trauma surg

[kendall]

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hello all! first time poster here. i wanted to get some info on the life of fellowship trained trauma (general) surgeons.
-what are the hours like? i know that trauma is a night time job, but do they work only at night? do they have elective schedules during the day? are all trauma surgeons in academia, or do some join multi specialty surgical practices (to cover trauma call)? what is the difference in pay between a gen surgeon and a trauma surgeon? how competitive are trauma surg fellowships? any other info would be great also. thanks!!!😕

 

[unregistered]

While the topics up...

Can anyone give info on the best trauma programs out there - ie, those programs where I won't need to do a trauma fellowship? Where theres also good teaching...

So far, I've heard great things out of Ryder trauma in Miami, and UTSW Parkland

(I'm making my list of gen surg programs to apply, thanks)

 

[Winged Scapula]

Originally posted by kendall
hello all! first time poster here. i wanted to get some info on the life of fellowship trained trauma (general) surgeons.
-what are the hours like?

Depends on the local climate, the season, and your group/practice type. For example, you can expect to be busier at a Level I Trauma center in a rough "inner city" environment, especially if you also have a wide geographical referral base, than you would at a smaller hospital. Summers tend to be busier due to more people traveling, "heat of summer" arguments, etc.

i know that trauma is a night time job, but do they work only at night?

Trauma is by no means only a "nighttime job". Trauma can and does occur at any time of the day - although there do tend to be predictable times, especially for MVAs (ie, during the before and after work rush hours, and around 3 am - a short while after the bars close). Industrial accidents occur throughout the day and night as well.

Thus, trauma surgeons can be busy day and night. In a typical university setting, you will be the first call for at least 24 hours (ie, through the day and night). You may do nothing surgical that entire time, work through the day and sleep all night, or the reverse.

do they have elective schedules during the day?

Because trauma surgery is increasingly non-operative, most Trauma surgeons also do general surgery during the day. This can include anything from choles, appys, colon surgery, gastric bypass, etc. They are general surgery trained and most are required by their employer to utilize those skills. Others serve as critical care consultants and do mainly ICU work.

are all trauma surgeons in academia, or do some join multi specialty surgical practices (to cover trauma call)?

Most Trauma surgeons are employed by a large hospital - which often has a residency training program. However, there are smaller centers which do not have Trauma surgeons on staff or cannot cover their call schedule and will frequently hire out moonlighters to cover their Trauma. General surgeons with an interest or fellowship training in Trauma may work in this type of environment as well as their regular daily practice.

what is the difference in pay between a gen surgeon and a trauma surgeon?

Depends on the environment. Trauma surgeons are not amongst the best paid but generally if fellowship trained they can earn several thousand more a year than general surgeons. Perhaps someone else has links to recent pay scales. Moonlighting, or taking Trauma call can often be quite profitable.

how competitive are trauma surg fellowships?

Not very.

In response to unregistered, I'd imagine any place with good Trauma programs would also give you a residency experience...consider Baltimore, Penn, Jacksonville, Cook County, Houston (Ben Taub), Memphis, Temple, Orlando (I was suprised too), and of course, La County Gen and Miami.

 

[scutking]

Some of the busiest trauma centers include: LA County (USC), Charity (Tulane and LSU), Parkland (UTSW), Grady (Emory), Ben Taub (Baylor), Ryder (U. of Miami), Presley (UT-Memphis), and Cook County. Train at any one of these programs and you'll get excellent trauma training.

 

[fourthyear]

I agree with all of scutking's list above. You will see tons of trauma at these places.

 

[kendall]

that was great info. what about trauma surgeon malpractice insurance premiums? i've heard that they are among the worst, but i've also read "trauma surgeon wanted" ads that said malpractice was paid by the hospital. is that standard?
also, could you explain why trauma surgery is becoming more non-operative. and lastly, what do you think about trauma surgeons in underserved (rural) areas performing life saving procedures that in better served areas would be performed by neurosurgeons? i read something about it recently, and i live in kentucky, where a large portion of the state is considered to have a critical shortage of physicians. subsequently, trauma victims are often too far away from a neurosurgeon to risk transport.

 

[droliver]

Malpractice insurance cost is somewhere in the middle of the general surgery specialties. It is less then Vascular, Cardiothoracic, or Bariatric practice rates. Places who are more desperate to maintain their trauma system level accredidation (ie. Level I,II,III,etc..) might cover your malpractice, these are usually the level 2 or 3 hospitals in smaller areas that rely on their status for some of the billing privledge that goes along with it for certain care & reimbursements.


