Trauma Surgery!

[Dupree]

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I am/was interested in cardiac surgery (haven't decided yet if I'm completely giving up on the career despite alll the problems in the field).

Recently though I've become interested in trauma surgery for some reason I can't adequately put into words. Maybe because cardiac surgery was sooooooo routine (I could almost set my watch to how routine those CABG operations were).

I had done a lot of investigating on a career CT surgery and I'm now starting to look into trauma surgery. If anybody here wouldn't mind giving me some advice, I would like to hear from you. Some specific questions I have are:

1. What is the difference between a 'trauma surgery fellowship' and a 'surgical critical care fellowship'? I sometimes see them listed separately and sometimes they are combined into one fellowship.

2. What is the nature of what a trauma surgeon does? Yes of course handle trauma, but I've heard some disconcerning things like they don't really handle trauma because when a person comes in with a head injury then neurosurgery is called in, and when a person comes in with multiple fractures then orthopedics takes charge. I'd like to know what is specifically the role of a trauma surgeon. I'm hoping it's more than babysitting a trauma patient until the other subspecialties arrive.

 

[doc05]

sooooooo routine? routine is a good thing. plus CT is doing much less CABG these days, and those patients are usually more complex. plus valve reconstruction, aortic surgery, lung/esophageal cases, how is that "routine"?

trauma surgery sounds exciting to medical students, but so many traumas are not operatively managed, plus you babysit patients for other services. when you do operate, it's when the s--t hits the fan, and that's not something you want to do for your entire career. it will get old real fast, and you'll eventually burnout.

 

[Pir8DeacDoc]

The above post sums up my thoughts pretty nicely. I thought it had a certain appeal before the rotation, but once you see it, it's not all that exciting. Basically they do the primary and secondary surveys on incoming trauma patients (usually just supervise while a resident or med student does it). Then they take them to the scanner and make sure nothing needs to be operated on. If needed, surgery. If specialist needed, call them. If no surgery, then you get to babysit until they go home in a few days.

The crititcal care side of things is where it can be tough. They manage all the SICU patients at our hospital. Lots of rounding and lots of changing of vents and stuff like that. Not the blood and guts that you had in mind most likely. .

Oh yeah BTW, the normal cases here that they do are things like debridement, trachs, pegs, etc. Overall many of them strike me as a bit more cerebral and internist like that surgeon like. They provide a very valuable service to the hospital, but it's most likely not the stuff you see on ER or what you had dreamed about.

 

[Winged Scapula]

Some specific questions I have are

:

1. What is the difference between a 'trauma surgery fellowship' and a 'surgical critical care fellowship'? I sometimes see them listed separately and sometimes they are combined into one fellowship.

A Trauma Surgery fellowship focuses on the initial rescuscitation and management of patients involved in a variety of trauma. These fellowships will have varying amounts of critical care time but without at least 9 months you are not eligible to sit for the Critical Care boards. These fellowships are usually only open to those who have completed surgical residencies. Trauma Surgery is not a board certified specialty.

A Surgical Critical Care fellowship focuses on the continued management of surgical patients requiring intensive management. It generlaly does not focus on surgical/OR management but you will often be trained to do endoscopy, trachs, PEGs, etc. on your patients. These fellowships are open to surgeons, ER and Anesthesiologists generally. Completion usually makes one eligible for sitting for the Critical Care Boards.


2. What is the nature of what a trauma surgeon does? Yes of course handle trauma, but I've heard some disconcerning things like they don't really handle trauma because when a person comes in with a head injury then neurosurgery is called in, and when a person comes in with multiple fractures then orthopedics takes charge. I'd like to know what is specifically the role of a trauma surgeon. I'm hoping it's more than babysitting a trauma patient until the other subspecialties arrive.

It really depends on where you practice. If you're at a Level 1 trauma center, and a MVC comes in with a head injury, then primary management will generally be done either by the Trauma team with Nsgy on board, or by the Nsgy team alone. Any Nsgy procedures are done by the neurosurgeons. Same goes for Ortho injuries; the orthopods will be taking the patients to the OR.
However, with penetrating trauma, at a busy center, you can be operating all day and night (my BF is a fellow and when he's on trauma service I never see him, he doesn't eat or sleep. they have enough penetrating trauma to keep them busy).

