General Surgery & Trauma Surgery…What’s The Difference?

What’s happening, you guys? Hey. Thanks for watching this video.

In this video, I’m gonna explain the difference between general surgery and trauma surgery and what you do for your residency and who does what kind of operations and stuff like that. So I had this question. Very good question because it’s very confusing. People in medicine don’t even know the answer to this question, so let’s go over that. Plus, I put a tie on today. I was looking pretty sweet. I got the haircut, I got the beard growing out. So I figured I can’t miss the chance to make a little video.

Sorry about the steering wheel and all that stuff. It’s a little close because I forgot my Go Pro little drive, so I gotta shoot this on my phone different.

Anyway, let’s first talk about general surgery residency, okay? General surgery residency is five years. In general surgery residency, you are required to do a certain amount of trauma training. So some places do it- Say, like, I did my training at a level one trauma hospital. They have lots of trauma there, and so you stay in-house in that hospital to do your trauma training, and we honestly did, like, twice or three times more trauma than we had to just because that was one of the big things that our hospital did.

However, when you want to be an attending at a level one trauma center, most places, you have to have a fellowship. And the fellowship, this is where it gets all (bleep)ed up, the fellowship doesn’t necessarily have to be a trauma fellowship. It’s a critical care fellowship, okay? So, yeah, riddle me that.

Anyway, what ends up happening is that most people who do a critical care fellowship have had a significant amount of trauma training in their residency. So the catch is is that some places, some residencies, don’t have a lot of trauma. They just have a lot of general surgery,and they have emergency general surgery.

Hang with me. It’s gonna get a little bit weird.

Okay, so you have emergency general surgery. And you have trauma. We break up trauma into two types, blunt and penetrating, okay? And blunt trauma is like you fall and hit your head, you get in a car accident and you hit your chest. Or you hit your abdomen, or a seatbelt goes across your abdomen. You get a liver injury, you get a spleen injury, something like that. That’s a blunt injury.

Penetrating is like a gunshot wound, a stab wound, things like that. So blunt injuries, the more we progress as an industry or our research progresses, we understand that probably the less operating is better. And that’s for most blunt injuries, but the penetrating injuries have a higher percent chance of requiring an operation, okay?

So now if you are doing a trauma…If you’re a trauma surgeon at a hospital that does not have a lot of penetrating injury, you are not going to operate at all, right? Or hardly ever, which is a problem because you want to be able…You wanna operate. You don’t wanna lose those skills. Once you do five years of general surgery, you’re gonna lose your skills if you don’t keep doing it. And that happens, and people…Honestly, I’ve met people that are scared to operate because they end up in a position where they were not operating a lot. And they…They not forget how to do it, but it’s a little scary going back into doing it once you don’t do it for a while. So that can happen, so how this issue is solved is that these what’s called an acute care surgery program is developed. And that combines emergency general surgery and trauma surgery.

So in a place like a level one trauma center, you’re gonna take care of acute diverticulitis, small bowel obstructions, acute cholecystitis, appendicitis, things like that. You’re also gonna take those trauma patients that come in that have a gunshot wound to the abdomen or a stab wound to the abdomen and stuff like that, and those places typically get really bad blunt injuries as well. So we’ll get shattered livers. You’ll take spleens out. You’ll even have…I’ve had ruptured colons, I’ve had ruptured small bowels just from seatbelts, I’ve had MVA, stuff like that.

So those are the main things you’ll do. In a smaller hospital where you don’t have a lot of blunt injury, most of the operating is only gonna be emergency general surgery. But you will take care of the trauma patient, and the trauma patient will often have…be an elderly patient with a head injury or a hip fracture. Lots of…When you get older, the most common injury is a fall.

So the elderly patients fall. They break their hip, and they hit their head. And they get head bleeds, so you’ll take care of those patients a lot. But you won’t operate on those patients. The neurosurgeon or the orthopedic surgeon will take care of them, but the trauma surgeon is like the captain of the ship. And so they’ll say, “Okay, the patient’s got a head injury. And they’ve got a head bleed, and they’ve got a broken hip. Which- Who’s gonna go first? Who do I call first? What are we gonna do? How are we gonna manage this?” The trauma surgeon is the person that manages that, and the reason is because I guess that we just take care of those patients all the time.

