Massachusetts Chapter of the American College of Surgeons

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The Current State of the Acute Care Surgery Workforce: Results of a National Survey
Vijaya T. Daniel, MD, MPH1; Didem Ayturk, MS1; Catarina I. Kiefe, MD, PhD2; Heena P. Santry, MD, MS, FACS3
1Department of Surgery, University of Massachusetts Medical School, Worcester, MA; 2Department of Quantitative Health Sciences, University of Massachusetts Medical School 3Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH

Background: Acute care surgery (ACS) was proposed more than a decade ago to address a growing crisis in the general surgery workforce; however, the current composition of the national ACS workforce is unknown.

Methods: A hybrid mail/electronic survey was sent to 2,811 acute care hospitals nationwide having an emergency room and an operating room. Hospitals were queried on whether they had adopted the ACS model. The composition of the workforce among both ACS and non-ACS hospitals was evaluated using bivariate comparisons using both our emergency general surgery (EGS) survey and 2015 American Hospital Association Annual Survey Database.

Results: Survey response was 60% (N=1,690). The mean number ( SD) of EGS surgeons at ACS hospitals was 8 (5). A majority of ACS hospitals in the US have overnight OR availability with in-house OR staff (72%), around-the-clock in-house critical care specialists (52%), and around-the-clock in-house CT technicians ( 95%). Compared to non-ACS hospitals, ACS hospitals had a greater number of EGS surgeons (8 vs. 5, p<0.0001), female surgeons (20% vs. 14%, p<0.0001), and newly-trained surgeons (17% vs. 11%, p<0.0001). Fewer ACS hospitals compared with non-ACS hospitals lacked around-the-clock EGS coverage (3% vs. 16%, p<0.0001).

Conclusions: ACS hospitals have more human capital compared to non-ACS hospitals. All hospitals in the US may not be able to support the resource intensity needed at ACS hospitals; therefore, there is a need for the development of triage criteria and tiered centers of excellence of EGS care.

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