Reconciling the academic mission with workforce reality in acute care surgery

Recent multicenter studies have explored the current and desired clinical work for acute care surgeons. Acute care surgeons oversee and provide comprehensive care in trauma, surgical critical care, emergency general surgery, and burn patients. While these studies provide crucial data to guide planning at individual institutions to help address understaffed programs, translating this research into local practice and culture requires nuance and consideration of system (regional, institutional, department, and divisional) factors and individual surgeon goals. This opinion piece confronts the paradox at the heart of academic acute care surgery: how can surgeons deliver on educational and research missions when staffing models place the highest prioritization on clinical work? We present a practical, evidence-based framework that aligns sustainable clinical staffing with preservation of the tripartite academic mission in acute care surgery.