Trauma/Critical Care Surgeon: A Specialist Gasping for Air

Abstract

The economic dichotomy that exists between trauma centers and trauma/critical surgeons is significant. It drives institutional growth and, at the same time, discourages surgeons from entering the subspecialty. As physician reimbursement decreases and the number of uninsured patients increases, this economic dichotomy will amplify. Over the next decade, without a significant adjustment, the subspecialty is in danger of extinction.

Has the trauma surgeon become house staff for the surgical subspecialist?

“…Some have proposed rational approaches to increasing physician compensation based on strategies used by the trauma center to improve facility reimbursement, [12] while others have focused on dispelling the impression of a litigious, non paying patient population. [13] [14] The heart of the issue however remains the clinical responsibilities of trauma surgeon.…”

A novel way to remove a broken intramedullary nail

“…The increasing use of retrograde nails for calcaneotalotibial arthrodesis has a particular problem: the cannulation is often too narrow to allow passage of hooks or other commonly used extraction devices 2 . We propose a method using equipment that is readily available to aid removal of a deeply placed proximal fragment.…”

Surgical Management of Blunt Thoracic and Abdominal Injuries in Quebec: A Limited Volume

“…Even in the United States, the incidence of trauma is relatively low and decreasing among rural systems, 1 impeding access of some patients to advanced trauma care. 2,3 The number of surgical interventions performed in trauma cases is in even further decreased as the result of a diminution in the overall volume of trauma and a shift toward nonoperative management. 4 -10 This has led to the combination of trauma care with acute surgical care to ensure that there is an adequate volume of cases.…”