The argument over how much is too much care to deliver in the field by other providers (physicians, EMS, and others) is both a practical and political one. Numerous different studies have shown that wasting time with many things that delay transport cost lives ( xrays,lines,fluid resuscitation, & even intubation in some cases). On the other hand you see some people die from blunt abdominal trauma in transit who should have been explored & stabilized prior to transfer. It's amazing sometimes when a transfering facility can sometimes have programs that do open-heart surgery, abdominal & thoracic aneurysms, and advanced laparoscopy suddendly feel uncomfortable taking out a lacerated spleen. Burr holes for decompression and ER thoracotomies are some of those things you see written about as life-saving manuevuers, but for the most part if its not a neurosurgeon or thoracic surgeon doing those manuevers, you're going to die. Polling some trauma Neurosurgeons here on this point, they agreed to a person that burr holes are pretty futile in their opinion for salvage & that you can make potentially treatable injuries more complex from iatrogenic damage to the brain doing it in most peoples hands

 

[kendall]

i see that your location is louisville, so you are undoubtedly aware of the physician shortage in eastern ky. the paper i read recently was speaking specifically about trauma surg in montana, not kentucky. however, the decision to operate or transport must be an issue in some of the more far reaching counties of the state sometimes. also, the paper i mentioned was actually talking about trauma surgeons performing cranis (not just burr holes). do you think that STATFLIGHT (and the other aeromedicals) delivering trauma vicitims from far eastern ky to lex or lou is always the best bet. those choppers are fast, i know, but still we're talking about an hour or more transit sometimes.
while i have the ear of a ky physician, i would like to know what you think of the opening of the osteopathic school in pikeville. i''m not wanting to start one of those MD vs. DO threads, so please anyone/everyone let's not go there. just wondering if ky doc's think it is a good thing, will the impact on ky healthcare be positive, is it necessary for physician attainment/retainment in underserved areas?
also, are you at U of L, droliver?

-kendall

 

[womansurg]

Originally posted by droliver
ER thoracotomies are some of those things you see written about as life-saving manuevuers, but for the most part if its not a...thoracic surgeon...you're going to die

I'd have to disagree with this. Only a tiny - very tiny - fraction of ED thoractomies are performed by thoracic surgeons. The vast majority are performed by trauma surgeons and ED physicians. The survival rate of a penetrating chest wound with witnessed arrest and ED thoractomy is around 30 to 40%. Blunt trauma, of course, is far lower at about 2%. Would survival rates be higher if all ED thoracotomies were performed by thoracic surgeons? Perhaps. But that's not the reality of how a trauma patient presents and is triaged.

One of the urban legends of my program involved an internal medicine intern who stepped up and cracked the chest on an arresting gunshot victim as the ED doc was decompensating. (The surgery resident hadn't yet arrived). Released the pericardial tamponade and the guy survived to fight another day.

 

[droliver]

Womansurg,

I think you took my comment out of the context I was talking about (hospitals that aren't trauma centers).You're cherry picking a very small sub-group out for those rosy survival rates & extrapolating the experience from level I trauma centers to the community & beyond( ie. rural Eastern Kentucky in this case). If large recent series in experienced facilities can go 0 for 93 with ED Thoracotomies (all-comers) for GSW (Wayne State in J Trauma. 2000 Apr) you can imagine your chances declining precipitously even for favorable scenarios (precordial stab wound with ED arrest) where there's 1) an ER physician who would have to attempt it, 2) no surgeon in house, 3) no OR ready to take the patient to if you successfully do it, 4) no bypass capability most likely, 5) +/- blood & blood product availability.

Clearly as you point out, the procedure can be a life-saver when done appropraitely. I was just emphacizing what I feel is a pragmatic look at it when you get away from facilities with the mechanism set up to treat these.

I don't know about yourself but I've been pretty discouraged when I've seen them done. The ones I've done have all had huge ventricular wall disruptions that exsanguinate rapidly when you release the tamponade. Damned if you do....I guess

W.S. nice to see you still have time to come play here now that you're earning the big bucks🙂

 

[zorro21]

is there an offical list of trauma fellowships on the internet? i am pretty sure that trauma is a 5 yr general residency plus a trauma fellowship. if this is incorrect, please let me know.

