potentially initial stabilization (ABCDEs) in some cases
Thank you. That was incredibly helpful 🙂
 
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Why would your
Okay so I’m an MS3 at a US school, Decent step 1 score and interested in anything related to trauma.

I was just wondering what exactly are the specialities that deal with trauma. I know emergency med, trauma surgery and perhaps ortho or neurosurgery.

Any other specialities? even if they dealt with it indirectly. Listing them would help me keep an eye out for them so I can decide on a future speciality.

I’m an INTJ if that helps.
I appreciate any opinions or advice.

Why would your Myers-Briggs personality affect which specialties deal with trauma?

Also that personality test is bullsh*t.
 
@WedgeDawg great post.

If you are looking for operative trauma there is no specialty that operates on trauma patients more than the ortho trauma peeps. They operate a TON. Ortho trauma typically also generally has pretty good outcomes, as compared to like neurosurgery where their trauma patients often don’t fully recover (talking the crani patients) General surgery has a balance between non-operative and operative, with the scales heading more and more to non-operative. Unless you’re at a hospital that’s a member of the knife and gun club, those guys still do a heavy amount of operative trauma. The GS are typically the ones who lead the “trauma team,” at least at all the hospitals I’ve been at.

EM is good if you like the immediate crisis stabilization and then sending them to someone else.
 
IR is becoming much more involved in trauma care and will likely continue to do so.

Something to keep in mind though: trauma has one of the absolute worst patient populations (like really, really bad) and a lot of trauma is non operative and boring. It sounds great on paper but the cool cases are incredibly few and far between.
 
There's also Vascular, which falls under the GS umbrella.
 
Trauma is a huge part of general surgery training. But what it actually entails depends heavily on where you train. If you want to operate on trauma patients, doing general surgery residency at a place with a high volume of penetrating trauma (like USC/LA county) makes the most sense. You literally have to operate on everything from the neck down.
 
Trauma is a huge part of general surgery training. But what it actually entails depends heavily on where you train. If you want to operate on trauma patients, doing general surgery residency at a place with a high volume of penetrating trauma (like USC/LA county) makes the most sense. You literally have to operate on everything from the neck down.

I would also point out for the general surgeons employers want a trauma fellowship as well now. It’s not simply enough for most level 2s and up that one “had a lot of trauma in residency”.
 
OP, what makes you interested in trauma? Are you looking for a field that is high stress, hands-on/procedural, high acuity, fast paced, team-based, with younger/healthier patients, without much continuity, working inside a hospital setting with an irregular schedule? If so, maybe keep an idea out for L&D as well. Or are you looking for something else?
 
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Neurosurgery has a sort of privileged position because they are often given the right of first refusal in a polytrauma, unless there is significant hemodynamic instability. Usually other services will defer to neurosurgery first for cranial intervention and then for spine intervention before ortho or urology or whoever gets involved. This tends to be quite satisfying but comes at the cost of getting consulted for every single little boo boo. Obviously if the patient is bleeding out into the peritoneum then they will wait.

The downside is that a lot of trauma is nonoperative from a neurosurgical perspective (a lot of patients are either fine or dead), and then operative intervention for trauma is generally the least interesting of the cases in neurosurgery and it gets tiring. Crashing a crani at 3am is awesome for a while, but eventually you just wish that people would stop riding motorcycles in the rain.
 
If money is a consideration, NS and ortho get the fattest trauma stipends at my hospital.
 
Sure, residency is medieval torture. But every neurosurgeon i know personally makes 7 figures.

My point was mostly that a higher salary is less valuable if it takes longer to get there. The EM docs are the ones laughing at the neurosurgery salary, since they were adding to their investment portfolio for over 6 years prior.
 
My point was mostly that a higher salary is less valuable if it takes longer to get there. The EM docs are the ones laughing at the neurosurgery salary, since they were adding to their investment portfolio for over 6 years prior.

Neurosurgeon will catch up in 3-5 years and will far outearn an ED physician in his/her lifetime. But yes, EM is a good gig for the length of training.
 
I'm warning you now, ortho and NS trauma branch don't stop...literally every single day is trauma and every single day is an emergency. Think long and hard. Depending on where you're at, it's brutal. Some days you just want the most straight forward case as possible as it gets to even out some of the rougher days. As a trauma surgeon of anything, you might not get that. I love vascular and I absolutely love vascular emergencies. But only a few months in and I'm really starting to appreciate the lighter days where I'm on more elective, non-immediate life threatening surgeries that doesn't require me to be in that trauma mode. I'm so appreciative to be working under many great attendings and fellows but I'm still scared sh8tless when I'm holding down the fort at night.
 
