Trauma Surgery

[zinjanthropus]

Hello-
I have a question regarding training in trauma surgery. I am unclear as to what specific training is required and whether there is actual board certification in trauma surgery. I would have guessed that a general surgery residency followed by a trauma fellowship was required for training, however, I found no mention of Trauma Surgery Fellowships on FRIEDA. Although I did find Critical Care Surgery Fellowships and it seems as though many of those programs do offer an optional Trauma sequence/year. Could someone please clear this up for me? Thanks for any help.

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[mosfet]

Also I would appreciate if someone could tell me in detail what the lifestyle is like for a trauma surgeon AFTER residency. I understand its quite different in different work settings but could someone please elaborate what a typical day is like. Or is it based on shift work?? I am an MS III and I am seriously considering trauma/critical care.

 

[JSandall]

I'm an MSIII currently on a Trauma Surgery/Critical Care clerkship. I absolutely love it! I've talked to the trauma docs, and here's what I've gleaned:

5 yrs. GS (including internship) + 2 yr. fellowship (critical care & trauma surgery)

The docs I'm with work 12 hr. shifts much like EM hours. They absolutely love it, and have all stated that they are very happy with their lifestyle.

They have also told me that there is currently a major shortage in trauma docs.

If anyone has more to add, or I'm mistaken about something, please post. I would really like to know what I will be getting into if I decide that this is what I want to specialize in. Thanks for your time.

 

[Winged Scapula]

Not all trauma/critical care fellowships are 2 years; those that are are generally geared toward academic practices.

In addition, not all trauma/critical care fellowships are SURGICAL in nature, nor do they require a surgical residency. However, those that take other types of residents (ie, EM) do not generally allow those fellows to operate; they focus on critical care and small procedures.

While you may be on "shift work" as an attending, do not discount the fact that you often cannot walk out the door when your shift is over. You may still be involved in a trauma, in the OR or have a case pending which you can't sign over to the next attending coming in. You will generally take in house call if working at a Level 1 trauma center and may be back-up call on other nights, often coming in if at a busy center.

Finally, there is no board certification in Trauma Surgery; there is however one for Critical Care. Therefore, if you are doing a combined Trauma/Crit Care fellowship, make sure you get one which makes you BE for the Crit Care boards. You will get a pretty certificate for your Trauma fellowship but you will only be BE/BC in your residency completed before the fellowship (and Crit Care if you take those boards).

 

[mosfet]

It's nice to hear that they do 12 hour shifts.....do they also have a choice of 8, 10, 24 hour shifts. Also, how many 12 hour or 25 hour shifts are they expected to do every month. How is working in an academic setting different from a private practice.

I am sorry to ask so many questions but I am trying to learn some things. If there is a good website that answers all these questions, someone please direct it to me. I would really appreciate that.

thanks

 

[RichL025]

Trauma surgery is also going through a bit of a crisis right now (see this month's Annals of Surgery, or several past issues of J Trauma) - bad work hours, reimbursement problems seem to be the big issues, and they are concerned about the future of their specialty. It'll be intersting to see what changes transpire, but the recent Annals of Surgery article kinda pointed out that you can't make aliving anymore doing just trauma surgery (or specifically, trauma + emergency surgery, which was one of the possible solutions) - the only members in their practice who were making ends meet had a private surgical practice also.

What's that mean? It means that after 2 yrs of trauma & CC fellowship you need to still fix alot of hernias Or do ANOTHER fellowship on top.

Caveat: limited sample size in the article (n=6). Still, big changes of some kind are afoot for trauma surgery as a field.

 

[Winged Scapula]

It's nice to hear that they do 12 hour shifts.....do they also have a choice of 8, 10, 24 hour shifts. Also, how many 12 hour or 25 hour shifts are they expected to do every month. How is working in an academic setting different from a private practice.

I am sorry to ask so many questions but I am trying to learn some things. If there is a good website that answers all these questions, someone please direct it to me. I would really appreciate that.

thanks

I'm unaware of any that do 12 hr or less shifts; its usually 24 and as I noted above, at any trauma center that gets a decent amount of trauma, you aren't walking out the door at the end of your shift. There may still be OR cases to do, rounds, etc. The number of shifts you do a month depends on the center. For example, at Baltimore Shock Trauma the teams rotate on a q3 call schedule - in essence you are on 24 hr+ call every 3rd night. it may different at other institutions.

There really isn't an entity known as "Private practice" trauma surgeon. You are employed by the hospital and as noted in another post above, are generally required to do general surgery as well in all but the most operative heavy trauma centers.

Check trauma.org and east.org for more information about Trauma fellowships in general.

 

[avgjoe]

I'm unaware of any that do 12 hr or less shifts; its usually 24 and as I noted above, at any trauma center that gets a decent amount of trauma, you aren't walking out the door at the end of your shift. There may still be OR cases to do, rounds, etc. The number of shifts you do a month depends on the center. For example, at Baltimore Shock Trauma the teams rotate on a q3 call schedule - in essence you are on 24 hr+ call every 3rd night. it may different at other institutions.

There really isn't an entity known as "Private practice" trauma surgeon. You are employed by the hospital and as noted in another post above, are generally required to do general surgery as well in all but the most operative heavy trauma centers.

Check trauma.org and east.org for more information about Trauma fellowships in general.

http://www.east.org/tpg/futureposition.pdf has their position paper where they talk about the new proposal for trauma + emergency surgery.
btw, they state that they want the income to be over 75% of the agma level. whats that? and how would they 'set' that when currently trauma surgeons don't make much at all?
kimberly or others, do you know how the call schedule would change under this new specialty?

