Trauma

[bryanboling5]

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I am interested very much in trauma, but don't really go for the other areas of surgery. I love the initial ressusitation (sp?) of trauma and the critical care post-op, and even the actual surgery (though I'm more interested in the smaller procedures than the long cases...I think I'm a little ADD! 🙂.

I was considering Emergency Medicine, but they don't really get to do much outside the ER/initial workup do they? I found some info about Trauma Anesthesiology/Critical Care that looks really good, but it seems like it might be a somewhat limited field. From what I've seen, there are only a few places in the country that have anything like that. What I really want is to do just trauma and critical care. I don't want to spend most of my time doing appys or cholys (not that there's anything wrong with that, they were fascinating for me the first few times I saw them, just not something I want to do a lot of).

Any advice?

 

[IMnailer]

Unfortunately, few of the general surgery traumatologists I've worked with do just trauma/critical care. Many choose (or maybe forced depending on how you look at it) to devote a portion of their practice to general surgery (appys, choles, etc...) I think that this stems from the fact that trauma doesn't pay what their general surgery or other surgical subspecialist peers make. Trauma invites an interesting patient population, one that often does not have insurance, nor learn from their carelessness. Once you are out unless you find a busy referral center that is desperate for a dedicated traumatologist, you may end up doing some gen surg. In addition, the busy trauma centers usually are academic centers with house staff. This being said, alot of times the initial trauma eval and resuscitation are usually orchestrated by those in the trenches, namely the general surgery residents. Attendings often show up when the case goes to the OR. That being said, each center and attending are different and there is definitely opportunity to be as involved as you wish. If you like just the trauma evals, then emergency medicine with a trauma focus may not be that bad of a choice. ER programs vary widely, and some train their residents thoroughly in trauma (not just airway, as many turn out to be so I've been told). Then again ER is not without it's downfalls either. Its a tough choice, especially since only a percentage of a general surgery residency is focused on trauma. Good luck.

 

[Z]

The role a "Trauma" surgeon plays depends on where they practice. In some busy trauma centers the trauma surgeons with the residents care for and operate on only trauma patients. In other centers, the trauma surgeons do trauma and all the emergency general surgery. In other places, they care for both trauma and have a general surgery elective practice. So, location is key. With regard to the thought that you only want to do the short cases and only trauma cases and none of the boring general surgery...I would take issue with that. The care of trauma patients has evolved over the last 15 years into a mostly non-operative field. This means, though, that those patients that need an operation really need it. Therefore, you have to be a technically proficient surgeon with a fair amount of continued exposure. If you are not in a place with a large volume or a high penetrating trauma experience you may need to do the "boring" cases so that you remember how to operate when it really counts. Also, with the concept of damage control surgery many trauma cases are truncated due to the severity of the physiologic derangements that occur when a patient is under anesthesia and cold for a long period of time. Finally, the amount of money that a trauma/critical care surgeon can make is as good if not better than their general surgery colleagues. Rounding in the ICU on trauma and other critical care patients can generate an impressive amount of money billed (b/w procedures and the notes written). Also, trauma can be a good payer source with workman?s comp and the number of blunt trauma patients with "real" insurance. For example, the average starting salary for a university trauma surgeon is about $150,000/year. It is a little more for private practice. In some places, though, they want you to take only trauma call and not do any general surgery and the trade-off is that they are paying, sometimes, $400,000-500,000/year. If you have any other questions feel free to PM me.

 

[md03]

Add to Z's comments the fact that there is talk in the trauma arena of having trauma evolve into trauma and emergency surgery. And the fact that the busiest trauma (and the most advanced trauma management) is at teaching hospitals, you can see that you should know how to do basic general surgery cases.

I know how you feel. I enjoyed trauma as a student and see myself headed in that direction. I'd rather scrub a trauma case than anything else. But right now as an intern, it's challanging enough to do appys and hernias. I usually can't see the hernia sac right away in an ingunia hernia...I feel like the attending is just mucking around in goo until for a while. Doing those cases as a lower level resident helps you deveop your operative skills. Then when you get to help junior residents as a senior gives you the chance to learn how to be the one in charge of doing the case.

Plus if you are at an academic center you will have to teach residents basic surgical technique, it's important not to bypass the basic general surgery cases.

If you don't like operations other than trauma, then I think you might not be happy as a surgeon. Sounds like anesthesia might be your bag...realize that having good anesthesia support during a damage control laparotomy is very important. I recall watching anesthesia as a student when I'd be in the room but not scrubbed and those folks were working their butts off trying to resucitate the pt.

I can't see myself making a career of fixing hernias, but I believe there is lots of value in doing them as part of surgical training.