The shape of things to come: Results from a national survey of trauma surgeons on issues concerning their future

Background. This study seeks to characterize the opinions of practicing surgeons as a basis for formulating a plan to restructure the discipline of trauma surgery and its training path. Methods. A 52-item questionnaire was administered to the membership of the American Association for the Surgery of Trauma, the Eastern Association for the Surgery of Trauma, and the Western Trauma Association. The survey tool investigated issues related to current and future practice. Results. Response rate was 60%. Mean age was 49 years and 88 % were male. The average time in practice is 15 years. The average workweek is 80 hours with 48% of that time devoted to clinical practice. About half take in-house call and about one-third receive an on-call stipend. The median annual number of major trauma cases was 50. The most important disincentives to entering the field were felt to be lifestyle issues and a limited scope of practice. Almost 90% felt their work as trauma surgeons was undervalued by society and the health care system. The great majority (88%) responded that the discipline of trauma surgery must change. Respondents feel this restructuring should include broader general surgery (83%) as well as limited orthopedic (60%) and neurosurgical trauma-related procedures (59%). About one-half of respondents favored in-house call (54%) and a practice model similar to emergency medicine (55%). Factors that would most enhance practice were thought to be guaranteed appropriate salary and guaranteed time away from work. Training in a broad range of skills was felt to be essential or useful to the trauma surgeon of the future, although few currently employ such a wide breadth of skills. Conclusions: Current practicing trauma surgeons feel that the discipline must change to remain viable. This change should entail broader training to allow more procedures in trauma, emergency surgery, critical care, and elective general surgery. The preferred practice model is a large, hospital-based, diversified group practice with a predictable lifestyle and guaranteed salary commensurate with effort. Inclusion of selected emergency orthopedic and neurosurgical procedures are viewed favorably, as is in-house call. Efforts to increase public perception of trauma surgery's value to society and its impending demise are warranted.