 

[Pilot Doc]

Miscellaneous points:

1) Many general surgery residencies will train you very well to be a trauma surgeon with no fellowship. Given the current workforce issues in trauma, this should be at most a minimal disadvantage in your job search

2) The role of the trauma surgeon is changing. No one knows exactly where the field will end up. Likewise, while there are institutions who use 12 hour shifts (my own included) as well as 24 hr shifts, I don't think there is any nationwide standard. (i.e. don't confuse trauma with EM - they're no where close.)

3) There is a growing role for non-operative critical care boarded intensivists to manage ICU patients. This is a wide open field that is very predictable shift work, typically employed by the hospital with a predictable income.

4) There are some private practice trauma jobs. If you work with the right population, it can pay well. A practice in springfield, MO was advertising for a job that was something like 1 week days/1 week nights/ 1 week clinic/1 week off. Don't recall teh exact pay, but it was attractive.

 

[tripod]

Some clarifications:
Your shifts are defined by the contract you sign with the hospital. You may be an employee of the hospital but you can also be a priv pract gen surgeon that holds a contract with the hospital for call. It all depends on where you're working and what kinda business contracts you can get.

Trauma is definitely on the down turn. Almost all residencies will prepare you to take care of trauma...on the flip side tho, doing a lot of trauma during residency often makes most residents (no i'm not kidding) hate it. I am currently a 3rd year resident and I have to do 6 months of trauma. Trauma is a lot of baby sitting for subspecialties like ortho and neurosurg and now a days, most of it is non operative. hell, i've had grade IV splenic lacs coming leaving the hospital without an operation. It's basically the "medicine/scut" rotation of the residency..rounding on like 40 patients, maybe doing 1-2 OR cases a week (mostly trach's and feeding tubes) if any, and on top of that, most of that patients are the most ungrateful and noncompliant pricks you'll meet. Sure some of them are nice but it's not the "mother theresas" of the work that decide to have a bunch of tacos, drink 8 40 ouncers, hop in a stolen car and crash it into a playground full of little kids and then get tazed 8 times by the police (typical trauma pt).

If you're interested in trauma, i applaud you. It sounds glamourous (esp with shows like ER and Trauma life in the ER and other edited fluff) More props to you if you are still interested AFTER ACTUALLY doing it for a rotation. The world needs ppl to take care of the trauma pts. You'll have any easy time getting it, fellowships will be easy to find (it's like the pathology or family medicine of surgery), and jobs will be plentiful. Personally, I couldn't do it and it's part of the reason why i'm doing plastics.

 

[avgjoe]

The part of the new fellowship I'm really interested in is the emergency surgery. is there any chance that could become it's own sepcialty? kind of like a surgical 'hospitalist'?

 

[tripod]

There has been talk of having "surgical hospitalists" but that's still in evolution from what I understand

Emergency surgery is different - that's just straight general surgery which means hernias, gallbladders, perf'd whatevers, appys. You don't need a fellowship to know how to do those. If there's a surgical residency that doesn't prepare you for those, then it shouldn't be accredited.

You just need to contract with a hospital to cover their ER. depending on the hospital, that can mean with or without trauma call.

 

[davvid2700]

The part of the new fellowship I'm really interested in is the emergency surgery. is there any chance that could become it's own sepcialty? kind of like a surgical 'hospitalist'?

yeah its called trauma surgery!!

 

[Gfunk6]

.on the flip side tho, doing a lot of trauma during residency often makes most residents (no i'm not kidding) hate it. I am currently a 3rd year resident and I have to do 6 months of trauma. Trauma is a lot of baby sitting for subspecialties like ortho and neurosurg and now a days, most of it is non operative. hell, i've had grade IV splenic lacs coming leaving the hospital without an operation. It's basically the "medicine/scut" rotation of the residency..rounding on like 40 patients, maybe doing 1-2 OR cases a week (mostly trach's and feeding tubes) if any, and on top of that, most of that patients are the most ungrateful and noncompliant pricks you'll meet. Sure some of them are nice but it's not the "mother theresas" of the work that decide to have a bunch of tacos, drink 8 40 ouncers, hop in a stolen car and crash it into a playground full of little kids and then get tazed 8 times by the police (typical trauma pt).

Wow, I only did Trauma for 3 weeks as an MS-III, but this really sums up my experience. I'm glad I'm not the only one who feels this way.

I chose Trauma as a mini-elective b/c I thought I would do a lot of procedures and assist in some cool operations but I was basically a scut-monkey extrordinare.

 

[Winged Scapula]

Wow, I only did Trauma for 3 weeks as an MS-III, but this really sums up my experience. I'm glad I'm not the only one who feels this way.

I chose Trauma as a mini-elective b/c I thought I would do a lot of procedures and assist in some cool operations but I was basically a scut-monkey extrordinare.

You are by no means the only one who feels this way. Most people who work at trauma centers with a heavy blunt case load feel the same. Its the places with a lot of penetrating that seem sexy and cool (not to me, but others) and get more operative time.

 

[policymaker]

In addition, not all trauma/critical care fellowships are SURGICAL in nature, nor do they require a surgical residency. However, those that take other types of residents (ie, EM) do not generally allow those fellows to operate; they focus on critical care and small procedures.

Where can I find a list of these fellowships that are open to non-surgical residents?

 

[policymaker]

bump