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Trauma surgery to acute care surgery: defining the paradigm shift
Joseph M Galante1, Ho H Phan, David H Wisner
1Department of Surgery, Division of Trauma and Emergency Surgery, University of California, Davis Medical Center, Sacramento, California 95817, USA. joseph.galante@ucdmc.ucdavis.edu
The Journal of Trauma
|May 11, 2010
Summary
Trauma surgeons perform fewer procedures but more bedside work than other specialists, indicating a shift towards acute care surgery (ACS). Their practice patterns show a distinct focus on intensive care unit cognitive tasks alongside evolving operative roles.
Area of Science:
- Surgical Practice Analysis
- Healthcare Economics
- Surgical Workforce Studies
Background:
- Trauma surgery is evolving into acute care surgery (ACS).
- Characterizing current practices of trauma and ACS surgeons is essential.
- Work relative value units (wRVU) can quantify surgical practice patterns.
Purpose of the Study:
- To define the evolution of trauma surgery into ACS.
- To characterize current practices of trauma and ACS surgeons using wRVU data.
- To compare trauma surgeon practices with general, oncology, and vascular surgeons.
Main Methods:
- Utilized fiscal year 2007-2008 data from the UHC-AAMC Faculty Practice Solutions Center database.
- Included coding and billing data from 85 institutions.
- Compared average wRVU data for trauma surgeons against general, surgical oncology, and vascular surgeons.
Main Results:
- Trauma surgeons derive only 43% of wRVU from procedures, compared to 69-75% for other specialties.
- Trauma surgeons perform a comparable number of total procedures but more bedside procedures.
- Trauma surgeons' higher wRVU for appendectomies suggest a transition towards ACS.
Conclusions:
- Trauma surgeons exhibit distinct practice patterns with more intensive care unit (ICU) "cognitive" work.
- While performing comparable procedures, trauma surgeons emphasize bedside interventions.
- Evidence suggests a paradigm shift in trauma surgery towards increased operative experience, aligning with the ACS model.
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