In areas without trauma centers you will either stabilize the patient until he can be transferred to a trauma center or if you have done some additional training or rural general surgery work, you have priviledges at your hospital to do some routine ortho or vascular procedures. If the patient doesn't have injuries which require a specialist (ie, a neurosurgeon, ortho, pediatric surgeon, etc.) if they should need an ex-lap, it would be your job.

A hospital with mostly blunt trauma (like Hershey) will see most of its cases going to the OR withOrtho and Neurosurg. If you like the knife and gun club type places, then you will be doing a fair bit of ex laps, wound explorations and chest crackin's.

 

[Disco]

i did a month in trauma this past year...it was a lot of fun. BUT the majority of cases did not even go to surgery. those that did were usually ex-laps to identify and stop bleeding for pts with gunshot wounds, stabbings, and MVC's.

This does involve a lot of consults. Example: Lady comes in, she's been shot in the abdomen, hand and pelvis. Trauma surgeon does a laparotomy to find bleeding. Interventional radiology called to embolize an artery in the pelvis. The trauma surgeons do a hemicolectomy or place a colostomy. Over the next week the trauma team takes her back to the OR to do abdominal washouts. At the same time plastics is consulted to fix her hand and do a muscle flap/skin graft to fix the defect in the pelvis.......
So yes, there are a lot of consults and working with other teams, but I didn't feel like I was babysitting the patients or doing triage for other specialties (thats what Emergency Medicine looks like, in my opinion).

Thing to consider: You will have in-house call the rest of your life, even if it is just once a week (alternating with other attendings). Forget about just being on the pager at home. This is an obvious point, but sleeping at the hospital when you're 50 or 60 years old might not be what you had in mind.
hope that helps, and don't forget, this is all coming from an MSIII.

 

[mddo2b]

I am/was interested in cardiac surgery (haven't decided yet if I'm completely giving up on the career despite alll the problems in the field).

Recently though I've become interested in trauma surgery for some reason I can't adequately put into words. Maybe because cardiac surgery was sooooooo routine (I could almost set my watch to how routine those CABG operations were).

I had done a lot of investigating on a career CT surgery and I'm now starting to look into trauma surgery. If anybody here wouldn't mind giving me some advice, I would like to hear from you. Some specific questions I have are:

.1. What is the difference between a 'trauma surgery fellowship' and a 'surgical critical care fellowship'? I sometimes see them listed separately and sometimes they are combined into one fellowship

In most cases they are combined into one fellowshi with the majority of time spent in critical care. However, some programs offer a second year for research and an increased exposer to trauma.Also, most programs are expanding to include emergency surgery, which allows you to stay in general surgery.



2. What is the nature of what a trauma surgeon does? Yes of course handle trauma, but I've heard some disconcerning things like they don't really handle trauma because when a person comes in with a head injury then neurosurgery is called in, and when a person comes in with multiple fractures then orthopedics takes charge. I'd like to know what is specifically the role of a trauma surgeon. I'm hoping it's more than babysitting a trauma patient until the other subspecialties arrive.

The trauma surgeon is the conductor of the symphony....he handles trauma to all parts of the body...of course bones and brain are left to the specialists. Of course the trauma surgeon then takes cae of the pt and makes sure he survives longer than just gettin g off hte table.
Its obvious that i have a bias, but trauma surgeons are the real deal. They operate on everything....heart, lungs, GI hepato-billiary, vascular etc.After the OR, they make sure the patient lives. He is a master of surgery and a master of medicine. The do it all, and that why they kick ASS.

 

[mddo2b]

In most cases they are combined into one fellowshi with the majority of time spent in critical care. However, some programs offer a second year for research and an increased exposer to trauma.Also, most programs are expanding to include emergency surgery, which allows you to stay in general surgery.







