What's a trauma surgeon worth? A salary survey of the Eastern Association for the Surgery of Trauma

Understanding the Trauma/Acute Care Surgery Workforce

As the roles of trauma/acute care surgeons continue to evolve, it is imperative that health-care systems adapt to meet workforce needs. Tailoring retention strategies that elicit workforce satisfaction ensure continued coverage that is mutually beneficial to surgeons and health-care systems. We sought to elicit factors related to career characteristics and expectations of the trauma/acute care surgery (ACS) workforce to assist with such future progress. In this study, 1552 Eastern Association for the Surgery of Trauma members were anonymously surveyed. Data collected included demographics, career expectations, and motivators of trauma/ACS. Four hundred eight (26%) Eastern Association for the Surgery of Trauma members responded. Respondents were 78 per cent male and had a median age of 47.3 years. Forty-six per cent of surgeons reported earning $351K–$475K and 23 per cent >$475K. At this point in their career, 49 per cent of surgeons felt quality of life was “most important”, followed by 31 per cent career ambitions and 13 per cent salary. Prominent career satisfiers were patient care and teaching. Greatest detractors were burnout, bureaucracy, and work environment. Eighty per cent would change jobs in the final 10 years of practice, 31 per cent because of family/retirement, 29 per cent because of professional growth, 24 per cent because of workload, and 7 per cent because of salary. This study could be used to help develop trauma/ACS workforce strategies. This workforce remains mobile into late career; personal happiness and patient ownership overshadow financial rewards, and most prefer a total and shared patient care model compared with no patient ownership. Burnout, bureaucracy, and work environment are dominant detractors of job satisfaction among surveyed trauma/ACS surgeons.

Forensic Pathologist Salaries in the United States: The Results of Internet Data Collection

Despite their longer training period, forensic pathologists are among the lower paid of physicians. However, because forensic pathologists represent a relatively small group with only about 400–600 active full-time practitioners, they are not often included as a specific group in generalized salary surveys. Thus, individuals who practice in this area of medicine have little information regarding their financial worth as an employee. Using publicly available databases and other sources on the Internet, the salaries of 337 forensic pathologists were identified and used to calculate the mean and median salaries, as well as the overall range and 1st and 3rd quartiles for chief medical examiners, deputy chief medical examiners, and other medical examiners across the nation and between the general categories of death investigation offices: state, decentralized state, and county. Given a narrow classification scheme for titles, the range of listed salaries for chief medical examiner was $109 563 to $332 400 (with the lowest of the range being listed as “chief forensic pathologist”), for deputy chief medical examiners was $125 110 to $239 800, and for other forensic pathologists was $91 790 to $303 400. The respective (i.e., based upon a narrow classification scheme) mean listed salary for chief medical examiners was $219 778, for deputy chief medical examiners was $192 872, and for other medical examiners was $183 597. The results are useful for those forensic pathologists seeking employment and wishing to evaluate the salary offered or for those seeking information to use in future salary negotiations with employers.

Update on the status and future of acute care surgery: 10 years later

BACKGROUND

Ten years ago, the specialty of trauma surgery was considered to be in crisis. Since then, the Eastern Association for the Surgery of Trauma (EAST) created a position paper, and acute care surgery (ACS) has matured. A repeat survey of EAST members is indicated to evaluate the progress of ACS.

METHODS

A survey was e-mailed to EAST members. Results were evaluated and compared with the previous position paper and survey.

RESULTS

The response rate was 15%. More than three fourths of the respondents were male, and just less than one fourth of them were female. More than half of the respondents were in practice for less than 10 years. Seventy-three percent were involved in research, although only 16% were allotted protected time. Most respondents felt that reimbursement for their effort was inadequate: 54% thought reimbursement was fair for trauma care, 59% for critical care, 49% for nontrauma ACS, and 62% for general surgery. The biggest incentive to a career in ACS was that it was a challenging and exciting activity; the biggest disincentive was working at night. Seventy-two percent expressed satisfaction with their career profile, and 92% were either very or somewhat happy with their career. Sixty-six percent did feel either somewhat or very burned out. Surgeons were interested in learning more about contract negotiation, business/managerial issues, and billing/coding. Compared with the previous survey, overall career satisfaction seems stable.

