Hey, what’s up you guys? Thank you for watching this video.
In this video, I’m gonna talk about what is a trauma surgeon. ‘Cause I get this question all the time. People sort of have an idea, but they’re not exactly sure – number one – what you do and number two how you become a trauma surgeon. I’m gonna talk about both of those things.
It’s a little bit weird because trauma surgeons don’t necessarily have a board certification. That’s a little bit different than, say, a vascular surgeon or a cardiothoracic surgeon. Most surgery specialties, let’s say a lot of surgery specialties, cardiothoracic, transplant, vascular, plastics, colorectal, you first do a five-year general surgery residency. You med school- College is four years, med school is four years, residency, general surgery is usually five years. Now there’s a couple changes to that. Plastics are starting to move to a three and three situation. Vascular, they’re trying to move that to a three and three situation as well. But many places are five-year general surgery. Then you do a fellowship, you apply and the whole rigmarole again. You get into a fellowship and you get another two years.
Vascular surgery’s two years, plastics – I think – is two years, sometimes three. There’s some other fellowships like minimally invasive surgery which is a one-year. Rest Fellowship is a one-year. Surgical oncology, I think, is a two-year or three-year. Cardiothoracic is generally about a two-year fellowship.
Trauma surgery. Now, I’m telling you all this because it’s weird. Trauma is either a one-year or a two-year. When you’re a trauma surgeon, you first have to do general surgery. Then you can do- get a fellowship. You can do either a fellowship only in critical care, and you become board certified in critical care. But you don’t become board certified in trauma surgery because there is no board certification in trauma surgery. So what people do is they get a two-year fellowship, you do a one-year critical care fellowship, which is just in the ICU, and then…Actually, it’s nine months of critical care and three months of- depends on what fellowship you go to. Some of it is you rotate around through cardiac and transplant and do different things like that.
The second year is trauma where you’re the trauma attending. You function as a junior attending. You’re taking trauma call, you’re usually kind of the boss of the residents or whatever. Also, of course, you answer to your attending. That’s the two-year trauma fellowship.
You only get the board certification in critical care and not trauma surgery so…Don’t ask me. I think they’re trying to make a board certification, but it’s not done yet and whatever. You’ll find that a lot of trauma surgeons have done this to your fellowship and some of them have not. Some of them only focus on critical care, but the- Depending on your general surgery residency, you may or may not see a lot of trauma. Some smaller community hospitals, you won’t see a lot of trauma. If you do your general surgery residency there and you don’t see a lot of trauma, then it’s unlikely you’re gonna go into a one-year fellowship of critical care and then be hired as a trauma surgeon.
My situation is a little bit- is neither of those. I did a five-year general surgery residency at Detroit at Henry Ford Hospital so it was a 900-bed hospital, 60-bed ICU. We had a lot of trauma there, so one of the main things we saw all the time was trauma. I felt fairly comfortable with it by the time I finished. Obviously, I don’t have a fellowship in it. You’re not seeing it everyday, but I saw quite a bit of it.
A lot of guys in my situation might do critical care and then work as a level two center or a level one center, which I’ll go over in a different video. If you’re gonna work in a level one center by the way, you need a critical care fellowship to be a trauma surgeon. I do acute care surgery, which is a little bit different. I’ll talk about that, but they don’t require you to have a critical care because a lot of these ICUs have a special team for their critical care.
Because of my residency, we did a ton of critical care, literally, everyday critical care. I have the numbers and the experience, and I showed my team and my employer, my boss, that I wasn’t an idiot in the ICU. They were like, “Okay, you can take care of your patients in the ICU.”
It’s a little bit dynamic, let’s put it that way, right now. It’s essentially if you’re comfortable, you have enough experience, you can do it. If you’re not and you don’t have enough experience, then you can’t really do it without a fellowship. Does that make sense?
The other thing I wanna talk to you about is…That’s how you become a trauma surgeon, so there’s a bunch of different ways to do it. What I would recommend if I was gonna do it again and I knew I wanted to go into trauma, I didn’t know this really at the end of my residency. I didn’t really think I was gonna go into acute care surgery and trauma stuff. I thought I was gonna do general surgery, just elective general surgery. So I said, “I don’t need a fellowship. Whatever.” But I ended up coming back to it for various reasons, and that’s in my other videos.
What I would recommend if you know you wanna go into trauma, I would recommend doing the two-year fellowship. I would just do five years. Don’t do any research. You don’t need to do research ’cause nobody- Trauma fellowships are fairly easy to get because it’s a hard-ass job. Just do a two-year fellowship. You’ll be way ahead of everybody and then if they ever decide they wanna do a board certification, then you would probably be eligible for that board certification. That’s what I would recommend.
If you do- If you’re in a level one trauma center for your residency and you wanna do just a critical care fellowship, I think that’s probably reasonable too. If you wanna be the director of a trauma program, especially in a level one center, you should probably do the two-year fellowship. You can probably- You can be a director of a trauma program in a level two center if you just have a critical care fellowship and not the whole- the two-year deal. It’s a quagmire of disastrous (bleep) spiderweb. Anyway, that’s what it is.
The second thing I wanna talk to you about in this video was what does a trauma surgeon do? Basically, depending on your hospital and your team and your partners and stuff like that, you will- there’s a couple of different ways to do it. Most people, right now, are doing…If they’re in a level one center, there’s a bunch of trauma surgeons. You take, like, six to 10 days of call per month. Then when you’re on call, you do a 24-hour call generally. It’s seven a.m. or six a.m. – usually seven a.m. – to seven a.m. the next day. Then you may or may not go home right away.
