Although often used interchangeably, “emergency general surgery” and “acute care surgery” have different meanings, especially relative to the acute care surgery training paradigm. Whereas emergency general surgery refers to acute general surgical disorders, acute care surgery includes surgical critical care and the surgical management of acutely ill patients with a variety of conditions including trauma, burns, surgical critical care, or an acute general surgical condition. The challenges in caring for these patients include around-the-clock readiness for the provision of comprehensive care, the often constrained time for preoperative optimization of the patient, and the greater potential for intraoperative and postoperative complications due to the emergent nature of care. In managing these patients, acute care surgeons are fulfilling a huge patient care demand as the number of patients with acute surgical disorders is on the rise [4, 5]. And, each year, fewer general surgeons are available to participate in emergency room call to care for these patients. The general surgery workforce continues to shrink as each year more general surgeons retire and only about 25% of general surgery resident graduates choose to practice general surgery [11,12]. Hence, there is an increasing gap between the supply of general surgeons and the increasing numbers of patients with acute general surgical disorders. Another factor that contributes to the gap in supply and demand is the growing emphasis on minimally invasive techniques that have encouraged subspecialization. Minimally invasive surgery has also altered the operative experience of residents so that many general surgery graduates no longer feel comfortable taking care of patients with a broad range of general surgical conditions, especially those that are complex and time sensitive [9]. All of these factors support the continuous growing need for the well-trained acute care surgeon.
References
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9. Jurkovich GJ et al: Acute care surgery: trauma, critical care, and emergency surgery. A report from the Committee to Develop the Reorganized Specialty of Trauma, Surgical Critical Care, and Emergency Surgery.
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Dr. Davis is professor of surgery, Vice Chairman of Clinical Affairs, chief of the Section of Trauma, Surgical Critical Care and Surgical Emergencies,Yale University School of Medicine; Trauma Medical Director and Surgical Director, Quality and Performance Improvement, Yale–New Haven Hospital, New Haven, Conn. Dr. Jurkovich is chief of surgery, Denver Health Medical Center.