trauma surg with additional fellowships?

[epsilonprodigy]

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With so much overlap between trauma surgery and CT, ENT, vascular, etc...is it common for trauma surgeons to complete additional fellowships in other applicable subspecialties, thereby enabling them to handle more cases without such extensive consulting, and thus getting more operative time? This is pure speculation, but it seems to make sense that many trauma surgeons would want to be "jacks of all trades," especially since a common complaint is that TS has become largely non-operative. Thoughts? Anyone do this?

 

[LucidSplash]

ENT is a separate surgical specialty pathway; there is no fellowship in ENT from a GS residency.

I have one peds surg attending who did a trauma fellowship at Shock before doing his peds fellowship, but he practices as a pediatric surgeon, not an adult trauma surgeon. He is in his 60s at least and I think he did the trauma fellowship while waiting to get into a peds fellowship.

Otherwise, in my limited experience, I don't know of anyone in trauma/CC that specifically set out to do a separate vascular/etc fellowship to add to their practice. I'm sure there ARE some, but I do not think they are the norm. There is plenty of opportunity to do acute care general surgery to increase operative volume and few people want to extend their training indefinitely just to add another a fellowship skill set that somewhat overlaps with one they already have. Additionally, typically the types of things one calls in CT or vascular for in a trauma patient are things that take some practice to do well, and I think most trauma/CC folks prefer to defer them to their colleagues who do them frequently enough to have a good skill set.

 

[Encephalectomy]

one of the trauma attendings at my school did a one year thoracic fellowship to increase the breadth of trauma he felt comfortable handling, I don't think he does any general thoracic stuff, just trauma/ACS

 

[mimelim]

At the hospital I used to be at we had a Trauma surgeon that also did a Vascular fellowship. She was superhuman though, kept a relatively busy VA/University hospital vascular practice, took Trauma/ICU call, oh and raised 5 kids. She is on my shortlist of heroes. We also had a Peds/Trauma surgeon that took Trauma call (no ICU call) and had a healthy peds surg practice. The rest of our trauma guys (4 others) were dedicated Trauma.

 

[neusu]

Ask the trauma surgeons at your hospital.

Better yet. Do some research of your own. Most academic centers (i.e. trauma centers) have web sites that list the trauma surgeons' training backgrounds. Make a table with the program name, surgeon name, medical school, residency, fellowship(s) and report back to us.

You have 2 weeks.

 

[europeman]

Several of the surgeons at shock trauma are going back for additional training in order to learn IR skills. Two are doing vascular fellowships... And both are several years out. Their purpose is to supplement their trauma skills. Neither wants to do vascuLar. It's just for IR accreditation

 

[ESU_MD]

Thats pretty hardcore to do a vascular fellowship just to be a better trauma surgeon. If you look at the avg salary a trauma surgeon could make, those two extra years in fellowship will wind up costing >$500k in lost wages. Just to possibly be able to embolize someones iliacs once every 2 years? Not worth it financially, but it is cool.

Most of the double skilled trauma guys I know were old CT or vascular dudes who wanted the easy lifestyle of a trauma surgeon, and did the CC fellowship after their original training.

 

[Docgeorge]

With so much overlap between trauma surgery and CT, ENT, vascular, etc...is it common for trauma surgeons to complete additional fellowships in other applicable subspecialties, thereby enabling them to handle more cases without such extensive consulting, and thus getting more operative time? This is pure speculation, but it seems to make sense that many trauma surgeons would want to be "jacks of all trades," especially since a common complaint is that TS has become largely non-operative. Thoughts? Anyone do this?

So I will freely admit that I only read this post and haven't read any further before replying.

At some point in time you have to get off the tit and get into the real world and start to work. Fellowship after fellowship is not going to help you. Can I do a CABG? No but I can repair a ventricular laceration in an unstable patient. Will I fix Le Fort fractures? No but I can pack you posteriorly if you are bleeding from back there. Can I take out a brain tumor? But you can bet your bottom dollar that if no neurosurgeon was available and I couldn't transfer and you had an expanding ICH that I would burr hole you. This is what happens when you have well trained general surgeons.

 

[Docgeorge]

Several of the surgeons at shock trauma are going back for additional training in order to learn IR skills. Two are doing vascular fellowships... And both are several years out. Their purpose is to supplement their trauma skills. Neither wants to do vascuLar. It's just for IR accreditation

Where are they doing this? I would be interested in a mini fellowship for some more expanded skills in IR techniques.

 

[DrNick Riviera]

We have an attending at our county hospital who did his TCC fellowship there, went to a vascular fellowship, and is now back as primarily a vascular surgeon. He still takes trauma call though, but does not attend in the ICU.

 

[Danbo1957]

We only want general surgeons with a Surgical Critical Care fellowship for our Level 1 Trauma team.

 

[ESU_MD]

We only want general surgeons with a Surgical Critical Care fellowship for our Level 1 Trauma team.

Which is ironic since these are usually the ones who cant operate.

Think about it, finish chief year, then spend a year in the SICU, then do a few operative trauma cases a year. You wind up being pretty weak.

 

[ajimd]

I don't think I could disagree more - I suppose it all depends on the program at which you trained. I have found that community/university affiliated programs will still need you to operate quite a bit even during your TCCF year. Yes, I realize that the rules stipulate that you are to do no more than 25% operative, but I can assure you that as a TCCF I did my fair share of colons, gallbladders, VATS...etc. Ended up being able to operate circles around most of our general surgery chiefs... my 2 cents. As for "real world" scenarios, hospitals are looking to hire the "total package" and general surgeons with keen interests in trauma/CC are in demand. Why pay a general surgeon to take out an appendix or put a hot gallbladder on ice when the guy on call at your hospital can do it all. It's called Acute Care Surgery -

 

[Smurfette]

I don't think I could disagree more - I suppose it all depends on the program at which you trained. I have found that community/university affiliated programs will still need you to operate quite a bit even during your TCCF year. Yes, I realize that the rules stipulate that you are to do no more than 25% operative, but I can assure you that as a TCCF I did my fair share of colons, gallbladders, VATS...etc. Ended up being able to operate circles around most of our general surgery chiefs... my 2 cents. As for "real world" scenarios, hospitals are looking to hire the "total package" and general surgeons with keen interests in trauma/CC are in demand. Why pay a general surgeon to take out an appendix or put a hot gallbladder on ice when the guy on call at your hospital can do it all. It's called Acute Care Surgery -

In the real world, the general surgery guys are the ones on call for the gallbladders and appys, and whatever else walks in through the door needing something. Traumas too.

Acute care surgery service models don't work as well in smaller institutions or places that aren't busy trauma centers. Why would hospitals pay for an acute care surgeon to do cases and take call if the general surgeons already are taking call? It works both ways. Most people who want to do an acute care surgery type of set up want to be in a busier, more trauma heavy location.

 

[ajimd]

Agreed. You do need to be at a busy enough trauma center to allow the acute care model to work. The problem is, a lot of general surgeons are not wanting to take the trauma part of the call that a lot of hospital employed surgeons are - i.e. the acute care surgery model. It does work both ways... I think general surgeons are willing to give up the trauma aspect of the call, but keep the non-designated ED consults. I think a lot of places have streamlined their hospital employed surgeons to encompass the GS/trauma and even critical care aspect of it, thus phasing out the ones that don't want to do the trauma. On the flip side, this leaves a lot of general surgeons plenty of time to attend to their elective schedules.