A national study defining 1.0 full-time employment in trauma and acute care surgery

Background: Trauma and acute care surgery (ACS) staffing models vary widely across the United States, resulting in large discrepancies in staffing, compensation, schedule, and clinical/nonclinical expectations. An urgent need exists to define clinical, academic, and schedule expectations for a full-time employment (FTE) of a trauma and ACS surgeon in the United States.

Methods: A survey was distributed to departmental leaders at Levels I, II, III trauma centers across the United States regarding current workload. Variables concerning the responsibilities of surgeons, compensation models, and clinical expectations were collected. This was followed by virtual semistructured interviews of agreeable respondents. A thematic analysis was used to describe current staffing challenges and "ideal" staffing and compensation models of trauma centers.

Results: Sixty-eight of 483 division chiefs/medical directors responded (14%), the majority (66%) representing Level I centers. There were differences in clinical responsibilities, elective surgery coverage as well as number of and reimbursement for call. The median description of an FTE was 26 weeks (interquartile range, 13 weeks) with a median of 8 (interquartile range, 8) 12-hour call shifts per month. Level III centers were more likely to perform elective surgery and covered more call shifts, typically from home. In our qualitative interviews, we identified numerous themes, including inconsistent models and staffing of services, surgeon-administration conflict and elective surgery driven by productivity and desire.

Conclusion: Defining the workload of a full-time trauma and ACS surgeon is nuanced and requires consideration of local volume, acuity and culture. Between the quantitative and qualitative analysis, a reasonable workload for a 1.0 FTE acute care surgeon at a Level I center is 24 to 28 service weeks per year and four to five in-house calls per month. Nighttime and daytime staffing needs can be divergent and may lead to conflict with administration. Future research should consider the individual surgeon's perspective on the definition of an FTE.

Level of evidence: Prognostic and epidemiological, Level III.