Monday, January 15, 2007

More on the Future of Surgery......
Dr. Schwab has a post about his experience as an acute care surgeon (ACS) or a "surgical hospitalist". I have posted about this several times before (just click on the "future of surgery" tag). Dr. Schwab agrees that the acute care surgeon will have a role to play in the future. How and why? Let us count the ways:
1. The 80-hour work limits have exposed current trainees to five years of very predictable schedules, night floats, and guaranteed time out of the hospital. The ACS model fits this paradigm quite well.
2. With over 3/4 of current residents going on for further fellowship training having someone who can emergently "stop the bleeding and drain the pus" without much delay will be needed.
3. Hospitals will need a reliable cadre of surgeons who can provide emergency room coverage.

Dr. Schwab shares the opinion that objections will be raised by some because "it cuts into their gig" I think that objection is overcome by what I have called the "briar patch effect" of ACS:
A popular trend to increase the operative potential of the trauma service is to add nontrauma emergency surgery responsibilities. Although this appears to improve the trauma surgeon's operative experience and job satisfaction, reports thus far have focused on providing general surgery emergency services with limited coverage of vascular and thoracic nontrauma emergencies. Initial enthusiasm for this solution has the potential to be short lived because the majority of these surgical emergencies consist of draining soft tissue infections and excising necrotic gastrointestinal structures. Indeed, it can be argued that the trauma surgeon coverage of these surgical emergencies has a greater effect on the job satisfaction of the somnolent elective surgeon that is relieved of these responsibilities.
Emphasis mine.
Dr. Schwab and his group have,IMHO, done it the right way with an estblished group bringing somebody in to allow the other surgeons to be in the OR making money.
Stronger objections will concern the "ownership" of the surgical patient, how the acture care surgeon relates to his "somnolent elective" colleauges, and the possibility that acute care surgeons will be considered a "surgical underclass". No matter how many curricula, meetings, or fellowships they may come up with, how the ACS system addresses these will determine the fate of the acute care surgeon.


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