CONCLUSION

Most surgeons are satisfied with a career in ACS. There are still some facets of the career that warrant improvement. Focus on surgeon satisfaction may lead to enhancements in patient care.

Trauma and surgical critical care workforce in the United States: a severe surgeon shortage appears imminent

BACKGROUND

We conducted a survey to determine the state of the trauma and critical care workforce and compensation for such surgeons.

STUDY DESIGN

We sent questionnaires to 460 directors of Level I and Level II trauma centers in the US to gather information about their current and expected resource needs and compensation packages.

RESULTS

We received responses from 117 directors (25%). Midlevel faculty mean salary was $282,000 +/- $85,000; with a mean bonus of $33,000 +/- $34,000; and a mean trauma call stipend of $1,690 +/- $900. Mean of the yearly representative value units of work was 7,845 +/- 3,154. An average of 1.7 +/- 1.4 trauma surgeon positions per center are currently unfilled (mean vacancy duration of 19 +/- 20 months), with another 1.2 +/- 0.5 full-time equivalents expected to retire within 3 years. A mean of 0.9 +/- 0.9 additional positions are expected to be added within the next 3 years because of the growing workload. By 2012, the US might have 1,500 unfilled trauma surgeon positions (with 2,250 occupied).

CONCLUSIONS

Trauma and critical care surgeons in the US are clinically busy and well compensated for their efforts, but a severe shortage of surgeons in this specialty appears imminent.

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"?

Economic modeling comparing trauma and general surgery reimbursement

BACKGROUND

The viability of trauma care as a surgical subspecialty is continually challenged by economic pressures related to reimbursement and opportunity costs.

METHODS

The literature was examined for articles focused on economic implications of a trauma focused surgical practice. Economic forecasting techniques were applied using a recalculating spreadsheet to examine charge and revenue generation comparing the effects of numerous variables affecting a trauma or general surgical service.

RESULTS

Elective general surgery practices derive the majority of revenues from procedural services, whereas trauma practices derive the majority of revenues from evaluation and management. Only centers with high admission volume can expect trauma surgeons to cover salary and expenses, predictably in association with high opportunity costs.

CONCLUSION

The differences in time, effort, and patient volume required for a trauma surgeon to generate revenues comparable to an elective practice are dramatic. The current system creates disincentives for surgeons to participate in trauma care.

Surgeon reimbursement for trauma care

BACKGROUND

Trauma care is a well-known financial burden for hospitals, yet reimbursement for the surgeon has not been reported.

METHODS

For 1999, the percent of the surgeons' bills reimbursed for general surgery services (gPR) was compared with that for trauma services (tPR). Mean tPR for various groups were compared. Factors predictive of tPR lower than gPR were identified.

RESULTS

The gPR was 49%, and, for 371 trauma patients, tPR was 45% (P = 0.03). The mean tPR for injury severity score (ISS) < or =10 was 48%, and for ISS > or =11, 57% (P = 0.03). Patients transferred from outside facilities did not have a significantly lower mean tPR. Penetrating trauma (odds ratio 3.7, P = 0.008) was predictive of tPR lower than gPR.

CONCLUSIONS

Surgeon reimbursements for trauma care was significantly, yet only slightly less than for all general surgery care. Surgeons should not be reluctant to take trauma call based on perceptions of low reimbursement.

General Surgeons and trauma. A questionnaire survey of General Surgeons training in ATLS and involvement in the trauma team

OBJECTIVE

To determine the level of training of General Surgeons in the UK in the Advanced Trauma Life Support (ATLS) course and their involvement with hospital trauma teams.

METHODS

Postal questionnaire sent to General Surgical Consultants and Higher Surgical Trainees (HSTs).