 

[maxheadroom]

There is no official "trauma" fellowship or board exam/CAQ. Most trauma surgeons (the old school ones) are Surgical Critical Care specialized. Newer trauma surgeons are going to 2 year fellowships that include both Trauma surgery and Surgical Critical Care. I don't think FREIDA contains trauma fellowships, but you might look. You might also check:

http://www.trauma.org

 

[Winged Scapula]

Originally posted by zorro21
is there an offical list of trauma fellowships on the internet? i am pretty sure that trauma is a 5 yr general residency plus a trauma fellowship. if this is incorrect, please let me know.

You are correct. Most trauma surgeons are general surgery trained (5+ years) with further trauma training (1-3 years).

There is no BC in Trauma. Most trauma programs either combine Trauma/Critical Care into 1 year (which is usually 9 months of SICU and 3 of Trauma Surgery) or longer programs (some requiring research). Trauma.org has the most comprehensive list of programs; they are not listed on FREIDA except as Surg Crit Care. Also check out www.east.org

 

[Fah-Q]

Just FYI on the Houston trauma scene...Hermann (UT-Houston) sees more trauma than Ben Taub (Baylor). I couldn't qoute you exact numbers but I do know that Hermann sees more blunt trauma than any other hospital in the country. If its volume you want in a fellowship, go to Hermann...those damn helicopters never stop coming. I wouldn't recommend UT-Houston's general surgery program though, very malignant.

 

[droliver]

Fah-Q,

if I understand it correctly, isn't the penetrating trauma almost exclusively diverted to Ben Taub?

 

[trauma_junky]

Originally posted by Fah-Q
Just FYI on the Houston trauma scene...Hermann (UT-Houston) sees more trauma than Ben Taub (Baylor). I couldn't qoute you exact numbers but I do know that Hermann sees more blunt trauma than any other hospital in the country. If its volume you want in a fellowship, go to Hermann...those damn helicopters never stop coming. I wouldn't recommend UT-Houston's general surgery program though, very malignant.

This is because baylor has no Neurosurg, it's all Herman. Also Herman has life flight, so anytime they get called to a scene, it's going to Herman.

 

[Airborne]

Just curious -

What do you mean that they have no N-Surg at Baylor? Do you mean residents or attendings? I ask this because I'm to interview there soon, (for a surgical subspecialty) and want to ensure that the support is there for both scheduled and emergent cases -

Please enlighten....

Airborne

 

[trauma_junky]

Originally posted by Airborne
Just curious -

What do you mean that they have no N-Surg at Baylor? Do you mean residents or attendings? I ask this because I'm to interview there soon, (for a surgical subspecialty) and want to ensure that the support is there for both scheduled and emergent cases -

Please enlighten....

Airborne

But a simple google search has proved me wrong. Apparently Baylor does have a neurosurg program so I don't know why it is advised to send all heads to Herman.

Here is the link:
Baylor College of Medicine Neurosurgery Residency Program

 

[DO_Surgeon]

I have a question regarding fellowships in general. Are they MD/DO specific? I am a third year at DMU and considering general surgery. If I wanted to do a fellowship, such as trauma, are there DO fellowships or do MD's and DO's apply for the same programs. I did not take the USMLE, thus plan on doing an osteopathic residency, so after residency would I be eligible for any type of fellowship? If there are only DO fellowships, where can I find any info on them?

 

[Been there]

I don't think there is different between MD or DO for trauma fellowship. Most surgeon doing trauma aren't not fellowship trained. If you want to do a fellowship, I don't think they will care which degree you have. They are really hard on for fellows in some less desirable program.


ED thoracotomies have their roles. I did one, and repaired the right ventricle, and he lived to gang bang another day.

 

[Foxxy Cleopatra]

There is an enormous amount of babysitting in trauma. I was very surprised because I had the exciting images in my mind of running to the OR to explore abdomens, thoracotomies, etc. My program has a relatively high amount of penetrating trauma, but most of our patients still have mostly blunt issues (broken limbs, vertebral fractures.)

This means that they are admitted to us, but ortho does all of the fun stuff while we get to worry about bowel regimens, coordinating with the discharge planner, being kept on hold to find out if it is okay with ortho to clear the pt's c-spine. It made me want to pull out my hair.

