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Macroeconomic trends and practice models impacting acute care surgery
  1. Andrew Bernard1,
  2. Kristan Staudenmayer2,
  3. Joseph P Minei3,
  4. Jay Doucet4,
  5. Adil Haider5,
  6. Tres Scherer6,
  7. Kimberly A Davis7
  1. 1Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
  2. 2Surgery, Stanford University, Stanford, California, USA
  3. 3Surgery, UT Southwestern, Dallas, Texas, USA
  4. 4Department of Surgery, University of California San Diego Health System, San Diego, California, USA
  5. 5Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  6. 6Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
  7. 7Surgery, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Andrew Bernard, Surgery, University of Kentucky Medical Center, Lexington, KY 40506, USA; andrew.bernard{at}


Acute care surgery (ACS) diagnoses are responsible for approximately a quarter of the costs of inpatient care in the US government, and individuals will be responsible for a larger share of the costs of this healthcare as the population ages. ACS as a specialty thus has the opportunity to meet a significant healthcare need, and by optimizing care delivery models do so in a way that improves both quality and value. ACS practice models that have maintained or added emergency general surgery (EGS) and even elective surgery have realized more operative case volume and surgeon satisfaction. However, vulnerabilities exist in the ACS model. Payer mix in a practice varies by geography and distribution of EGS, trauma, critical care, and elective surgery. Critical care codes constitute approximately 25% of all billing by acute care surgeons, so even small changes in reimbursement in critical care can have significant impact on professional revenue. Staffing an ACS practice can be challenging depending on reimbursement and due to uneven geographic distribution of available surgeons. Empowered by an understanding of economics, using team-oriented leadership inherent to trauma surgeons, and in partnership with healthcare organizations and regulatory bodies, ACS surgeons are positioned to significantly influence the future of healthcare in the USA.

  • cost
  • trauma
  • emergency
  • insurance
  • reimbursement
  • workforce

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  • Contributors JPM and KS conceived and organized the research. AB and KAD did the research and drafted the article. JD, AH, and TS provided critical review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This review article was exempt from IRB review.

  • Provenance and peer review Not commissioned; internally peer reviewed.