Trauma and emergency surgery: South African model

South Africa is a low- to middle-income country with huge disparities in income, and a legacy of a disadvantaged majority. During the last 30 years, many of the advantaged minority found greener pastures and emigrated to first-world countries. We are left with a desperate shortage of specialists (including surgeons), particularly in the public sector. The need is especially acute in secondary and rural hospitals. A career in general surgery has become less attractive because of issues of lifestyle, remuneration, and the expanding requirements of the first-world part of our population.Worldwide, South African surgeons are recognized as hardworking and capable, with a broad repertoire-because that is the way they are trained. They are backed by a relatively small group of subspecialists, and all categories of specialists are burdened by a heavy workload. Continuing surgical education is mandatory but poorly enforced.Trauma surgery and intensive care form a substantial proportion of postgraduate training and general surgical practice. In isolation, these fields cannot sustain the needs and demands for the operative skills of a general surgeon. Trauma surgeons would have to find operative general surgical work to maintain their operative skills (and credibility).Because of the large gaps in service delivery to our population, and the shortage of general surgeons, particularly in secondary centers, there is at present limited space for a discipline of emergency surgery. The primary need for our population is access to well-trained generalists, backed by a small cadre of subspecialists.