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Fri Nov 18 21:35:44 GMT 2005

Dear John
Thanks for your insight.

I refer you to David Spain's recent article J Trauma August 2005 "Education
and Training of the future trauma surgeon  in acute care surgery: trauma,
critical care and emergency surgery".
There is a problem in the Antipodes as well with which we are trying to
grapple.
Residents don't want to do Trauma surgery as it doesn;t pay as well as
breast, upper GIT, Plastics etc.., not to mention increasing non-operative
management, less penetrating trauma ( in the USA),more elderly,  more
unsociable hours anf more unhealthy if you don't eat right and don't
exercise.
.
One solution is to concentrate your resources as he suggests to combine
acute Surgery and trauma. This will mean shifts but if you are remunerated
appropriately ( and this needs to be communicated to the politicians and
hospital administrators) , then the acute care surgeons of the future will
have a rewarding professional and personal life. Not to mention want to do
it. You also have to think re succession planning and after 50 you don't
handle being up all night as well as the 30s and 40s.

And we will also have to reduce the number of hospitals taking trauma, acute
surgery etc as you also need us Emergency Physicians, Anaesthetists,
Intensivists ( for those not in the USA). All working shifts and being
appropriately remunerated.

This is the direction we are being forced to go down here and the
politicians are just starting to get the message but we have some way to go

Regards
Tony Joseph
Sydney

On 18/11/05 11:58 AM, "Hall, John R" <John_R_Hall at Wellmont.org> wrote:

