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Acute care surgery: Now that we have built it, will they come?

Coleman, Jamie J. MD; Esposito, Thomas J. MD, MPH; Rozycki, Grace S. MD, MBA; Feliciano, David V. MD

Journal of Trauma and Acute Care Surgery: February 2013 - Volume 74 - Issue 2 - p 463–469
doi: 10.1097/TA.0b013e31827a0bcf

BACKGROUND Concern over lack of resident interest caused by the nonoperative nature and compromised lifestyle associated with a career as a “trauma surgeon” has led to the emergence of a new acute care surgery (ACS) specialty. This study examined the opinions of current general surgical residents about training and careers in this new field.

METHODS A 36-item online anonymous survey regarding ACS was sent to the program directors of 55 randomly selected general surgery (GS) training programs for distribution to their categorical residents. The national sample consisted of 1,515 PGY 1 to 5 trainees.

RESULTS Response rate was 45%. More than 90% of residents had an appropriate understanding of the components of ACS as generally described (trauma, surgical critical care, and emergency GS). Nearly half (46%) of all respondents have considered ACS as a career. Overall, ACS ranked as the second most appealing career ahead of surgical critical care and trauma but behind GS. Most residents believed that ACS offers better or equivalent case complexity (88%), scope of practice (84%), case volume (75%), and level of reimbursement (69%) compared with GS alone. Respondents who answered ACS had a better scope of practice (61% vs. 36%), lifestyle as an attending surgeon (77% vs. 34%), or level of reimbursement (83% vs. 38%) compared with GS were twice as likely (p < 0.0001) to have considered ACS as a career. Overall, 40% of the residents believed that ACS offers a worse lifestyle in comparison with GS.

CONCLUSION These results suggest that there is notable interest in the emerging specialty of ACS. The level of resident interest in ACS as a fellowship and career may be increased by marketing those aspects of practice, which are viewed positively and addressing negative perceptions related to lifestyle. It may be appealing to add an elective GS component to certain ACS practice options.

From the Department of General Surgery, Indiana University (J.J.C.), Indianapolis, Indiana; Department of General Surgery, Loyola University (T.J.E.), Maywood, Illinois; Department of General Surgery, Emory University (G.S.R.); Atlanta Medical Center (D.V.F.); and Department of General Surgery, Mercer University (D.V.F.), Atlanta, Georgia.

Submitted: September 7, 2012, Revised: October 10, 2012, Accepted: October 10, 2012.

This study was presented at the 71st annual meeting of the American Association for the Surgery of Trauma in Kauai, Hawaii, September 12–15, 2012.

Address for reprints: Jamie J. Coleman, MD, Indiana University, 1604 N. Capitol Ave, B232, Indianapolis, IN 46202-1203; email:

© 2013 Lippincott Williams & Wilkins, Inc.