Are We Training Too Many Trauma Surgeons

1
Are We Training Too Many Trauma Surgeons?

• Michael J. Bosse, MD
• Orthopaedic Trauma Surgeon
• Carolinas Medical Center
• 2nd Past President - OTA

2
Without a Doubt

• YES

3
The Unthinkable

• Unsustainable
• Unregulated
• Uncontrolled
• Unfulfilled
• Underestimated
• Unstated

4
Unsustainable growth
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Unregulated Production

• 50 Programs
• 12 new programs in 2009
• xx new programs in 2010
• 80 Positions
• 99 applicants
• 25 of the graduating class

6
Production Effect

• 2010 2015
• 500 new orthopaedic trauma surgeons
• 50 retire
• 50 give it up full time
• 400 net gain
• Dont know the case increase in those years
• Dont know the economics

375 Active OTA Members
7
Ortho Emergency Care

• 80 - routine and relatively uncomplicated
• Community care appropriate core competencies
• 20 - complex
• Stabilize and transfer to higher level of care

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Unlike our Spine and Sports Colleagues

• We cannot invent / reduce surgical indications
• X number of pelvic and acetabular fractures
• Y number of femur fractures
• Z numbers of bicondylar tibial plateaus

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The math
125 pelvic and acetabular fractures

31 cases
4 traumatologist

6 traumatologist
20 cases

8 traumatologist
15 cases
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Uncontrolled Growth

• Risk the survival of the Level 1 centers
• Current healthcare safety net
• Diverting cases that typically drive the ortho
  trauma service
• Multi-trauma
• Pelvic and acetabular fractures
• Peri-articular fractures

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Unfulfilled Expectations

• Current excitement and camaraderie of the
  Orthopaedic Trauma Surgeons
• Yields to aggressive local competition for even
  the simplest of cases
• Stream of referrals to the Trauma Centers
  choked
• General orthopaedic surgeon further devalued
• Pool of tough cases becomes too diluted

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Supply Low / Demand High

• Trauma rooms
• Funded research assistants
• Mid-level providers
• Call stipends
• Salary subsidies
• Positive lifestyle changes

Stimulated Increased Supply
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Supply High / Demand Low

• Hospital regains the leverage
• Support might go away
• Funding likely to shift to other critical need
  area

Will fix a fracture for food
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Risk Destroying the Very Appeal of the
Sub-specialty

• Access to complex cases
• Daily challenges
• Acceptable number of cases to sustain a career
• IE dont need to search for scopes or DJD
• Pride of working with an elite FEW
• Ability to negotiate positive change

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The CauseTOO MANY

• FELLOWSHIP POSITIONS

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Fellowship Goals

• Advanced training, research skills
• Mentoring
• Networking into the belly of the profession
• To go into a practice to treat
• Complex fracture patients
• Peri-articular fractures
• Pelvic and acetabular fractures

17
OTA Underestimated

• Response to our drive to recruit new surgeons
• Ability of our surgeons to profoundly influence
  Generation XYZ
• Growth of new fellowships
• No criteria
• No oversight..

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Trauma Fellowship Growth

• Intrinsic or extrinsic need
• Intrinsic
• Filling call and resident work hour shortfalls
• Income generation
• Extrinsic
• Needs of society
• Needs of medical education

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Yet UNSTATED

• Develop strict criteria for fellowships
• Cap the number of approved fellowships
• Determine and monitor societal needs
• Protect the case flow to the Level 1 trauma
  centers

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Understand

• What made ortho trauma so popular
• The surgeon group
• The case mix
• The sense/satisfaction of purpose
• The respect of those less gifted or inclined

Protect the Core