The Journey: 3. Trauma surgeon or ER Doc ?

One of the questions I get asked the most whenever I talk about going in trauma surgery is: "So you basically want to be an emergency department doctor?" and such. Those who know me well are often surprised because they know I value human relationships and that I don't really have neither the patience nor the interest to spend my life treating sore throats and minor injuries, for I know others will do it way better than me anyways. Most of the time, these interrogations come from a lack of knowledge regarding the differences between an ER doc and a trauma surgeon. Hence, I chose to do a bit of research on the matter to help me popularize my explanations and have the proper information to share. 

An unfortunately inaccurate scene of Grey's Anatomy: The head of trauma surgery wouldn't usually be taking charge of patient in the ambulance bay

Differences Between an ER Doctor and a Trauma Surgeon:

1. Type of injuries treated

Whilst an emergency room doctor is considered a generalist, a trauma surgeon is seen as a specialist. Therefore, the ER doctor will treat a broader spectrum of injuries and illnesses, ranging from the minor migraine to various stages of labour and even the basic stabilization of trauma patients. Usually, the trauma surgeon will come in from blunt or penetrating traumas and diverse injuries or disease that require surgery to preserve life, limbs and functions from serious damage. 

2. Relationship with patients

When a patient has undergone triage at the emergency department, they most likely will be seen, later on, by the ER physician. Of course, ERs are more often than not packed with patients who need attention and the physicians have limited time with each of them. Thus, it is very hard for ER physician to develop a meaningful and personalized relationship with patients. However, even if they do not truly meet their patient before surgery, as most require a quick turnaround in their care, trauma surgeon, on the long end, can take the time to get to know their patients mostly during post-op follow ups and rehabilitation. 

3. Skill sets and strengths 

An ER doctor, because they are the first physician most ER patients will see, must have a wide knowledge regarding conditions and injuries and be proficient with diverse stabilization techniques. They generally are great with differential diagnosis, especially that they have the make the initial decisions concerning the next steps of care. On the other end, trauma surgeons have to think on their feet with often limited informations regarding the injury and the patient and therefore have good deduction skills, in addition to confidence. Furthermore, trauma is a very human discipline as you have to deal intense emotions and situations. Hence, having empathy and being able to soothe patients and families are a most for trauma surgeons.

4. Education

Like all doctors and surgeons, ER physicians and trauma surgeons undergo the same basic medical studies. Nevertheless, trauma surgeons are in for a longer period of studies. Effectively, whilst most ER physician will get certified in an emergency medicine residency, trauma surgeons will have to complete a surgery residency, often general surgery and then complete a fellowship in trauma or critical care, ergo they will spend most of the times at least an additional 4 years in school compared to ER physicians. 

Sources: 

Vroomen Durning, Marijke. “Trauma Surgeons vs. ER Doctors: What's the Difference? .” Campus and Health News, David Geffen School of Medicine, 28 Feb. 2017, medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=937.  Summary: Trauma surgeons and emergency specialists work hand in hand on a daily basis. The first one has had a longer education and specializes in treating life-threatening emergencies that require surgery and the second one has comprehensive knowledge of many injuries, diseases and techniques, especially those related to stabilization. Although both work in emergencies, the pathway to each role is quite different.

“Becoming a Trauma Surgeon.” The Apprentice Doctor, 12 Sept. 2018, www.theapprenticedoctor.com/becoming-a-trauma-surgeon/.  Summary: Becoming a trauma surgeon requires a specific skillset and dedication both to studies and care. Effectively, the trauma surgeon can expect twelve to fifteen years of training and a lot of personal hard work on soft skills to be ready for work in the ER and the OR. Once a trauma surgeon is properly certified, in surgical critical care or similar, many pathways are open to them. Whilst most will decide to work in an hospital, some will join the military or teach.

Schuerer, Douglas. “A Day in the Life of a Trauma Surgeon.” Barnes-Jewish Hospital, 2012, https://www.barnesjewish.org/Newsroom/Publications/Innovate/Spring-2012/A-Day-In-the-Life-of-a-Trauma-Surgeon. Summary: On a typical day, a trauma surgeon will start their day by taking a look around the emergency and trauma department, assessing the pulse (pun-intended !) of their environnement and of the day. Once that's done, they complete rounds in the trauma unit. Afterwards, they consults in the ICUs as well. That routine will most likely be disrupted at some point or another during the day by emergency traumatic surgery. 

Communications team, AMA Physician. “What It’s like to Specialize in Emergency Medicine: Shadowing Dr. Clem.” Shadow Me , AMA, 2017, https://www.ama-assn.org/residents-students/specialty-profiles/what-it-s-specialize-emergency-medicine-shadowing-dr-clem. Summary: Dr. Clem talks about her strategies, such as "front-loading", to properly manage her ER. She explains the common disruptions that can happen in the day of an ER doc and most importantly, common frustrations and hardships that emergency physicians specially can face.