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To Be or Not To Be a Fellow

We believe that trauma surgeons, or acute care surgeons, exemplify these values. We have provided these services to surgical patients for the past 25 years. Trauma surgeons have been leaders in quality improvement, as demonstrated by the American College of Surgeons Committee on Trauma verification program.

We take care of whoever comes through the door, regardless of acuity, time of day (or night), or payer status. We have always provided comprehensive care for our patients—from involvement in prehospital care and planning, through the emergency department, operating room, ICU, and even post-discharge rehabilitation. This requires an effective healthcare team and a truly multidisciplinary approach with other physicians (orthopedics, neurosurgery, anesthesia), nurses, and others, including respiratory, occupational, and physical therapy.

Conclusion

We see a synergy between hospitalist and acute-care surgeons. Both groups have stepped forward to fill a void in patient care. The redefining of trauma surgery as acute care surgery and the development of dedicated training programs will no doubt benefit current and future surgeons, but our patients will benefit the most. TH

Dr. Spain is professor of surgery and chief of Trauma, Emergency and Critical Care Surgery, Stanford University (California). He is also chairman of the Critical Care Committee, American Association for the Surgery of Trauma. Dr. Jurkovich is professor of surgery at the University of Washington, chief of Trauma and Emergency Surgical Services at Harborview Medical Center, and chairman of the Acute Care Surgeon Committee, American Association for the Surgery of Trauma.

References

  1. Committee to Develop the Reorganized Specialty of Trauma, Surgical Critical Care, and Emergency Surgery. Acute care surgery: trauma, critical care, and emergency surgery. J Trauma. 2005;58:614-616.
  2. Spain DA, Miller FB. Education and training of the future trauma surgeon in acute care surgery: trauma, critical care, and emergency surgery. Am J Surg. 2005;190:212-217.
  3. Pryor JP, Reilly PM, Schwab CW, et al. Integrating emergency general surgery with a trauma service: impact on the care of injured patients. J Trauma. 2004 Sep;57(3):467-471.
  4. Reilly PM, Schwab CW, Haut ER, et al. Training in trauma surgery: quantitative and qualitative aspects of a new paradigm for fellowship. Ann Surg. 2003 Oct;238(4):596-603.
  5. Kim PK, Dabrowski GP, Reilly PM, et al. Redefining the future of trauma surgery as a comprehensive trauma and emergency general surgery service. J Am Coll Surg. 2004 Jul;199(1):96-101.
  6. Austin MT, Diaz JJ Jr, Feurer ID, et al. Creating an emergency general surgery service enhances the productivity of trauma surgeons, general surgeons and the hospital. J Trauma. 2005 May;58(5):906-910.
  7. Wellikson L. Hospitals recognize and reward value. The Hospitalist. 2005;9:3-5.

Unlikely Fellows

Dan Goldblatt, MD, a hospitalist in Minneapolis, was an atypical fellow. A family practice physician for about 17 years, he was burned out on clinic work and was attracted by the prospect of caring for sicker, more complex hospital patients. However, he knew that he would need more specific clinical training to be successful in this role.

“Most hospitals around here wouldn’t hire a family medicine physician as a hospitalist,” says Dr. Goldblatt. “The fellowship was a way to get into this growing field without going through an internal medicine residency. A lot of that training would be redundant anyway. I just wanted to focus on specific areas.

“Someone fresh out of an internal medicine program probably wouldn’t need this,” he adds. “But I needed to refresh my skills and gain more hospital experience. It’s like skiing. If you don’t do it for a while and then you go out on the slopes, it’s a little uncomfortable because you aren’t used to it.”

The hospital medicine fellowship was a rewarding and eye-opening experience for Dr. Goldblatt. “It was very helpful to get in there and get caught up,” he recalls. “Things have changed a great deal since I did my original training years ago.”

All of the skills and experience he gained also increased Dr. Goldblatt’s confidence that he would be effective working with acutely ill, complex patients.

He admits that the fellowship route isn’t necessary for everyone. In fact, he said that he knows of at least one family physician who was able to become a hospitalist without this extra training. However, he notes, “This was the right course for me. It was hard to take a big salary cut, but it was well worth it. I definitely think that it will increase my employment opportunities.”

Padma Pavuluri, DO, a pediatric hospital medicine fellow at Baylor College of Medicine (Section of Emergency Medicine) Houston, explains her reasons for choosing such a program: “As the hospitalist field matures, there are a lot of questions we are asking ourselves. A fellowship gives us the opportunity to answer questions with research projects.”

She also lauds the value of her ability to learn from her mentors and teachers. “I have 100 combined years of pediatric experience working with me,” she says. “As long as I do well in this program, I have a good shot at getting the job I want later.”—JK

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