RESULTS

58% of General Surgeons who responded had attended ATLS, but only 30% of those who had been Consultants for more than 10 years. Eighty-seven percent considered the course 'essential' or 'some value'. Sixty-one percent of hospitals represented had a trauma team. A Consultant General Surgeon was a member of the team in 50% and the General Surgical HST in 82%.

CONCLUSION

ATLS has been widely accepted by General Surgical Trainees and recently appointed Consultants. The trauma team approach to resuscitation has yet to become fully established in the UK and there is limited input from Consultant General Surgeons.

Two careers in one: an analysis of the earning power of certification in surgical critical care

BACKGROUND

The core of general surgery supports multiple disciplines, each of which entails similar operative care for different diseases. The purpose of this study was to compare variations of practice patterns of four general surgeons to define the general surgical core that each shared in common, and to determine the effect of subspecialization in surgical critical care on the scope of practice and efficiency of revenue production.

METHODS

The charges and collections of four members of the same surgical faculty were analyzed for the 6 months beginning July 1, 2000. Three members practiced general surgery with additional specialization in surgical oncology, surgical endoscopy, and trauma/critical care. The fourth covered all aspects of general surgery, including in-house trauma call, but not surgical critical care. Data were stratified by Current Procedural Terminology code and categorized as operative, bedside care (which included minor procedures), and evaluation/consultation care. Scope of practice was defined as the proportion of operative cases represented by the 10 most frequently performed procedures. General surgical core was defined as those cases that were preformed by all four surgeons at the same frequency. Efficiency of revenue generation was defined as collection rate for these procedures divided by the established, budgeted collection rate for each practitioner. All results were compared using chi(2) with significance accepted at p < 0.05.

RESULTS

Fifteen operative procedures were performed with equal frequency by each surgeon and represented a broad spectrum of surgical disease. These procedures constituted a similar proportion of operative practice for all specialists (mean, 45.2%; 90% confidence limit, 3.5%), yet occupied 70% of the trauma surgeon's 10 most frequent surgical procedures versus 36% for the surgical oncology and surgical endoscopy. Charges generated by the provision of surgical critical care, especially in bedside procedures commonly performed in the intensive care unit, exceeded all of the other three surgeons and equaled the revenue generated by operative care. Although overall revenue-generating efficiency was less for the trauma surgeons (57% of eventual collections vs. 67%, chi(2) p = 0.1), immediate reimbursement for critical care was higher than for any other clinical services.

CONCLUSION

These data demonstrate that subspecialization in surgical critical care provides valid additional earning capacity to surgical practitioners. Reimbursement is at least as good as for traditional operative care, and fees generated can actually exceed revenue from operative care. With impending decreases in global reimbursement, and attempts to unbundle operative fees, this additional capability becomes an important consideration in potential career choice, as well as a major component in the fiscal stability of trauma programs.

The profile of level I trauma center directors

BACKGROUND

No data are available regarding the characteristics of the trauma directors of Level I trauma centers.

METHODS

Questionnaires were mailed to 102 directors of Level I trauma centers. Data were analyzed in a blinded fashion.

RESULTS

Seventy-two directors responded. All were men, with a mean age of 48 +/- 6 years. Fifty-eight percent of directors were fellowship trained. Directorship was assumed 7.3 +/- 6.1 years after training and the average time on the job was 8.6 +/- 6.1 years. Directors work in urban (93%), university-affiliated (67%) institutions that admit 1,000 to 2,000 patients annually (50%). Practice time distribution is as follows: trauma clinical care, 33%; general surgery, 20%; administrative work, 18%; critical care delivery, 17%; and research, 11%. Directors take 6.6 +/- 2.2 night calls per month, with half of them taking in-house call. Eighty-eight percent of directors are involved in research. Seventy-eight percent of directors earn $200,000 to $325,000 per year, with the largest group making $225,000 to $250,000. Salary is derived from clinical revenues (42%) and hospital (37%) or university (20%) support. Compensation is higher in community hospitals and tends to be higher in the Midwest.

CONCLUSION

The profile of the trauma director at a Level I trauma center was described. This may be important in trauma career and systems development.