> Unfortunately, it is killing the trauma surgeon as well.  Having worked 36
> hours every third night for many years, I got fat (decreased metabolism from
> lack of sleep, increased neuropeptide Y, poor eating habits, increased coke,
> coffee and tobacco to stay awake, etc) and then Type II diabetes forcing me
> into a medical sabbitical (ie forcing me to see my kids grow up, become
> "happy" again, loose weight, get into shape...).  I have other friends who
> have done trauma for 20 years with same situation.  We need to look into our
> lifestyles and limit our hours as our residents have.
> John
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of Geehan, Douglas
> Sent: Thu 11/17/2005 12:11 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: Whither the Trauma Surgeon?
> 
> 
> Bill,
>  
> Your reply incorporates much of the problems.  How do you encourage the
> general surgeon to  go see a patient at 2am???  Are you serious?  It is called
> being a doctor.  You go and take care of your patients.  The business of
> medicine is killing medicine as a profession.
>  
> Regards,
>  
> Doug
>  
> Douglas Geehan, M.D.
> Associate Professor
> Department of Surgery
> University of Missouri-Kansas City
> geehand at umkc.edu
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of William Bromberg
> Sent: Thu 11/17/2005 10:44 AM
> To: trauma-list at trauma.org
> Subject: RE: Whither the Trauma Surgeon?
> 
> 
> 
> OK I'll bite, how?
> 
> I agree that the dedicated trauma/emergency surgeon is probably a stopgap (or
> at least suboptimal) because it does produce a small cadre of overworked
> surgeons who are "forced" to go to shiftwork to have any sort of life and a
> bunch of very happy private practice docs who can "berry pick," and not work
> nights and weekends. But,  how do you make (encourage) the general surgeon at
> a 100 bed hospital get out of his bed at 2AM and see the uninsured stab wound
> victim as opposed to telling their ED doc to call the trauma center, rolling
> over and going back to sleep?
> 
> I have 2 suggestions. 1. Make charity care (self-pay is a laughable euphemism)
> tax deductable at medicare rates ? I believe that this would eliminate the
> problem of the uninsured  in one fell swoop. Doctors would be MUCH more
> willing to treat trauma patients if you got some sort of reward on the back
> end. Or 2. Mandate pro bono work by physicians like (I believe) is mandated of
> lawyers.
> 
> What do you think?
> 
> Bill B
>>>> geehand at umkc.edu 11/17/05 09:33AM >>>
> Bill,
> 
> We are the ones that create our own reality.  We hate allowed general surgeons
> to "berry pick" their practices.  At the risk of offending the "giants", the
> schism between general surgery and trauma should never have been allowed to
> happen.  General surgery is on the verge of a true catastrophe.  Our
> practicioners are becoming technicians and shift mentality workers.  The
> concept of being a patient's physician and surgeon are being overshadowed by
> lifestyle and other issues.  We should be redefining general surgery as a
> specialty to include elective and emergent surgery coupled with the required
> perioperative care....oh wait. We don't have to redefine it.  That IS what is
> required to graduate from a general surgery residency.
> 
> Regards,
> 
> Doug
> 
> Douglas Geehan, M.D.
> Associate Professor
> Department of Surgery
> University of Missouri-Kansas City
> geehand at umkc.edu
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of William Bromberg
> Sent: Thu 11/17/2005 8:20 AM
> To: trauma-list at trauma.org
> Subject: RE: Whither the Trauma Surgeon?
> 
> 
> 
> Doug,
> 
> I think in a perfect world that would be the case ? trauma surgeon/general
> surgeon would be synonymous. However in my (very) limited career I am already
> seeing increasing reluctance for community general surgeions to do any trauma
> care. We regularly admit patients with 1-2 rib fxs, or GCS 14 with a normal
> CTH and an alcohol of >200 because the surgeon at the presenting hospital
> "doesn't feel comfortable."  Stable patients with stab wounds to the abdomen
> that require nothing more than a local exploration are a common reason for a
> call to the helicoptor in my neck of the woods. I'm not complaining (much) ? I
> just had a kid and you wouldn't BELIEVE what college costs are estimated to be
> in 18 years. Do I think that general surgeons need more or different training
> to be trauma surgeons? No. But they do need the inclination to care for the
> patient no matter who and when (and how well insured). I fear that willingness
> is decreasing. And (in the vein of "rage against the dying of the light"), I
> think the 80 hour/no call residency lifestyle will accelerate that trend.
> 
> Bill Bromberg
> 
> William J. Bromberg
> Savannah Surgical Group
> 912 350-7412
> 
> William J. Bromberg
> Savannah Surgical Group
> 912 350-7412
> 
>>>> geehand at umkc.edu 11/16/05 11:12PM >>>
> Karim,
> 
> I'm two days behind on my email, so I will timidly jump into a fray that I
> haven't yet read.  A trauma surgeon is a general surgeon in the purest sense
> of the word.  Operate on the skin and its contents.  Elective and emergent.
> IN BRIEF, the practice model that I trained under during a general surgery
> residency.  The dissociation of trauma from general surgery (or more
> specifically general surgery from trauma) has been one of the saddest trends I
> have observed.  There is no need to redefine "trauma surgery".  It has, in
> fact, already been defined.  It is general surgery.
> 
> Regards,
> 
> Doug
> 
> Douglas Geehan, M.D.
> Associate Professor
> Department of Surgery
> University of Missouri-Kansas City
> geehand at umkc.edu
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of Karim Brohi
> Sent: Mon 11/14/2005 5:36 PM
> To: 'Trauma & Critical Care mailing list'
> Subject: Whither the Trauma Surgeon?
> 
> 
> 
> We haven't discussed this before and I'm interested to hear the list's views
> on the future for the trauma surgeon.  The 'Trauma
> Surgeon' as a single specialty is almost certainly unsustainable and has never
> really existed in all but a very few centres in the
> US. Despite the longevity of organised trauma systems in the US there has
> never been a separate Board exam in Trauma Surgery.
> Clearly changes are afoot and on both sides of the Atlantic there is a move to
> fold Trauma Surgery into a new 'Trauma & Emergency
> Surgery' specialty.  Yet the European models of Trauma & Emergency Surgery
> really haven't gained popularity either.
> 
> What exactly will 'Emergency Surgery' consist of?  Is this really the right
> direction to take - to make the specialty popular,
> improve training, increase operative load etc.?  Or are other models better?
> Trauma surgery & critical care?  Trauma surgery and a
> base elective practice (which should obviously be vascular ;-)  )?
> 
> The world view on this should make for an interesting read...
> 
> Karim
> 
> 
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