And so if it’s the chest/abdomen, then the trauma surgeon’s gonna operate on them. Those are generally the most lethal injuries besides the head injuries, and so those are taken care of in the trauma- by the trauma surgeon. And the specialists, they’re very niched down. And the trauma surgeon’s very…a little bit more broad. I guess that’s why we take care of those patients, so the American College of Surgeons is also taking control in ownership of the trauma patient. And so they want the general surgeon/trauma surgeon to take care of the trauma patient instead of that patient being admitted to medicine because the medicine guys are often not really familiar with the different traumatic injury patterns and the complications and things like that. So, as surgeons, we’re more familiar with surgical complications, which are also similar to traumatic complications because surgery is a trauma, right?

You cut somebody open, or you stab them. Or they get injury with the liver from a MVA. It’s all the same thing. You’re traumatizing the tissues, and then you end up with similar complications.

What’s it evolved into is the acute care surgery model, and the acute care surgeon is at a level one hospital – more of a trauma surgeon, okay? At a level two or level three, more of a general surgeon. So they take care of more general…emergency general surgery. Low level trauma. By that I mean falls, low speed MVAs, bicycle accidents.

Once you take care of patients and get shot in the head, Grandma falling and breaking the hip is not that big of a deal anymore. I mean, it is a big deal to Grandma. But not to the surgeon who is used to taking care of somebody that gets shot in the chest. You gotta crack their chest with ED. That’s just…That’s the real (bleep), not the grandma falling anymore. So that’s what I mean low level traumas.

If you want…Answer the question, “What the hell is a general surgeon compared to a trauma surgeon?” If you wanna do trauma, you want to take care of patients with gunshot wounds and stab wounds and MVAs and bad stuff. And you’re gonna be in the ICU a lot and all that stuff, then you wanna be…You wanna do a fellowship in critical care. Either critical care or a trauma fellowship. Here’s where it gets more- even weirder. You can also do a trauma fellowship, which is a two-year fellowship. One year is critical care, and one year is trauma. And then you’ll be set up to be a trauma surgeon in a level one hospital.

If you don’t want to do a level one hospital and you don’t wanna take care of patients with gunshot wounds and stab wounds and MVAs and all that stuff, which is fun for a while. But after a while, you’re gonna be like, “The gangbanger thing is not that cool anymore, and am I really doing- making a difference in the world?” Yes and no, but people do get burned out.

So if you wanna do mostly general surgery and you wanna do some…still some cool stuff where people are sick, then I would suggest doing a critical care fellowship after your general surgery residency. And then you can still take care of those critical patients. You will still do some trauma. You can be a trauma medical director at a, say, a level two or level three and still do emergency general surgery.

If you don’t wanna do any of that, if you just wanna do emergency general surgery, you can do just a general surgery residency without a critical care fellowship. But I suggest doing one at a place that is high acuity and not just one that’s easy gallbladders and appendix and hernias because those are the three – maybe small bowel obstruction. But those are the three operations that- And some general surgeons will just do elective surgery and end up doing a lot of…I wanna say low level but more simplified practice where it’s elective, and the only emergency stuff is an appendix here and there.

If you wanna do emergency general surgery…You’re doing bowel obstructions, you’re doing colon cancer, colon perfs, and some foregut stuff. Acute pancreatitis and…what else? Hiatal hernias. I had a gastric foveolar a couple weeks ago, stuff like that. Then you probably should do a residency at a little higher acuity, as in a level one or one hospital that’s in a large city. It’s a big…A lot of beds. 900 beds. Over 700 beds. You probably wanna do that.

That’s a handful! It’s a mouthful. I hope you guys understand what I’m doing out there. I hope it makes it a little more clear for you about what a general surgeon is and why a trauma surgeon is different. And then acute care surgery. And you don’t hear it a lot because it’s very confusing, but acute care surgery is basically, you’re an emergency surgeon. Let’s put it that way. What- How I put it is people ask me what I do. If- I said general surgery for a very long time, and then I said acute care surgeon for a really long time. People have no goddamn idea what you’re talking about, so I just started telling people that I’m an emergency surgeon. And then they get that, and you’re like, “Oh, okay.”

“What kind of stuff do you do?” I was like, “Appendix, gallbladder, gunshot wounds, stab wounds, MVAs, splenectomies.” They go, “Oh, okay, okay, I get that.” So that’s how I put it.

But emergency surgeon is not exactly…It’s not a part of the American Board of Surgery…their deal. They don’t call anybody an emergency surgeon, but that’s just something people…The layperson understands better.

But anyway, I thought this was an important one. It’s a really good topic. You guys, hey, I really appreciate all your feedback. It’s been fantastic and fun. I love doing these.

Send me comments, and subscribe to my channel would be great. And also like the video, and the best part is when you guys ask me what you wanna hear in these videos. So put in the comments below what other topics you want me to talk about, and I’ll do that.

Thanks. Take care.

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