Our trauma surgeons do a great job when the need arises- I would want them operating on me if I came in with a GSW to the abdomen, but I secretly think they are a whole lot more patient than they let on because you couldn't pay me enough to spend most of my time babysitting for ortho and neurosurgery. They never wanted to return their pages! 😱

 

[bryanboling5]

In response to the discussion about Trauma in KY....

I am a pre-Med at UK and I work as a tech in the ER here. I see a lot of trauma patients come in after spending considerable time since intial injury. This is often due to the patient going (sometimes by county EMS "protocol") to a local hospital first. Now, this COULD be a very good thing if they recieve good care at the facility. But, more often than not, they simply lay in the ER for a few hours while the doc there (who is really afraid to mess with "trauma") calls and talks to the Trauma service here. Then the patient comes to us. I think that this delays care quite a bit. I think it would greatly benefit KY to establish a trauma network of level 2 and 3 centers that would then feed bigger cases to UK and U of L. Thoughts?

Sometimes I'm VERY afraid of being injured in this state outside of Lex or Lou. We got a patient the other night who came from an outlying and the report we got from the RN AT THE OUTLYING ER was that the patient had a blood pressure of 67/68! That's one of MANY great stories I could tell about the outlying hospitals.

BTW, I'm interviewing at U of L in a month and I don't know much about the school. Can anyone give me the inside scoop?

Bryan

 

[maxheadroom]

Costs lots of money to maintain the ancillary staff and physicians necessary to make a center Level 2 or even Level 3. Sure, it would be great to have a more extensive trauma network in lots of states, but it probably won't happen anytime soon. Politicians make a lot more hay by funding prescriptions for seniors and getting better Medicare benefits than providing trauma care for the rural poor.

 

[LaCirujana]

Originally posted by bryanboling5
In response to the discussion about Trauma in KY....

Sounds like trauma in Michigan. States out West have trauma figured out much better: centralized trauma centers that bypass the podunk pit stops where no one knows how the hell to even stabilize the patient, let alone manage them appropriately.

 

[bryanboling5]

Originally posted by LaCirujana
...podunk pit stops where no one knows how the hell to even stabilize the patient, let alone manage them appropriately.

Well, it's good to know that this isn't limited to KY! I could tell all sorts of scary stories of the stuff we've gotten in report from outlying hospitals. My favorites always involve the GCS. I always love it when a patient is given a GCS of 16. I guess that means, spontaneous eye opening, alert and oriented, following commands and has ESP? The other day we got a report of a patient coming with a GCS of 2. When we informed them that the lowest GCS you could have was 3, they replied (dead serious), "I know, but he's REALLY sick, so we figured he 'ought to be a 2."

 

[md03]

Boy, where I went to med school (big trauma center in SE) stories like that occured daily!

For example, one rural hospital transfered a pt to us with a "head lac" as the only injury. It was accepted, the policy being to take all transfers cuz you can't rely on the info given to you by the outlying places (sometimes even by the urban EMS). When the pt arrived at the trauma center, guess what was coming out of the head lac (which nobody bothered to mention to us!)? You guessed it.....grey matter.

Or on another occasion, the city EMS reported bilat near amputation of LE. Pt arrived and we found only a deep laceration in one butt cheek. Both LE were firmly attached and intact.

Or how 'bout the guy seen first at an outlying hospital with a head injury. They got a head CT which showed a midline shift. They kept the pt in the ED for several hours after that, and then rescanned his head. Guess what? The midline shift was bigger! (Imagine that!). After the second scan they decided to send the pt to us.

I could go on. But I won't

 

[DO_Surgeon]

So is it safe for me to assume that I could do an osteopathic residency in general surgery and be eligible to apply for any type of fellowship MD/DO? Where can I find the best info on trauma fellowships? trauma.org? Thanks all!!

 

[kendall]

check out FREIDA online at:

http://www.ama-assn.org/ama/pub/category/2997.html

it has info on all residency and fellowship programs.

k

 

[Been there]

Originally posted by DO_Surgeon
So is it safe for me to assume that I could do an osteopathic residency in general surgery and be eligible to apply for any type of fellowship MD/DO? Where can I find the best info on trauma fellowships? trauma.org? Thanks all!!

Yes, you can, but you will not be boarded if you go thru a DO-gen surg residency.

The problem is the American Board of Surgery will only board a surgeon who has gone thru an ACGME residency. This means if you do an ACGME fellowship in trauma with DO-gen surg residency. You won't be able to sit for the board.

