Hear his approach to excision, including why he looks for signs of “paprika” and “glistening corn silk” to evaluate the readiness of a wound...
Trauma is the leading cause of death for people age 44 or younger in the U.S. Yet, there aren’t enough surgeons to treat these patients. The number of trauma surgeons in the U.S. began to plateau in 2012.
Then, between 2014 and 2020, only 124 self-identified trauma surgeons were added to the workforce, a growth rate that’s 19 times slower than the rate from 2007 to 2014. This decrease in new surgeons in the specialty occurred while the U.S. population increased by 12.6 million people.
Researchers warn that the shortage of trauma surgeons will lead to higher costs to treat major trauma injury patients and could lead to worse patient outcomes.
Fewer Trauma Surgeons in the Pipeline
Yet less and less residents are choosing to focus on trauma injury. While an estimated 1,000 general surgeons become board-certified each year, only a small fraction enter trauma specialties. Researchers also note that nearly a quarter of all surgical critical care fellowships went unfilled from 2016 to 2020.
Trauma surgeons were once seen as “master technicians,” but the 1990s saw the emergence of surgical specialists and subspecialists, narrowing the scope of the specialty. Trauma surgeons then began to treat more blunt trauma cases, becoming more of a critical care specialist and less of an operating surgeon.
A 2010 survey of more than 1,200 general surgery residents about their plans and perceptions of a trauma surgery specialty found that 71% of respondents found it unappealing. Primary deterrents included lifestyle (60%), poor reimbursement (29%) and limited operating room exposure (34%).
Lifestyle factors that contribute to poor job satisfaction among surgeons that treat trauma injury include long shifts, a stressful work environment, unpredictable schedules and perceived high rates of burnout.
Regional Impact of Trauma Injury and Trauma Surgeon Density
This surgeon shortage is even more pronounced in some areas of the U.S. For example, Elkbuli et al. evaluated the location and density of trauma surgeons by state and region. They found a national average of 12.8 trauma surgeons per 1 million people, but a disparity when it comes to how many trauma surgeons are available for patients on a regional level in the U.S.:
- Northeast: 2.95 trauma surgeons per 500 admissions
- West: 2.12 trauma surgeons per 500 admissions
- South: 1.96 trauma surgeons per 500 admissions
- Midwest: 1.93 trauma surgeons per 500 admissions
What’s more, the U.S. regions with the lowest density of trauma surgeons reported higher trauma mortality rates per trauma surgeon, except for the west coast. States with at least 15 trauma surgeons per 1 million population had 100% better mortality rates compared to the national average. Elkbuli et al. also found that states with at least 80% fellowship-trained trauma surgeons have a lower trauma mortality rate compared to states which do not.
Likewise, Chang et al. showed that a higher density of trauma surgeons was associated with a significant reduction in deaths from motor vehicle accidents in their research.
Addressing the Trauma Surgeon Shortage
It’s estimated that the U.S. needs up to 2,400 new and practicing trauma surgeons to improve mortality from major trauma with a disproportionate number of those surgeons needed in the southern and midwestern U.S.
Elkbuli et al. suggest the following in order to alleviate this gap in care:
- Better reporting
Trauma scientific societies should come to a clear consensus on what is officially defined as a trauma surgeon shortage to more accurately assess shortages.
- Send resources where needed
Courses offered through the American College of Surgeons may enable more non-fellowship-trained general surgeons to take trauma calls in rural and low-density areas, increasing the capabilities and supply of practicing trauma surgeons.
- Improve lifestyle
Hospital administrators should focus on improving the lifestyle of trauma surgeons and reducing burnout. This could reduce attrition, encourage more trainees to join the specialty and boost trauma surgeon density across the U.S.
In addition, the American College of Surgeons advocates for a national trauma system that emulates the military. This includes seamless sharing of data, best practices and continuous improvement rather than what they call the “patchwork of care” in place today.
The ACS report, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” notes this effort has been needed for some time, but says other factors are now driving an urgency to:
- Better prepare for mass casualty events and disasters
- Remember the lessons learned from trauma care in Iraq and Afghanistan
- Improve pre-hospital care and empower bystanders as first responders
- Optimize and coordinate trauma data and research