Elsevier

Surgery

Volume 141, Issue 3, March 2007, Pages 317-320
Surgery

Special section—acute care surgery
Acute care surgery from the orthopedic surgeon’s perspective: A lost opportunity

https://doi.org/10.1016/j.surg.2007.01.003Get rights and content

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Is there a need for trauma surgeons to provide orthopedic care?

Many emergency departments report difficulty getting orthopedic surgeons to cover call.1 In a survey of 1400 emergency departments, the American College of Emergency Physicians found that 2 of 3 departments did not have enough specialists for call; neurosurgeons, orthopedic surgeons, and obstetricians were at the top of the list of specialists who comprised the shortage.2 The proliferation of surgery centers not affiliated with hospitals has allowed orthopedic surgeons to perform elective

Can acute care surgeons be appropriately trained in a short period of time?

If the goal of the Acute Care Surgery program is for acute care surgeons to provide emergency care, the answer is probably “yes.” However, if the goal is for acute care surgeons to provide definitive care, the answer is most assuredly “no.” There is a growing body of literature and a general belief among orthopedic surgeons that it is rarely appropriate to provide definitive care at night, on an emergency basis. Most orthopedic trauma surgeons advocate damage-control orthopedics.4, 5 In other

Will orthopedic surgeons agree to train acute care surgeons?

In the current environment, the prospect of orthopedic surgeons agreeing to train acute care surgeon seems unlikely. The introduction of the proposed specialty has generated an extremely negative response from the Orthopedic Trauma Association (OTA) and the American Academy of Orthopedic Surgeons (AAOS).

The assumption that the American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association would support the “Acute Surgeon” treatment of orthopedic trauma patients is wrong. A

If trained, will the acute care surgeons be credentialed to perform these procedures?

It is conceivable that hospitals in need could force the orthopedic staff to accept the practice of acute care surgeons providing orthopedic care. However, this action would be extremely difficult if the orthopedic staff surgeons were opposed. Orthopedic surgeons could simply refuse to provide definitive care to patients initially treated by an acute care surgeon. Even if the hospital could somehow force orthopedic surgeons to accept these patients, the call problem would remain. Some kind of

A lost opportunity

The specialty of Acute Care Surgery seems like a viable option from the perspective of orthopedists. Orthopedic trauma surgeons should recognize that quality trauma surgeons are important and thus should have a vested interest in ensuring that the specialty remains viable. Although acute care surgeons may not resolve the shortage of orthopedists available for call, they could provide valuable manpower for trauma centers. In many cases, dedicated acute care surgeons who are interested in trauma

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There are more references available in the full text version of this article.

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