So You Want to Be a Trauma Surgeon

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Welcome to the next installment of our So You Want to Be series, where we highlight a specific specialty within medicine, and help you decide if it’s a good fit for you! You can find the entire list here. If you want to help us decide which specialty or healthcare professional to cover next, drop a comment down below with your request.

If you’d like to see what being a trauma surgeon looks like, check out my personal YouTube channel, Kevin Jubbal, M.D., where I do a second series in parallel titled a Day in the Life.

 

What is Trauma Surgery?

Trauma surgery is a subspecialty of surgery primarily dealing with patients who have undergone a physical injury, often in an acute setting. Not all trauma requires surgery and depending on the specific injury, these patients may also need further treatment from neurologists, internal medicine doctors, and more. The majority of injuries addressed by trauma surgery include those of the neck, chest, abdomen, and extremities.

In Europe, trauma surgeons treat most of the musculoskeletal trauma, whereas neurosurgeons handle injuries to the central nervous system. In the United States and the UK, however, skeletal injuries are primarily handled by orthopedic surgeons, and facial injuries are often treated by plastic surgeons or maxillofacial surgeons. Neurosurgeons typically manage injuries to the central nervous system in these countries, too.

Trauma surgeons must be familiar with a variety of general surgical, thoracic, and vascular procedures. Trauma conditions can be described as blunt or penetrating. Blunt would include injuries from a motor vehicle crash, falls, ATV rollovers, and assaults. Penetrating injuries include gunshot wounds, stab wounds, and the like. Additionally, they’re dealing with high acuity situations, often with little time and incomplete information with a patient in front of them who is rapidly decompensating.

The more traditional trauma surgical interventions often include procedures such as exploratory laparotomy, where the abdomen is opened and the abdominal organs examined for injury or disease. Thoracotomies open up the chest, and tracheostomies are procedures for insertion of a breathing tube through the throat. Over the past few decades, advances in trauma and critical care have led to more non-operative, and sometimes minimally invasive treatment modalities. This is good for patients, as less invasive therapies often have better outcomes.

 

How to Become a Trauma Surgeon

To become a trauma surgeon, you’ll complete medical school and then do 5-7 years of general surgery residency, depending on whether your residency includes a two-year research block. From there, most trauma surgeons do a 1-2 year fellowship in traumatology, surgical critical care, or emergency surgery, for a total of 6-9 years of additional training after medical school.

Pediatric trauma surgery is part of regular peds surgery training. Depending on where the ambulance takes the patient, sometimes it gets managed and triaged acutely at the adult hospital, but ideally goes straight to the pediatric trauma center.

If you’re interested in more specific types of trauma, there are other specialties to consider. For example, orthopedic trauma focuses on surgical intervention of traumatic injuries related to bones. If you want to deal with spine and cranial trauma, neurosurgery would be your specialty.

General surgery residency is middle of the road in terms of competitiveness, with an average matriculant Step 1 score of 234, with the national average at 230. As with most surgical specialties, trauma surgery is male-dominated, although not as much as some other surgical specialties like neurosurgery or orthopedics.

As a surgical specialty, your general surgery residency and trauma surgery fellowship will be incredibly taxing with long and often unpredictable hours.

 

What it’s Like Being a Trauma Surgeon

Doctors joke around sometimes that trauma surgery is kind of like general surgery on steroids.

All of the regular principles that we have in general surgery are still there. And many of the procedures and maneuvers are the same, too. In trauma surgery, you might find yourself removing and reconnecting different portions of the small bowel and colon. You might find yourself removing a portion of the lung, or repairing a hole in the diaphragm. And you might find yourself deep in the abdomen exposing the retroperitoneum to repair a vascular injury.

All of these are techniques, and maneuvers, and procedures that we might do in other areas of general surgery. But the difference in trauma is the urgency and often the speed at which we have to do this work.

And just as trauma surgeons may have to perform surgery in a much more urgent timeframe, these surgeons also must make decisions about patient management, and take action, often with limited information, in the blink of an eye. But more on that in a few minutes.

 

Things You’ll Love About Trauma Surgery

There’s a lot to love about trauma surgery. It’s a specialty that’s fast-paced and exciting. And more than any other area in surgery, trauma is an environment where you can have an immediate and lasting influence on someone’s health, with actions that play out in seconds to minutes. After all, what could have a larger impact than saving someone’s life?

Trauma surgery also tends to attract surgeons who like to perform what we’d call “BIG” operations. Many of these procedures involve making long incisions, creating major exposures of vascular structures, and performing large-scale repairs of significant injuries throughout the body.