As written above, there is a trauma component to vascular surgery that some will either love or hate. We get called upon for a variety of pathologies such as, but not limited to:

- blunt traumatic aortic injuries/transections
- posterior knee dislocations
- penetrating trauma to the visceral segments (these are usually rotten and have high mortality)
- penetrating trauma to the extremities
- poly-trauma w/ ischemic extremities

There is also somewhat of a fireman's mentality to vascular whereby we are often called to help bail out other specialists when they get into uncontrolled bleeding issues. So even if you're not getting paged by the trauma team for assistance, sometimes it'll be a stat page from the OR and so-and-so has gotten into bleeding and can't get it stop please come now.

It's fun at first. Then not so much. Especially when you view it down the barrel of them happening at weird hours of the night and not actually having a post-call day because all of my calls currently are "at home." But at least I've been there, done that and have the t-shirt to show for it. Looking forward to a practice scenario where it is as minuscule as possible. Cheers.
 
As written above, there is a trauma component to vascular surgery that some will either love or hate. We get called upon for a variety of pathologies such as, but not limited to:

- blunt traumatic aortic injuries/transections
- posterior knee dislocations
- penetrating trauma to the visceral segments (these are usually rotten and have high mortality)
- penetrating trauma to the extremities
- poly-trauma w/ ischemic extremities

There is also somewhat of a fireman's mentality to vascular whereby we are often called to help bail out other specialists when they get into uncontrolled bleeding issues. So even if you're not getting paged by the trauma team for assistance, sometimes it'll be a stat page from the OR and so-and-so has gotten into bleeding and can't get it stop please come now.

It's fun at first. Then not so much. Especially when you view it down the barrel of them happening at weird hours of the night and not actually having a post-call day because all of my calls currently are "at home." But at least I've been there, done that and have the t-shirt to show for it. Looking forward to a practice scenario where it is as minuscule as possible. Cheers.

Nothing worse than getting a call to bail the primary team out but having both the attending and fellow from the primary team screaming at you and the chief resident while trying to figure out a game plan to fix their train-wreck.
 
I agree with this. Trauma ortho is full of a bunch of fun people.

You usually are very often going to take a pay-cut from your normal ortho potential though

I think my ortho-trauma folks are worth their weight in gold, but often your typical trauma patient is without a way to pay for the very serious services they need
 
You usually are very often going to take a pay-cut from your normal ortho potential though

I think my ortho-trauma folks are worth their weight in gold, but often your typical trauma patient is without a way to pay for the very serious services they need

Agree with this, you’re paid pretty well but if you want to crush it, ortho trauma is not where it’s at. Also, you’ll likely be employed because of what you stated. It’s hard to making a living as a trauma guy in private practice.
 
In many trauma programs including mine, the consultants are guaranteed 1xx% of Medicare for every case they do plus a sizable daily stipend. The daily stipend alone is over 7 figures yearly. Ortho trauma and NS do extremely well providing this service, so well in fact that we have private neurosurgery groups competing vigorously to provide trauma coverage.
 
In many trauma programs including mine, the consultants are guaranteed 1xx% of Medicare for every case they do plus a sizable daily stipend. The daily stipend alone is over 7 figures yearly. Ortho trauma and NS do extremely well providing this service, so well in fact that we have private neurosurgery groups competing vigorously to provide trauma coverage.

Where are you located? It’s true for neurosurgery as their is shortage of neurosurgeons... ortho trauma is highly dependent on location. Ortho trauma will do well, but you ceiling is def lower than ortho joints and spine.... even sports.
 
Where are you located? It’s true for neurosurgery as their is shortage of neurosurgeons... ortho trauma is highly dependent on location. Ortho trauma will do well, but you ceiling is def lower than ortho joints and spine.... even sports.


Large city. West coast. Yes you are correct, ceiling is lower than the busiest joint and spine guys.
 
Large city. West coast. Yes you are correct, ceiling is lower than the busiest joint and spine guys.

I’m in a large Midwest city, even the busiest level 1 center will pay $1k for call. Academic centers have their own salaried guys. Forget about stipend at level 2 and 3s.
 
I’m in a large Midwest city, even the busiest level 1 center will pay $1k for call. Academic centers have their own salaried guys. Forget about stipend at level 2 and 3s.


Anesthesia gets more than that at level 1’s in my area.
 
Got tired reading about surgical subspecialties so sorry if someone said it but if you want to just chart stalk trauma patients and remind people to use more cryo and antifibrinolytics, transfusion medicine deals with trauma regularly.

And forensics! Almost forgot them. The other path subspecialty that deals with trauma. You’re not fixing the trauma obviously (unless it’s a gunshot to the face, they will try and sew that back together for the funeral) but you still get to see it all up close and personal.
 
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depends if you mean 1k as a base pay (plus pay for RVUs) vs. straight 1k regardless. I'd be surprised if any surgeon is working for 1k a call day without additional incentive.
 
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