trauma surg

[Winged Scapula]

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from what i gather surgical critical care fellowships are basically non-operative experiences, and most follow this up with a year of trauma surgery. my questions are: do you lose some surgical skill in the year out of the OR? does the trauma surgery year involve emergent surgery only, or does the fellow participate in the general/elective/daily surgery schedule as well? even after five years of residency training, a year seems like a long time to be out of the OR. any thoughts?

k

depends on the program. Most Trauma programs are not separate but rather a combined trauma/Critical care in 1 year - some months dedicated to Trauma and others to ICU settings.

If you are at a program that affords you junior attending priviledges you may very well be doing general surgery as well as trauma, but remember even trauma patients need general surgery procedures, which may or may not be emergent.

Your concerns about being out of the OR are common; my BF is a Trauma/Critical Care fellow who has not been in the OR since June. He's gotten lots of experience doing bronchs, trachs and the like but is worried that when hitting the ORs next month that his skills will have deteriorated. I'm sure you do lose some, but it must come back, especially in busy programs where you're operating all the time.

 

[VAspa]

Let's not fight here gang. Ben Taub and Hermann are both great programs for trauma. The Trauma Registry supports the claim that annually, Hermann receives roughly 30% more trauma admissions than Ben Taub. Part of this is attributed to Life Flight and part due to an out-dated county system that does not provide for enough staffing, forcing Ben Taub to go on divert more than Hermann. As of a 1986 Congressional Bill, ALL ERs must take anyone who shows up in a trauma situation, therefore, the county v.s. private argument is voided. The Life Flight system is the 2nd air-ambulance system in the country and transports most, if not all, major accidents in the Houston metro area to Hermann. Most gun-shots from the not-so-nice parts of town go to Ben Taub. The debate then rages as to which patients are harder to care for, the blunt trauma patient with multiple organ systems damaged or the penetrating trauma patient. Regardless, when it comes to patient care, both provide excellent training in trauma surgery. Faculty at both institutions are brilliant.

Ben Taub supports a neurosurgery training program through Baylor, while Hermann has a staff of Board Certified Neurosurgeons and Neuro PAs on call 24/7. I think this is a null point, unless your interest is neurosurgery, as Hermann does not support a Neurosurgery training program.

I was just kind of peeved that people are trying to build up "their program" simply by chopping another one down. Baylor has lost 3 residents over the course of the last 18 months, and UT hasn't lost any (from what I'm told). Based on that, I wouldn't say UT is "more malignant."

For people going to Houston for training, realize that there are two great training programs in the TMC for surgery. No need to fight about it folks.

 

[praying4MD]

Let's not fight here gang. Ben Taub and Hermann are both great programs for trauma. The Trauma Registry supports the claim that annually, Hermann receives roughly 30% more trauma admissions than Ben Taub. Part of this is attributed to Life Flight and part due to an out-dated county system that does not provide for enough staffing, forcing Ben Taub to go on divert more than Hermann. As of a 1986 Congressional Bill, ALL ERs must take anyone who shows up in a trauma situation, therefore, the county v.s. private argument is voided. The Life Flight system is the 2nd air-ambulance system in the country and transports most, if not all, major accidents in the Houston metro area to Hermann. Most gun-shots from the not-so-nice parts of town go to Ben Taub. The debate then rages as to which patients are harder to care for, the blunt trauma patient with multiple organ systems damaged or the penetrating trauma patient. Regardless, when it comes to patient care, both provide excellent training in trauma surgery. Faculty at both institutions are brilliant.

Ben Taub supports a neurosurgery training program through Baylor, while Hermann has a staff of Board Certified Neurosurgeons and Neuro PAs on call 24/7. I think this is a null point, unless your interest is neurosurgery, as Hermann does not support a Neurosurgery training program.

I was just kind of peeved that people are trying to build up "their program" simply by chopping another one down. Baylor has lost 3 residents over the course of the last 18 months, and UT hasn't lost any (from what I'm told). Based on that, I wouldn't say UT is "more malignant."

For people going to Houston for training, realize that there are two great training programs in the TMC for surgery. No need to fight about it folks.

Agreed. They are both good programs and anyone trained from either of the programs would be competent, I have no doubts about that. I do still maintain however, that simply because of dr. Mattox at Ben Taub, who does not allow an Emergency medicine program at baylor, and also because of our strong trauma program, that baylor is one of few programs in the country that you can go through five years of general surgery and be qualified enough to be a trauma surgeon WITHOUT doing a critical care fellowship, which is pretty amazing. and i have to say, i think it has to do with the fact that baylor's residents rotate through these massive, huge-ass hospitals offering everything: you want kids: TCH, you want old ppl with end stage everything: the VA, you want county trauma: Taub, you want rich ppl and cool new, innovative, cutting edge of research: Methodist and St. Luke's.

 

[kendall]

depends on the program. Most Trauma programs are not separate but rather a combined trauma/Critical care in 1 year - some months dedicated to Trauma and others to ICU settings.

If you are at a program that affords you junior attending priviledges you may very well be doing general surgery as well as trauma, but remember even trauma patients need general surgery procedures, which may or may not be emergent.

Your concerns about being out of the OR are common; my BF is a Trauma/Critical Care fellow who has not been in the OR since June. He's gotten lots of experience doing bronchs, trachs and the like but is worried that when hitting the ORs next month that his skills will have deteriorated. I'm sure you do lose some, but it must come back, especially in busy programs where you're operating all the time.

thanks kimberli. in reading bits about fellowships on FRIEDA and EAST, it looks to me like the one year "trauma" fellowships (Cook County etc...) are of the nature you describe. the 2 year surgical critical care/trauma fellowships appear to be quite different. apparently the ACGME requires that SCC fellowships be no more than 25% devoted to direct operative care. several of these programs make it clear that 11 months of the SCC year will be non-operative. and as you mentioned many of these programs give the fellows that stay for the 2nd year (trauma year) junior attending or instructor of surgery status, which likely affords them more time in the OR. so, now i have some new questions. which is the better route? does it matter that there is no board cert. for the "trauma surgery-only" fellowships? is research likely the biggest difference between the two types? which type is the most competitive?

thoughts?

k

 

[DO_Surgeon]

What is the work schedule for a trauma surgeon? Is it similar to ER where you work in 12-24 hour shifts "x" times a month and off the other days? Or do most trauma surgeons have a general practice along with covering the trauma center? So is their salary similar to a general surgeon plus any additional pay from covering the traumas that may come in (similar to moonlighting)?