The trauma surgeon is the conductor of the symphony....he handles trauma to all parts of the body...of course bones and brain are left to the specialists. Of course the trauma surgeon then takes cae of the pt and makes sure he survives longer than just gettin g off hte table.
Its obvious that i have a bias, but trauma surgeons are the real deal. They operate on everything....heart, lungs, GI hepato-billiary, vascular etc.After the OR, they make sure the patient lives. He is a master of surgery and a master of medicine. The do it all, and that why they kick ASS.
__________________

 

[zbarnes]

A lot of the problem regarding trauma surgery stems from location. In a relatively small chill area, you may not even have a dedicated "trauma service" and maybe you do just refer and babysit. This is not the case at many places, we have a three week rotation as part of Surg I at USC and call nights are usually anything but pure babysitting, thats what ER is for, surgery opportunity depends of course on how many people try to kill each other on any given night, but youll definitely do surgery. There seems to be a lot of hate for trauma surgery as in the aforementioned posts, but if you think you like it do a rotation somewhere trauma oriented and if you like it do it and who cares what other people think thats why they chose some other field.

 

[Denial]

In most cases they are combined into one fellowshi with the majority of time spent in critical care. However, some programs offer a second year for research and an increased exposer to trauma.Also, most programs are expanding to include emergency surgery, which allows you to stay in general surgery.
some programs have a critial care fellowship with not a heavy inlination on trauma.yet other programs have a combined trauma, critical care fellowhip.

 

[Celiac Plexus]

Well, let me see... we don't get much penetrating trauma here so... the term "blunt stable" sums up 90% of what our trauma service does. We run the primary, secondary survey, put in lines/chest tubes/sutures prn, and then spend the rest of the time filling out paperwork, calling consults, and sitting in the scanner room.

the trend seems to be to move away from operative management of traumas. for god's sake we don't even operate on massive splenic injuries most of the time... we just park 'em in the unit, volume load like crazy, and then possibly take the patient to the IR suite to coil the bleeders.

what i do find cool about the trauma service is managing the unit players. i have learned a hell of a lot of critical care medicine on trauma. i can see the appeal of trauma surgery for those interested in critical care.

i suppose if we had more gsw, and knife wounds, i would have a different view of trauma surgery, but, alas, i do not.

 

[Dupree]

Thanks for all the advice, it has been helpful. Maybe I'll go ahead and do CT surgery and when I can't find a job as a CT surgeon then I'll do trauma surgery on the side to pay the bills! j/k

 

[zbarnes]

Well you should do what you like and feel drawn to. Its funny how everyones view of specialties is so influenced by where you are and your universities and cities make ups.
Nonetheless trauma is feast or famine, which i dont necessarily mind, its fun when you have 3-4 TTA's back to back with four ORs running, and i think it would be nice to sleep on call sometimes (though i havent yet). We did two ER thoracotomies on one call i had, and some minor surg and non op management on other nights. If you are really interested and are able do an away at LAC+USC there will be plenty of stuff to do.

 

[DrDawg]

I did a Trauma CC rotation most of the attending seemed a little unhappy because operative case are down. On the upside its shift work. Yeah you may spend a night in the hospital but you don't have to worry about your pager going off and finding a sitter for you kids or whatever. Many the the Trauma docs I worked with also found other niches to fill. One saw many pts for wound care and ran the hyperbaric chambers, some of them were trying to start a light gen surg practice doing out pt stuff like.
Hope this helps

 

[MD Dreams]

trauma surgeons are the real deal. They operate on everything....heart, lungs, GI hepato-billiary, vascular etc.After the OR, they make sure the patient lives. He is a master of surgery and a master of medicine. The do it all, and that why they kick ASS.

Is it correct that trauma surgeons operate on the heart and lungs? I thought only CT surgeons were allowed in the thoracic cavity. To what extent can trauma surgeons intervene in this region, in other words, do they just patch up the hole and then let CT finish the job or are they the ones fixing the lesion.

Two other questions: Is trauma surgery shift work (kind of like ER with no pager responsibilities while off) and what is the salary compared to a general surgeon?

Thank you.

 

[DO_Surgeon]

trauma surgeons are the real deal. They operate on everything....heart, lungs, GI hepato-billiary, vascular etc.After the OR, they make sure the patient lives. He is a master of surgery and a master of medicine. The do it all, and that why they kick ASS.

