Identity Crisis

Courtesy of Flickr user Paul Keleher (CC)

Courtesy of Flickr user Paul Keleher (CC)

from the annual meeting of the American Association for the Surgery of Trauma in Pittsburgh

AAST is still struggling with an important identity crisis.  The health of trauma surgery as a specialty may not be critical yet, but an infusion of new blood sure would help.  That seems unlikely unless the specialty reinvents itself with or without a new name.   There appear to be a number of factors responsible for the dwindling number of medical graduates choosing to go into trauma surgery.  As outgoing president Dr. Gregory J. Jurkovich noted in a 2007 article in Surgery,

Limiting surgical practice to trauma cases alone is insufficient to maintain surgical skills; nonoperative practice is simply not surgery. Trauma care alone has too great a time commitment for too low a financial reimbursement or job satisfaction reward. In isolation, it is unattractive to current as well as future surgeons.

As far as reinvention goes, acute care surgery seems to be in the lead.  AAST is well on its way to creating non-ACGME fellowships in acute care surgery that would include rotations in trauma surgery, critical care, emergency and elective surgery, along with suggested rotations in thoracic surgery, vascular surgery, and neurosurgery, among others.

Still, there will be bumps along the road.  Dr. Grace Rozycki and Dr. Ernest Moore presented the results of a survey of surgical critical care program directors at the AAST Acute Care Surgery Committee meeting held in Chicago, IL this past July.  Most of the 47 respondents were not planning to start an acute care surgery fellowship at their facility or were unsure.  Their concerns included an adverse impact on general surgery residency, the limited value of such a fellowship, lack of fellows interested in the 2-year program, and that such a fellowship would dilute the trauma experience.

Not everyone appears to be on board the acute care surgery train—including trauma surgeons at the annual meeting.  I heard a number of alternative names—and presumably different directions for the specialty—used during presentations and discussions: trauma surgeons, acute care surgeons, critical care surgeons, trauma hospitalists.  The two things that were clear to me at the meeting is that trauma surgeons want to do more surgery and that if the specialty is to survive, it has to figure out a way to recruit medical school grads.

—Kerri Wachter, @knwachter on Twitter

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Filed under Hospital and Critical Care Medicine, Practice Trends, Surgery

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