Try www.east.org

 

[droliver]

There is no "board" for trauma as such, many programs do include eligibility for critical care medicine boards if they're 2 year programs

 

[DO_Surgeon]

Ok, I am now somewhat confused. Yes, I can do an MD fellowship in trauma after a DO general surgery residency. But I dont have to worry about being "board certified" in truama because there is no such thing? I have always wanted to general surgery, and I just got done doing a rotation with a surgeon who did a fellowship at Shock Trauma in Baltimore which sparks my interst after watching him during some critical moments. I just want to make sure that being a DO and not taking the USMLE would hinder my chances of doing a fellowship in trauma following residency. So if I understand everything correctly, there is no board certification and being a DO doing an osteopathic residency will not hurt my chances of doing a fellowship?

My second question is how "accepting" are programs such as Shock Trauma, Ryder, and others in taking DO surgeons?

 

[Been there]

Originally posted by DO_Surgeon
Ok, I am now somewhat confused. Yes, I can do an MD fellowship in trauma after a DO general surgery residency. But I dont have to worry about being "board certified" in truama because there is no such thing? I have always wanted to general surgery, and I just got done doing a rotation with a surgeon who did a fellowship at Shock Trauma in Baltimore which sparks my interst after watching him during some critical moments. I just want to make sure that being a DO and not taking the USMLE would hinder my chances of doing a fellowship in trauma following residency. So if I understand everything correctly, there is no board certification and being a DO doing an osteopathic residency will not hurt my chances of doing a fellowship?

My second question is how "accepting" are programs such as Shock Trauma, Ryder, and others in taking DO surgeons?

DRoliver is right there is no board certification for trauma, and the board cerfications are for critical care. Most trauma fellows I know use the fellowship for CC board. Some programs are two years, but I think most are still accrediated for only one which is the CC year. Therefore, many programs combine the two into one year. This means if you do a AOA G-surg residency; you will not be able to sit for the CC board. As far as I know, trauma fellowships are not very popular.

 

[droliver]

Most programs that get accredited for the critical care boards are 2 year programs. I'm not even sure if the one year fellowships in trauma can sit for them due to some regulatory issues with the fellowships (I could be wrong, anyone know of a one year program with one?) where you must do a certain % of your time doing various lab work, patient care, etc.... I think all the big programs are two years.

The competition for these spots is not very much except for just a very few programs, and in many cases they'll take anyone they can get if you're interested. Of note, I think Vanderbilt has a wierd endowed program that pays off a good chunk of student loans & makes it an extremely competative one (I think they usually are lined up several years ahead of time for the position).

I'm not sure you'd be able to sit for the surgery critical care boards for the allopathic schools, but maybe there is some AOA equivalent that might let you sit for something

 

[DO_Surgeon]

So if I have this all figured out, it would pretty much be a waste of my time to try to do a trauma fellowship as a DO doing a osteopathic residency. It wouldn't really count for much since I will not be able to sit for any type of boards.

Again, maybe a stupid question but what does it matter if one is board certified? Could I do a one year trauma fellowship for the experience and training without sitting for the boards, or am I way out in "left field" with that idea?

 

[Been there]

not stupid at all, that is what I been trying to tell you. You can gain experience during the fellowship eventhough you can not sit for the CC board.

Also remember trauma fellowship is not essential for a trauma surgeon.

 

[supercut]

Only one year of fellowship is needed to sit for critical care boards. You must be a board certified general surgeon first, though.

 

[dr.evil]

Baltimore Shock does have a one year critical care fellowship.

 

[pjr]

while board certification is important for large academic hospitals where you would be doing critical care (i.e. covering as SICU attending for certain months), it isn't so important for places where you cover mostly trauma and burns. many trauma surgeons at large centers are indeed only (i use the word "only" sort of tongue-in-cheek) trained in general surgery, but trained in places where trauma was a good chunk of their residency. the fellowship without the critical care year is a feather in your cap if you are job hunting for trauma spots, but is by no means necessary.

 

[Habeed]

Essentially, if one wanted to do trauma because the time limited nature of the procedures mean skill plays a greater role than usual in outcomes (basically, if the patient is dying NOW, a master surgeon who can think on the fly and make the best choice will get far better outcomes than someone who can only basically memorize textbooks) the system will let them? "All" one has to do to devote their life to saving lives in intense situations is to make it to and through med school and get a general surgery residency, no matter how crappy (the med school or the residency)?

