Should the trauma surgeon do the emergency surgery?

The specialty of trauma surgery is evolving. The continued decline in general surgery operative interventions in trauma patients has led to an exodus of promising young surgeons away from the field. A concurrent decline in the number of burn surgeons, as well as orthopedists and neurosurgeons interested in providing emergency care, led to a pressing need for surgeons able to perform emergency surgical care. In addition, the general surgery workforce has followed a trend of increased specialization, with young surgeons gravitating toward specialties that are perceived to have a more forgiving lifestyle. This development has led to troublesome gaps in the emergency surgery call schedule at many institutions. Several intrepid centers already have begun assimilating acute care surgery into their departments with impressive results for their patients. Increased operative volume, increased reimbursements, and a palatable lifestyle add to the allure of treating these complex and interesting patients. Training future surgeons to staff the ranks of acute care surgery is an important and exciting challenge. It may be that "Should the trauma surgeon do the emergency surgery?" is the wrong question. A better question may be "How best can we train surgeons for this new specialty"?