Profitable Versus Unprofitable Expansion of Trauma and Critical Care Surgery

Background:The American Association for the Surgery of Trauma has proposed that the specialty of trauma and critical care include emergency surgery. We assessed whether this change will have an impact on the financial challenges that this specialty confronts, including inadequate reimbursement for efforts exerted. Methods:Over a 2-year period, we collected financial data on 6 trauma and critical care surgeons. Three included emergency surgery as part of their practice, but no private elective component. The other 3 included both emergency surgery and a private elective component. Results:Trauma and critical care surgeons who had included emergency surgery but no private elective component had significantly lower charges ($5,941,482 vs $9,209,535), collections ($1,439,913 vs $2,973,319), generated relative value units (50,440 vs 80,327), generated reimbursement per relative value units ($28.55 vs $37.02), and margins ($0.20 vs $1.48) than their counterparts who had an elective surgery component. Conclusion:The addition of emergency surgery did not improve the financial viability of trauma and critical care as a specialty. Without significant hospital or governmental financial support, the only viable financial option is to develop a substantial private practice that crosssubsidizes the practice of trauma and critical care. The appropriate professional bodies should incorporate changes in work processes that will allow the specialty to survive professionally but also financially.