If one were an addrenaline junkie and interested in medicine mainly for this aspect, as well as an avenue to fully utilize their talents, trauma surgery is the place to go?

Why isn't it very competitive? I mean, surely everyone wants to do high risk surgery at night, right? Succeeding would certainly give a bigger ego boost than a lap chole or something, eh.

 

[supercut]

Nope, most surgeons dislike trauma. First of all, the trauma population can be an extremely difficult bunch to work with. A large part of the population is the knife and gun club (who inflict trauma on one another), or people who do incredibly stupid things and inflict trauma most commonly on innocent bystanders (though sometimes they are the victims of their own stupidity).

Add to that the fact that trauma call is usually in house call, even at the attending level.

Then realize that for every adrenaline rush act now or pt will die save in the middle of the night, there are a number of pts who don't require operations, or whose only injuries are ortho and or neurological. THe trauma surgeon is the one who manages these pts global care, even though s/he hasn't operated on them. Plus the trauma surgeon often takes care of these pts in the ICU as well.

Many surgeons dislike ICU care. Many surgeons dislike in house overnight call. Many surgeons dislike operating under uncontrolled condidtions.

Most people would prefer to do operations that are scheduled, controlled, with minimal blood loss and operate on people with some semblance of intelligence. Most people prefer doing routine operations without any complications.

A lot of people start out thinking trauma, and then quickly burn out or realize that these drawbacks I've listed are things they aren't willing to deal with.

Having said that, there are some weridos like me who acutally like operating on super sick pts under uncontrolled circumstances and don't mind the (or like) the ICU stuff (and in house call) and aren't bothered too much by stupidity. These are the people who usually wind up in trauma.

And no, you probably couldn't be a trauma surgeon just by finishing any crappy residency. Not at a big center with a decent amount of trauma anyway. Trauma requires a set of skills and knowlege that can be different from other areas of general surgery. You'll have to have had enough experience with damage control surgery during residency to be able to get a trauma job afterward.

 

[Daniel vD]

Originally posted by supercut
Having said that, there are some weridos like me who acutally like operating on super sick pts under uncontrolled circumstances and don't mind the (or like) the ICU stuff (and in house call) and aren't bothered too much by stupidity. These are the people who usually wind up in trauma.

Sounds like fun to me. 😉

I wonder how it can be that people don't like working like that. To me, it sounds very interesting.
Not knowing what your next patient will have. Working all specialties, because that's what trauma is all about.
At least, that's what it is here in the Netherlands. The ED is primarily an advanced 'family practice' place, where people with all kinds of things, ranging from IM to neuro, from ortho to infectious diseases receive their initial treatment. That's what attracts me to it: you get to deal with the acute things of all specialties. Which, in fact, makes you a sort of advanced family physician. Which, somehow, attracts me.

 

[JKP]

Hello, just wondering whether anyone has any advice for an MSIII contemplating EM vs. trauma surgery...

😴 😱

 

[supercut]

I had the same dillema.

After attending talks about EM, I finally realized that there was a lot of EM that I didn't like and when I thought about EM I was primarily thinking about trauma.

In EM, you will participate in the initial stabilization of trauma pts. However, the more unstable the pt, the quicker they will be wisked off to the OR and your involvement will end. EM also deals with medical issues. MI, stroke, DKA. However, the vast majority of pts who come to the ED do not acutally have an emergency. They will come for a variety of reasons...no insurance, can't be bothered to see there PCP during the day, or to get a Rx for an OTC med that's covered under medicaid if they have a Rx but the rest of us have to pay for ourselves. People easily become irate over long waits while you treat the people with real issues. Most of the pts in the ED are there with minor problems and/or primary care problems. As an ED resident you will rotate in an ICU but you will never actually work in an ICU. You see pts, and then never follow up on their care. EM residency is 3-4 years. Hours are better than surgical residency hours, and most attending hours are better as well.

Trauma surgeons take the trauma pts to the OR and operate on them. They also care for them in the ICU. Many times, pts have no belly injuries and have ortho/neuro injuries. Ortho/neuro operates on them and then drops the pt of in the ICU for the trauma surgeon to take care of. You'll follow the trauma pts for their entire hosptial course and also afterward in clinic. At many places, (and at an increasing number of places) the trauma surgeons are also taking the emergency surgery (appys, SBO, perforated GI tract, etc). Depending on where you practice, your surgical trauma may also include thoracic and vascular injuries. To be a trauma surgeon you need to do a 5 year general surgery residency. If you want to work at a bigger trauma center, you'll need to add a 1-3 year fellowship. GS residency hours are worse than EM. As an attending you may very well have 24 hour in house call.