Is it correct that trauma surgeons operate on the heart and lungs? I thought only CT surgeons were allowed in the thoracic cavity. To what extent can trauma surgeons intervene in this region, in other words, do they just patch up the hole and then let CT finish the job or are they the ones fixing the lesion.

Two other questions: Is trauma surgery shift work (kind of like ER with no pager responsibilities while off) and what is the salary compared to a general surgeon?

Thank you.

Ok, how do you go from making such a strong bold statement that trauma surgeons operate on everything including the chest and then in your next paragraph you ask if that is true? Granted they do, but it makes your post seem like you have no idea what you are talking about.

 

[kendall]

to the OP, there was a thread about trauma sx a while back that had some pretty good info on it. check it out:

http://forums.studentdoctor.net/showthread.php?t=76084

k

 

[Fascia Lata]

Ok, how do you go from making such a strong bold statement that trauma surgeons operate on everything including the chest and then in your next paragraph you ask if that is true? Granted they do, but it makes your post seem like you have no idea what you are talking about.

Hi DO_Surgeon

The first paragraph was taken from an earlier post by mddo2b 🙂

 

[MD Dreams]

Ok, how do you go from making such a strong bold statement that trauma surgeons operate on everything including the chest and then in your next paragraph you ask if that is true? Granted they do, but it makes your post seem like you have no idea what you are talking about.

Sorry for the confusion. The first paragraph was from a previous post.

 

[DO_Surgeon]

Sorry for the confusion. The first paragraph was from a previous post.

Sorry if I came across like an a$$, I was just a little confused by it all. I am finishing up my second month of trauma/SICU at the busiest level one center in Phoenix and have developed an interest in trauma as well. I dont know awhole lot about the different fellowships with some being 1 year and others being 2 and what you need to become BC. Any input from anyone?

 

[Winged Scapula]

Sorry if I came across like an a$$, I was just a little confused by it all. I am finishing up my second month of trauma/SICU at the busiest level one center in Phoenix and have developed an interest in trauma as well. I dont know awhole lot about the different fellowships with some being 1 year and others being 2 and what you need to become BC. Any input from anyone?

There is no Board for Trauma Surgery. However, there is for Critical Care which can be entered from a variety of specialty residencies, ie, Surgery, Anesthesiology, IM, etc.

If you desire to be a Trauma Surgeon, you would complete a Gen Surg residency (and presumably the BC examination) and then onto a Trauma/Critical Care fellowship.

The requirements to sit for the Critical Care Boards are as follows:

1. Certified Diplomate of the appropriate Board (ie, Surgery, Anesthesiology, Peds)

2. Each candidate must be in good standing with the Board.

3. Satisfactory completion of education in Critical Care of no less than 12 months full-time duration.

This education must be in a program fulfilling the requirements of The American Board of Surgery for Surgical Critical Care or the requirements of The American Board of Anesthesiology for Critical Care Medicine, Pediatrics, EM, etc.

4. The credentials and training of the candidate must be approved by The American Board of <insert specialty X here> prior to admission to the examinations in Surgical Critical Care or Critical Care Medicine.

Applications must be received at least six months prior to the date of the examination.

5. Successful completion of the examination in Surgical Critical Care administered by The American Board of Surgery or the examination in Critical Care Medicine administered by The American Board of Anesthesiology

Most 1 year Trauma/Critical Care fellowships will allow you to sit for the Critical Care Boards; but make sure you check before accepting an offer. There are 2 year programs which often give you research time, more trauma time or time as a junior attending. Unless you are academically oriented or see some need to do additional time, its not necessary, at least not to be BC in Crit Care.

 

[DO_Surgeon]

There is no Board for Trauma Surgery. However, there is for Critical Care which can be entered from a variety of specialty residencies, ie, Surgery, Anesthesiology, IM, etc.

If you desire to be a Trauma Surgeon, you would complete a Gen Surg residency (and presumably the BC examination) and then onto a Trauma/Critical Care fellowship.