In our- my residency, the trauma surgeons would- They also did general surgery, acute general surgery. We lumped everything together. It’s a little bit different in different places. Henry Ford, at the time when I was there, we lumped everything together as emergency general surgeon and trauma surgeon. That trauma surgeon took both of those during that 24 hours. The next time…Then the following day, they would pass it off and they would say, “Okay, well, we have three appys, three appendix to do. This next day while you’re on-call because I’m done being on-call and maybe that person had to do clinic or maybe that person had to do elective surgery, so you may end up with that scenario.
But because they’re also critical care certified, they might do…They make a round in the ICU that week. If you- of course it’s different in all places but say in our place, critical care. All the trauma surgeons were critical care certified. They do a week of critical care rounding on the ICU patients. During that week you may have also a call or two of trauma, so that’s where it gets a little crazy. You might have clinic too ’cause you have post-op patients and stuff like that and maybe some pre-op patients in clinic.
One guy might have everyday rounding in the ICU in the mornings, so you may go 8:00 a.m. or something, whatever it is, to noon rounding. You may have elective cases. I think they try not to do that when you’re rounding that week. You may have a day, half a day, of afternoon clinic or something like that. In addition, maybe Wednesday and Saturday, you take call. That’s a super busy week. It’s not always like that everywhere. But at Ford, at the time, it’s something like that.
What I do is different. I’m in a level two center, and we generally do either 12 on 12 off – that’s hours – or 24/7 for a period of time. Like, five days, seven days, whatever. Depending on the hospital and how busy they are. If you’re super busy, typically, you don’t do 24/7 ’cause you’re gonna be up all night. You can’t be up all night every night for seven days. That’s stupid, so the hospitals that are less busy, have less trauma in the middle of the night, you can do 24/7. You have PA’s to help you out in the daytime.
The other hospitals that are super busy at night, they may have a trauma surgeon for 12 hours during the day – seven A to seven P – and then from seven P to seven A. A lot of those places that are really busy like that, they may have PA’s unless they have a residency where they have residents helping you out as well. That’s what I do. I go back from- One hospital is less busy in the middle of the night, and we don’t do general surgery everyday. We just do trauma and then we’ll take maybe- Maybe I’ll take six days of total trauma call- total general surgery call for the entire month. Maybe I’ll take, like, six days of general surgery call for the entire month, but I’m taking trauma call everyday of that month. Does that make sense? That’s a little bit different than the other situation where those guys were taking trauma and general surgery every time they were on-call.
That’s- I think, I hope, that makes sense. I didn’t really talk about the surgeries we do at all, so let’s talk about the surgeries real quick and what trauma surgeons do.
Most places, it is lumped together as you are a general surgeon and you’re a trauma surgeon. Trauma, in general, you do less operations. As time goes on, we’ve figured out that opening people less is probably better for a lot of different scenarios, and there’s different techniques. Really, really invasive stuff and per-ce-ha-nus tra-nus from radiologists and stuff like that that we can do a lot less surgery ends up being a lot less morbid for the patient, so we figure those things out.
Over all, trauma is less operating as time goes on it seems. That’s why a lot of trauma surgeons also do general surgery because if you don’t, especially if you’re on a level two center and it’s not really busy. There’s not a lot of penetrated injury around, and you won’t operate very much. You won’t do anything, so you gotta keep your skills somehow. A lot of the general surgery…a lot of the emergency general surgery and the trauma surgery are essentially one and the same, so we typically do mostly abdominal surgery.
We have consultants for a lot of the other operations. If it’s an arm or it’s a vascular injury or something like that, then some trauma surgeons will do that themselves if you’re comfortable. Some of them will say, “We want a vascular surgeon for that.”
You do do chest surgery depending on your comfort level and what you’re used to and what institution you’re at. If someone’s getting shot in the chest, and you put a chest tube in and a bunch of blood comes out. You think it’s a bad injury, lung or blood vessels, then a trauma surgeon typically does that. The neck is the same way. If you have- somebody gets shot in the neck, a lot of the trauma surgeons will do that themselves. Some will, some won’t. A consult will have a vascular surgeon or maybe a cardiac surgeon ’cause they also do blood vessel operations.
The belly, spleen injuries, we’ll do splenectomies and we’ll take out all the bowels. We’ll fix all the bowels if they have, if they ruptured from motorcycle accidents or motor vehicle accidents or gunshot wounds, kidneys. Even the kidney, if it’s kidney bleeding real bad or something like that from a gunshot or a blunt injury then we’ll take that out. Typically, like the t-shirt and Bermuda shorts, that’s kind of where the trauma surgeon works. If it’s distal to that, either in the limbs – I mean, the upper limbs – or the lower limbs then generally you might have a vascular surgeon do that.
We don’t do any of the bones. The bones are orthopedics. We don’t really do the brain; that’s more neurosurgeons.
Obviously, that’s a quick and dirty thing I just told you. That gives you an idea, I hope, of what the trauma surgeon does. It’s fluid, definitely, with each institution and each person and each comfort level. It’s a little bit fluid, so that is my spiel on trauma surgeons and what we do and who does what and how you do it and how you get there.
I hope that makes sense. I hope that clears up some stuff for you guys, especially medical students and residents who are not sure how exactly you get there.
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