Postgraduate trauma education; the surgeon; the cost.

Injuries account for 3.6 million hospital admissions and approximately 100 billion dollars in health care costs annually. Surgical educators have expressed concern about the adequacy of postgraduate trauma education in light of this trauma epidemic. The purpose of this report was to evaluate our residents' trauma exposure and to examine the associated cost of training a physician to treat critically injured patients. From July 1982 through June 1987, 38,714 patients were evaluated for injuries in the emergency department. Five thousand sixty-one patients required admission to the hospital, and of these, 2,045 were admitted to the intensive care unit. In addition, 3,851 major trauma operations were performed during this 5-year period. The majority of these procedures were neurosurgical and orthopedic; however, we have seen an increasing percentage of abdominal operations in the last 2 years. The last five graduating chief residents averaged 181 major trauma operations during their training. The hospital currently writes off an average of $250,000 per month in trauma patient non-collections. This averages to 1.5 million dollars per resident for 5 years of trauma education in our institution. It is imperative that we continue to train trauma surgeons to manage critically ill patients; however, society must address the enormous cost of doing so.