The requirements to sit for the Critical Care Boards are as follows:

1. Certified Diplomate of the appropriate Board (ie, Surgery, Anesthesiology, Peds)

2. Each candidate must be in good standing with the Board.

3. Satisfactory completion of education in Critical Care of no less than 12 months full-time duration.

This education must be in a program fulfilling the requirements of The American Board of Surgery for Surgical Critical Care or the requirements of The American Board of Anesthesiology for Critical Care Medicine, Pediatrics, EM, etc.

4. The credentials and training of the candidate must be approved by The American Board of <insert specialty X here> prior to admission to the examinations in Surgical Critical Care or Critical Care Medicine.

Applications must be received at least six months prior to the date of the examination.

5. Successful completion of the examination in Surgical Critical Care administered by The American Board of Surgery or the examination in Critical Care Medicine administered by The American Board of Anesthesiology

Most 1 year Trauma/Critical Care fellowships will allow you to sit for the Critical Care Boards; but make sure you check before accepting an offer. There are 2 year programs which often give you research time, more trauma time or time as a junior attending. Unless you are academically oriented or see some need to do additional time, its not necessary, at least not to be BC in Crit Care.

What if you are a DO doing an osteopathic general surgery residency? Will there be difficulty in obtaining a critical care/trauma fellowship being that nearly all of them are allopathic? What about sitting for the borads after fellowship?

 

[Winged Scapula]

What if you are a DO doing an osteopathic general surgery residency? Will there be difficulty in obtaining a critical care/trauma fellowship being that nearly all of them are allopathic? What about sitting for the borads after fellowship?

Shouldn't be a problem. Trauma fellowship now goes through the NRMP for most programs. Like any other, I'm sure you might find some residual osteopathic stigma from some of the programs (I don't know of any, I'm just assuming it might be present) but there are no restrictions on applying ( know aTrauma fellow at Penn a couple of years ago was a DO) or sitting for the boards.

 

[ctdoc]

I was under the impression that if you are in a D.O. residency program that you can't sit for ACGME boards.

 

[Pir8DeacDoc]

I had heard the same. If you are a DO and want to do MD fellowships then you better find a way to get MD GS.

 

[Winged Scapula]

Hmmm....well I have to admit that I didn't research the answer before I gave it, just discussed it with some fellow friends.

They were all under the impression that as long as you completed an ACGME fellowship that you were eligible for the boards and that none of the fellowships required you to have done an ACGME residency.

I did a Freida search and checked a few programs and none of them said you had to do an allopathic residency. But I only looked at a few.

Suffice it to say, I could be wrong, but I'll try and find some hard data for you guys unless someone else comes up with it.

 

[kendall]

i believe the scc/trauma fellow at vandy is a DO.

k

 

[Pir8DeacDoc]

It doesn't have to do with whether they are a DO or not, but rather where they did their general surgery training. I.e. I have heard that you can not do a DO general surgery program and then be accepted to an MD fellowship.

 

[DO_Surgeon]

It doesn't have to do with whether they are a DO or not, but rather where they did their general surgery training. I.e. I have heard that you can not do a DO general surgery program and then be accepted to an MD fellowship.

That is not true. You can do a DO residency and get into a fellowship but getting BC is another story. There is a DO that did his residency at Suncoast hospital in Largo FL and then went on to do Trauma at Ryder in Miami, I have no idea if he is BC or not

 

[Gibby Haynes]

It doesn't have to do with whether they are a DO or not, but rather where they did their general surgery training. I.e. I have heard that you can not do a DO general surgery program and then be accepted to an MD fellowship.

Can't speak for general surgery, but for ortho every osteo program I interviewed and rotated at had graduates doing allo fellowships (thankfully b/c there are no osteo fellowships). However I don't know if they can sit for the boards or not.

 

[Pir8DeacDoc]

well I don't think the point changes all that much. Why would you want to go through a fellowship and not be able to sit for the boards? You have relegated yourself to working at a small hospital that doesn't give a crap about credentials.

 

[DO_Surgeon]

well I don't think the point changes all that much. Why would you want to go through a fellowship and not be able to sit for the boards? You have relegated yourself to working at a small hospital that doesn't give a crap about credentials.