One of the most common procedures we do in trauma surgery is called an exploratory laparotomy. In this surgery, a long incision is made from the top of your abdomen just below the ribs, straight down the midline to below the belly button. Once the abdomen is entered, surgeons are able to quickly “run the bowel,” meaning that they examine your entire intestines from end to end. This type of procedure is typically carried out very quickly so that surgeons can quickly locate injuries – for instance, from a bullet or a knife wound – and then determine the next best steps to stabilize the patient, control any bleeding, and repair the injury.

And at the same time, they’re inspecting the intestines, they’re also looking at solid organs within the abdomen and different zones where your major vascular structures lie – like your aorta – to see what other injuries may need to be addressed.

Another trauma procedure that’s unfortunately somewhat common in urban areas with a large amount of crime and violence is called an “ED thoracotomy,” or a “crash thoracotomy.” This is a procedure that’s typically carried out in a portion of the emergency room called the trauma bay, and it’s done for patients who come in without a heartbeat after a form of penetrating trauma. In this procedure – over the course of a few minutes, a large incision is carried out across the left chest, the heart is released from the pericardium, and a cross-clamp is placed on the aorta to help reduce the amount of blood loss. Visible injuries to the heart and lung may also quickly be controlled with a clamp to help achieve hemostasis or stop bleeding. At this point, the surgeon performs what’s called open cardiac massage, which means squeezing the heart between one’s hands to try to restore a heartbeat, like a kind of internal CPR.

As you can probably tell, even though most specialties within surgery these days require a surgeon to specialize and commit to operating in one part of the body, a trauma surgeon could find him or herself removing a portion of the lung, repairing a bleeding cardiac injury, removing a damaged spleen, and repairing a hole in the intestines, all in the same day – and maybe on the same patient.

Another thing to love about trauma surgery is the mix of critical care medicine that’s involved. Most trauma surgeons balance their time operating with helping to manage ICU patients. This requires a more intellectual side of surgery that can often be a really nice balance to the more intense operative side of things.

Also, trauma surgery typically runs on a shift-type schedule. This means that while you might be incredibly busy while you’re at the hospital, once your shift is over, one of your partners takes over your responsibilities and your time outside the hospital is completely yours. In contrast, some surgeons within other specialties are on call 24/7 for their patients.

 

Things You Won’t Love About Trauma Surgery

But there’s also a flip-side to all of the excitement. The high intensity, action-packed moments of trauma surgery can also come with their toll – it can be exhausting and draining, both physically and emotionally.

Having critically ill, badly injured patients often means that unfortunately there will be many patients who arrive in your trauma bay that you just can’t save. Having to break bad news to loved ones of patients on a regular basis is an emotional weight that can be hard to over-emphasize. This is an incredible burden that trauma surgeons have to carry.

And – because traumas can occur at any time in the day, trauma surgeons also have to be available 24 hours a day, too. That means that when you’re on call at the hospital, there’s no guarantee what your day (or night) will be like. Things can be quiet all morning, afternoon, and evening, and then trauma patients can suddenly start pouring in, needing multiple operating rooms to open up to take care of the sudden volume. Shifts like this can be exhausting for surgeons, and for some people, they do take a toll. The unpredictability can also be a source of stress in itself.

Also by the very nature of what trauma surgeons do it’s one of the areas of surgery where you’re unlikely to have patients seek you out to be their surgeon. After all, trauma patients aren’t expecting to be having an emergency! But along those lines, it’s good to know that most trauma surgeons also have an office practice of general surgery – so these surgeons often see patients who come to them for elective surgeries like hernia repair, gallbladder surgery, and other procedures.

Who Should Become a Trauma Surgeon?

At the end of the day, trauma surgery is an incredibly meaningful and rewarding surgical specialty.

People who should go into trauma surgery are those who thrive within fast-paced, high-intensity environments … people who like making a decision, putting together a plan, and executing it, quickly – and without hesitation. If you’re someone who prefers to mull over every decision, trauma may not be the field for you.

Trauma surgery is also ideal for people who thrive in working on teams. Everything we do requires close coordination with our colleagues in surgery, nursing, anesthesia, and more.

And trauma surgery is also ideal for doctors and surgeons who like critical care medicine, too – surgeons who enjoy running an ICU and managing patients in intensive care.

Finally, trauma surgery is also ideal for people who like to have a shift work-type schedule in their life – so that when you’re off you’re truly off from the hospital and free of responsibilities. This type of schedule in trauma makes the specialty really ideal for people who have other passions in life and wish to balance their surgical career with other time commitments outside of their surgical practice.logic

 

Massive thanks to Dr. Hindin for sharing his expertise in general and trauma surgery. He has a super interesting story as a surgeon and medical technology innovator, so be sure to check out his channel, David Hindin, M.D. Which specialty should we cover next in our So You Want to Be series? Let me know with a comment down below. Thank you all so much for reading!

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