Whether it’s a collision or an emergency appendectomy, acute care surgeons, take care of the sickest patients in the hospital. We are hospital-based surgeons who, as part of a dedicated and collaborative team, provide care to patients during their most critical times of need, 24/7.
Because we are highly trained and are at the ready when patients need us most, we help to save lives and improve outcomes.
Acute care surgery is an evolving specialty encompassing the components of trauma, critical care, and emergency general surgery. The specialty addresses one of the biggest transformations happening in the ever-changing environment of surgery. It is taking on new responsibilities for emergency surgical care, and increasing the ability to care for these patients as new techniques are developed, in the face of advancing technology. Acute care surgeons are pioneering a new approach to in-patient surgery.
The Surgical Shortage versus the Demands of Inpatient Surgery Today
Why is this transformation necessary? Patients’ emergency care can be compromised by physician shortages in the surgical suite and increased volumes in the ED, a situation that has been escalating over the last several years. In fact, more than 10 years ago, a Robert Wood Johnson Foundation (RWJF) survey found that two-thirds of EDs do not have enough surgical call coverage to meet the demand for emergency surgical care.i This ongoing problem has only grown worse. A subsequent study by RWJF of on-call specialty care found that three-quarters of EDs had inadequate surgical call coverage.ii
Now, with millions of Americans obtaining health coverage for the first time, hospitals across the nation are reporting that even more patients are presenting to their emergency departments, in part because these newly insured patients have trouble finding primary care physicians.iii Taking care of these patients is exacerbated by the growing shortage of surgeons. Estimates are that there will be a shortage of 46,100 surgeons and medical specialists by 2020.iv
Clearly, the old, traditional method of surgeons in private practice taking a call, just will not work today. There aren’t enough surgeons. Those in private practice often want to focus on their practices which are intensive enough without the “nuisance of being on call.”v Furthermore, the demands of patient care today require responses in minutes, not hours. As the acuity of patients who are hospitalized rises, so too is their need for responsive, immediately-available teams to provide acute care surgery. Finally, within the hospital environment, all departments are required to step up their timeliness and performance in delivering care according to best practices.
A New Acute Care Surgery Model
The acute care surgery model initially arose in the academic environment as a solution to manage these patients with physiologic needs similar to trauma patients for whom access to 24/7 care could make a difference in their outcome.vi, vii, viii, ix, x, xi With time, with the creation of Acute Care Surgery Fellowships and the American College of Surgeons’ (ACS) vision to bring together surgeons, resources and the infrastructure to provide 24/7 care for surgical emergencies, a new model emerged that is gaining acceptance across the nation. Implementing the acute care surgery model has proven very beneficial to patients with emergency surgery needs, reducing adverse outcomes and increasing overall positive results, improvements that are attributed to the focused care of these patients.xii
As noted, the evolving specialty of acute care surgery encompasses trauma, critical care, and emergency general surgery. Arising to satisfy the need for emergency call coverage, acute care surgeons help speed up, standardize and improve patient care overall from the ED. The rise of on-site hospital surgeons, often acute care surgeons and frequently referred to as surgicalists, is helping mitigate the problems created from the increasingly limited number of surgeons who provide this care in the community.
Recognizing the growing national need for acute care surgeons, there are now 18 fully accredited AAST Acute Care Surgery fellowship programs focusing on this track. Acute care surgery now offers surgeons coming out of residency a new career path, one that acknowledges and rewards their skills and commitment. In an era of surgeon shortages, we must find ways to attract the best and brightest to this profession; this is an important step toward that goal.
Stay tuned for my next blog on this topic which addresses the advantages this model brings to hospitals and patients.
i American College of Emergency Physicians. “On-call Specialist Coverage in U.S. Emergency Departments, ACEP Survey of Emergency Department Directors.” September 2004. (http://www.acep.org/workarea/DownloadAsset.aspx?id=8974)
ii Robert Wood Johnson Foundation. “Severe Shortage of Surgical Specialists Plagues Nation’s Emergency Departments.” Mitesh Rao, M.D., M.H.S., et al. February 10, 2011. (http://www.rwjf.org/en/library/articles-and-news/2011/02/severe-shortage-of-surgical-specialists-plagues-nations-emergenc.html)
iii California HealthLine. “Many Newly Insured Individuals Struggle to Find Primary Care Docs.” December 8, 2014. (http://www.californiahealthline.org/articles/2014/12/8/many-newly-insured-individuals-struggle-to-find-primary-care-docs)
iv Bonnie Darves. “Physician Shortages in the Specialties Taking a Toll.” The New England Journal of Medicine Career Center. March 2011. (http://www.nejmcareercenter.org/article/physician-shortages-in-the-specialties-taking-a-toll/)
v Deborah Gesensway. “Surgicalists: Why Aren’t They in Your Hospital?” Today’s Hospitalist. January 2015. (http://www.todayshospitalist.com/index.php?b=articles_read&cnt=1977)
vi Derlet RW, Richards JR. “Overcrowding in the nation’s emergency departments: complex causes and disturbing effects.” Annals of Emergency Medicine. 2000; 35:63–68.
vii Lewin Group. “Emergency Department Overload: A Growing Crisis. The Results of the AHA Survey of Emergency Department (ED) and Hospital.” 2002.
viii Asplin BR, Magid DJ, Rhodes KV, et al. “A conceptual model of emergency department crowding.” Annals of Emergency Medicine. 2003; 42:173–180.
ix Scherer LA, Battistella FD. Trauma and emergency surgery: an evolutionary direction for trauma surgeons.” Journal of Trauma. 2004; 56:7–12.
x Kim PK, Dabrowski GP, Reilly PM, et al. “Redefining the future of trauma surgery as a comprehensive trauma and emergency general surgery service.” Journal of the American College of Surgeons. 2004; 199:96 –101.
xi Capacity. Available at: http://www.hospitalconnect.com/aha/press_roominfo/content/EdoCrisisSlides.pdf. Accessed Online May 5, 2006.
xii “Sustainability and Success of the Acute Care Surgery Model in the Nontrauma Setting.”Journal of the American College of Surgeons. Volume 219, Issue 1, Pages 90–98. (http://www.journalacs.org/article/S1072-7515(14)00220-8/fulltext)