Questions to ask yourself
Would you be happy in a career where you never set foot in the OR again?
Is it the inital management of trauma that appeals to you? Would you be statisfied or dissatisfied with spending 10 min helping to stabilze a GSW pt under the direction of a surgeon and then have the pt wisked away?
How do you feel about other aspects of surgery? Could you do OK in a surgical residency to get through to being a trauma surgeon?
Would you mind seeing a pt at 3am who called EMS to come to the ED to get an Rx for OTC lice shampoo?
How do you feel about never having to do any followup on any pt you see?

I realized that I the drawbacks of EM for me were worse than the drawbacks of surgery. And I would want to go to the OR with any pt I saw in the ED that surgery took to the OR (basically, that I would not be happy never going to the OR again). And I'd be really, really angry at the idiot who calls EMS for lice shampoo (true story, too). Somehow, I dont have the same anger at people who shoot each other. Don't know why.

Now that I"m almost finished with year 1 of a GS residency, I don't regret my decision at all.

Anyway, good luck with your decision.

 

[JKP]

Thanks, supercut. I appreciate your reply and the time you put into it.

Are you thinking about going into trauma surgery and what other career paths are you thinking about? Having almost finished your internship, what were your expectations going in and how have your experiences changed your perspective?

 

[erdoc61]

Good advice above. Weigh the pros and cons of each. (there are plenty of both). I chose EM because, in the end, the cons of surg outweighed the pros in my mind. Everyone is different. I'm more interested in the initial workup/resus anyway. I didn't like the idea of doing basic gut surg most of the time. Remember, very few trauma surgeons do trauma exclusively.

There are also options for EM. Shock-Trauma Center in Baltimore (one of the top places for trauma in the world) offers a fellowship for EM grads in Trauma/Critical care. These grads often go on to serve as attendings with their time split between the ED and the ICU (the best of both worlds.) There's a big movement in EM right now to get more of this. Look on the EM boards for more info!

In the end. Be sure that you're happy with your decision. Don't look at what you missed by going into one or the other. Focus on what you gain.

 

[runnermoore]

SUNY Downstate in Brooklyn, tons of trauma at Kings County and they are going to open a new ED and ORs in the next year.

 

[phillymed]

for trauma surg. attendings, how does their weekly schedule breakdown?
I now they do 24hr in house call. I assuming that they rotate through trauma on a weekly basis. I am basicly debating between Surgcial vs MICU/CCU.

 

[Apollyon]

The trauma attendings at Duke are a varied bunch: one is General and SICU, another ShockTrauma fellowship trained, another vascular, and another plastics (and a few others I forgot); they all do their respective "thing", and trauma in addition. I haven't seen anything but the same high level of care.

 

[praying4MD]

Just FYI on the Houston trauma scene...Hermann (UT-Houston) sees more trauma than Ben Taub (Baylor). I couldn't qoute you exact numbers but I do know that Hermann sees more blunt trauma than any other hospital in the country. If its volume you want in a fellowship, go to Hermann...those damn helicopters never stop coming. I wouldn't recommend UT-Houston's general surgery program though, very malignant.

Gonna have to disagree on this one. Do you have any real stats to back up your claim that "Hermann sees more trauma than Ben Taub?" Ben Taub is still completely a public, county hospital and Hermann is no longer completely public. It has private affiliates. So if it is County style trauma on a friday night you're looking for, Ben Taub beats out every single hospital in the state. Period.

If you are referring the fact that there is no "ER" residency program at ben taub, that is because the head of ben taub trauma has declared ER medicine redundant and the domain of trauma surgeons only. he is pretty strong about this, but has his loyalties to trauma surgeons [um, he is one.] but, actually this will be changing in the next few years for sure.

Basically, Ben Taub is where the **** hits the fan and where it's trauma-- county style.

Also, OF COURSE baylor has a neurosurg program. Sheez.

As far as malignancy-- isn't every surgery residency program? 😉

don't mean to be rude about all this, but you made some pretty bold statements about Ben Taub that should be backed up with facts if they are indeed true.

 

[kendall]

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