Understaffed and overworked: The stark reality of acute care surgeon staffing in the United States, an Eastern Association for the Surgery of Trauma multicenter study

Patrick B. Murphy, From the Division of Trauma and Acute Care Surgery, Department of Surgery (P.B.M., M.A.d.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (J.J.C.), University of Louisville, Louisville, Kentucky; Department of Surgery (D.J.W., J.G., E.B.), and Department of ? (M.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (T.H.K.), UMass Chan Medical School-Baystate, Springfield, Massachusetts; Division of Acute Care Surgery (K. Mukherjee), Loma Linda University Health, Loma Linda, California; Department of Surgery (S.B.), Hackensack University Medical Center, Hackensack, New Jersey; Division of Trauma, Acute Care, and Critical Care Surgery, Department of Surgery (M.M.B.), Penn State Hershey Medical Center, Hershey, Pennsylvania; Division of Acute Care Surgery, Trauma, and Surgical Critical Care (R.D.W.), University of Kansas Medical Center, Kansas City, Kansas; Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center (R.P.D.), Dallas, Texas; Department of Surgery, Detroit Medical Center (J.K.), Detroit, Michigan; Department of Surgery (R.G.-C.), SUNY Upstate Medical University, Syracuse, New York; Department of Surgery Emory University School of Medicine (J.D.S.), Atlanta, Georgia; Department of Surgery (B.M.), University of New Mexico, Albuquerque, New Mexico; Maine Medical Center (B.C.M.), Portland, Maine; Department of Surgery (M.W.C.), University of Colorado, Aurora, Colorado; Division of Trauma, Surgical Critical Care, and Emergency General Surgery (S.G.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (G.M.), Cedars-Sinai Medical Center, Los Angeles; Department of Surgery (J.L.), UCSF Fresno, Fresno; Department of Surgery (J.N.), University of California, Irvine, Orange, California; Department of Surgery (L.F.), University of Wisconsin-Madison, Madison, Wisconsin; SWAT Surgical Associates, Covenant Medical Center (C.V.B.), Lubbock, Texas; Department of Surgery (T.E.), Cooper University Hospital, Camden, New Jersey; Department of Surgery (L.M.K.), Stanford University, Stanford, California; Department of Surgery and Trauma, Broward Health Medical Center (J.D.B.), Fort Lauderdale, Florida; Department of Trauma and Surgical Intensive Care (C.F.), Good Samaritan University Hospital, West Islip, New York; Division of General and Trauma Surgery, Department of Surgery (M.S.), Ascension Sacred Heart Pensacola, Pensacola, Florida; Department of Surgery, Ascension St. Vincent Hospital (L.E.J.), Indianapolis, Indiana; Department of Surgery (M.S.F.), Lehigh Valley Health Network, Allentown, Pennsylvania; Department of Surgery, University of Texas Health Science Center (L.G.F.), Tyler, Texas; Department of Surgery (B.M.M.), Prisma Health, Greenville, South Carolina; Department of Surgery (R.S.M.), Atrium Health Wake Forest Baptist, Winston Salem, North Carolina; Division of Trauma and Acute Care Surgery (J.M.K.), Westchester Medical Center, New York Medical College, Valhalla, New York; Division of Acute Care Surgery (I.R.), Henry Ford Hospital, Detroit, Michigan; Trauma & General Surgery (M.S.E.), Billings Clinic, Billings, Montana; Department of Surgery, University of Connecticut Medical Center (S.C.M.), Farmington, Connecticut; Department of Surgery (B.B.), HealthPartners Regions Hospital, St. Paul, Minnesota; Department of Surgery (B.E.), Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Surgery (K. McKenzie), Jamaica Hospital Medical Center, Richmond Hills, New York; Department of Surgery (S.T.), Tulane School of Medicine, New Orleans, Louisiana; Department of Surgery (L.C.T.), Northwestern University, Chicago, Illinois; and Division of Acute Care Surgery (K.W.C.), Atrium Health Carolinas Medical Center, Charlotte, North Carolina.
Jamie J. Coleman
Danielle J. Wilson
Morgan Maring
Jaclyn Gellings
Elise Biesboer
Tovy H. Kamine
Kaushik Mukherjee
Stephanie Bonne
Melissa M. Boltz
Robert D. Winfield
Ryan P. Dumas
Jason Kurle
Roseanna Guzman-Curtis
Jason D. Sciarretta
Baila Maqbool
Bryan C. Morse
Michael W. Cripps
Stephen Gondek
Galinos Barmparas
Jordan Lilienstein
Jeffry Nahmias
Lee Faucher
Charles V. Bayouth
Tanya Egodage
Lisa Marie Knowlton
John D. Berne
Charles Fasanya
Meredith Shaddix
Lewis E. Jacobson
Michael S. Farrell
Luis G. Fernandez

Document Type

Article

Publication Date

10-1-2025

Journal Title

The journal of trauma and acute care surgery

MeSH Headings

Humans; United States; Surgeons (supply & distribution, statistics & numerical data); Personnel Staffing and Scheduling (statistics & numerical data, organization & administration); Trauma Centers (organization & administration, statistics & numerical data); Workload (statistics & numerical data); Workforce (statistics & numerical data)

Abstract

OBJECTIVES: Rightsizing the workforce to clinical demand requires a balance of work intensity, productivity, and a definition of clinical full-time equivalent (cFTE). We hypothesized a shortage of acute care surgeons based on a 204-shift per year (average, 17 per month) definition of a 1.0 cFTE established in our prior mixed-methods study (two service weeks plus five calls per month). METHODS: This multicenter study used mixed methods, integrating clinical schedules (CY2022), work relative value units, and qualitative insights from semistructured interviews (July 2023 to June 2024). Schedules were converted to shifts (8-14 hours). Hospitals were short-staffed when shift demand exceeded supply based on each surgeon's cFTE. Interviews explored clinical demand and staffing challenges. Descriptive analysis and a deductive-inductive thematic analysis were performed. RESULTS: Forty Level I/II hospitals representing 412 acute care surgeons (287 cFTEs) from 25 states were included. Seventy-nine percent of hospitals were short-staffed. Compared with well-staffed hospitals, short-staffed hospitals had fewer cFTEs (6.5 [interquartile range (IQR), 3] vs. 8.6 [IQR, 3], p < 0.05), a higher demand for clinical work (1,889 [IQR, 933] vs. 1,388 [IQR, 674] shifts, p = 0.05) and a higher work relative value unit/cFTE (8,779 vs. 7,456, p = 0.12). The aggregate clinical demand exceeded available surgeon capacity by 21% overall. Based on volume, a 1.0 cFTE is needed for every 285 (IQR, 169) trauma admissions. There was a deficit of 75 cFTEs across the centers. Key themes identified were related to the value of acute care surgery and balancing unpredictable demand, intensity, and efficiency. CONCLUSION: There appears to be a shortage of acute care surgeons in the United States when a definition of 204 shifts per year cFTE is applied. Hospitals face significant financial and administrative barriers to workforce expansion despite the overabundance of clinical volume. Future research is needed to ascertain the effects of expanding the existing workforce on both clinical outcomes and surgeon well-being. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.

First Page

560

Last Page

570

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