I completely agree with you, that is my question though can you sit for the boards? Would the AOA grant you board certification? Would it make it make a difference if you were boarded by the AOA? I have developed an interest in critical care after spending two months doing trauma surgery and SICU at a busy level one center. I have already matched to Mercy Medical Center in Des Moines (AOA residency) but wondering if it would ever be possible to do a fellowship at Vandy, Shock Trauma, etc and be able to sit for the boards.

 

[Gibby Haynes]

well I don't think the point changes all that much. Why would you want to go through a fellowship and not be able to sit for the boards? You have relegated yourself to working at a small hospital that doesn't give a crap about credentials.

Actually that's not true. Several DO traumotologists are based out of Tampa General. See for yourself.

http://ots1.com

 

[Pir8DeacDoc]

That's some DO off shoot of Tampa General. And they all seem to be certified by the DO boards. I imagine it would be preferable to be board certified by the MD board folks. I'm sure there would be more job opportunities.

 

[Gibby Haynes]

That's some DO off shoot of Tampa General. And they all seem to be certified by the DO boards. I imagine it would be preferable to be board certified by the MD board folks. I'm sure there would be more job opportunities.

What do you mean off shoot, didn't you read the website.

"The Orthopaedic Trauma Service consists of seven fellowship-trained orthopaedic traumatologists. OTS offers the most comprehensive trauma care in the Bay Area, and provides all of the orthopaedic emergency room coverage at Tampa General Hospital, the Tampa Bay area's largest hospital and only Level 1 trauma center in West Central Florida."

You have also stated that: "You have relegated yourself to working at a small hospital that doesn't give a crap about credentials."

I guess that the next thing you're going to tell me is that Tampa General is a small hospital.

Also you state: "And they all seem to be certified by the DO boards. I imagine it would be preferable to be board certified by the MD board folks."

It doesn't appear to have stopped them.

 

[Pir8DeacDoc]

The point of the original post remains the same and the issue hasn't changed. The point is that you WILL NOT be board certified by the MD boards if you go to a DO general surgery program. As I understand it you can be accepted to an MD fellowship but you are not MD board eligible when you finish. My point was, and still remains, that you have in effect done a fellowship that really won't open too many doors for you in the MD world because you aren't board certified. Maybe that's not a big deal and you can find a job anyway, I don't know. But if I were going to do a fellowship I'd hope to be board certified at the end.

I'm gonna let this one ride from here on out. I hadn't intended for the thread to go off in this direction. It's really not fair to the OP. Cheers

 

[coach Ahmad]

i want to traiin in surgery then trauma/ critical care.
after training, however, i dont want to work full time at a hospital in the US.
the ideal would be if i could moonlight only for trauma several shifts a week, and be able to do several humanitarian projects a yr, wks/months each mission, with a group like doctors w/o borders or the like.

anyone have a knowledgeable opinion as to whether my idea is at all plausible? assume that i'd be married with a second income by then (i'm a girl by the way) and im low maintenance and dont need to make a ton of money to fund a fancy house and lifestyle, i just would want to break even with malpractice payments and basic needs.

i guess specifically my questions are (1) is it possible to just do a few shifts/ wk at a trauma center? without a full-time committment to a hospital or private practice? and (2) is malpratice ins. pro-rated for how few/many hours you work?

thanks

 

[spicysoup55]

i want to traiin in surgery then trauma/ critical care.
after training, however, i dont want to work full time at a hospital in the US.
the ideal would be if i could moonlight only for trauma several shifts a week, and be able to do several humanitarian projects a yr, wks/months each mission, with a group like doctors w/o borders or the like.

anyone have a knowledgeable opinion as to whether my idea is at all plausible? assume that i'd be married with a second income by then (i'm a girl by the way) and im low maintenance and dont need to make a ton of money to fund a fancy house and lifestyle, i just would want to break even with malpractice payments and basic needs.

i guess specifically my questions are (1) is it possible to just do a few shifts/ wk at a trauma center? without a full-time committment to a hospital or private practice? and (2) is malpratice ins. pro-rated for how few/many hours you work?

thanks

Also interested in this. This thread is from a while back, but are trauma surgery still shift work? What's a typical shift schedule? Is it easy to take off time to do medical work abroad?

What does the salary look like?

Is burnout a major issue?