Yes: Model provides cost-effective surgical care.

I can say without qualification that acute care surgery is the best model for handling surgical emergencies. Not only is the model safe and cost effective, but it solves many of the problems plaguing the surgical field and emergency departments.

With the super-specialization of surgery, rarely is a surgeon available who is interested and competent to perform emergent interventions. And because of the inconvenience and poor reimbursement associated with emergency call, it is hard to find a surgeon who is willing to take call.

From a hospital viewpoint, having acute care surgeons on staff is efficient because we are in the hospital 24/7, ready to operate, provide critical care, and minimize hospital stays.

Most importantly, patients deserve immediate, comprehensive care from a skilled surgeon.

I’ve spent my entire 35-year career practicing acute care surgery. I helped develop the model early in my career because I felt we needed to be comprehensive general surgeons to deliver optimal trauma care.

I believe that with appropriate training and ongoing commitment, this model is safer – competent individuals are available 24 hours a day, 7 days a week for emergent care – and more cost effective, because if you manage the acute problem promptly, the disease will not progress to a more complicated state. Additionally, you can improve hospital throughput since the patient need not wait for a so-called specialist to perform their operation.

Surgeons in rural America have long been practicing this concept. Some rural surgeons have been doing advanced procedures for cancer and aortic aneurysms with excellent results. Others think that we are abandoning them by developing the acute care surgery model, but I believe it’s exactly the opposite. Acute care surgery supports the model of the comprehensive general surgeon who skillfully performs complex operations.

But I acknowledge the model must be tailored to the local environment. My hope is that we’ll be able to train a sufficient number of acute care surgeons to handle the full gambit of emergency surgery, including thoracic and vascular surgery. But we can’t ask people to spend 9 years of their lives training to be an academic acute care surgeon and then relegate them to removing necrotic gallbladders and acting as house staff for neurosurgeons. That’s simply not going to work.

Dr. Moore is editor-in-chief of the Journal of Trauma and Acute Care Surgery and vice chairman for surgical research at the University of Colorado in Denver. He pioneered and implemented a successful model of acute care surgery.

Whether or not acute care surgery is the best way forward may depend on where you practice.

The field is in its infancy, and the exact model for acute care surgery varies from institution to institution. I suspect that it could end up working well in some large, academic medical centers. But when I consider rural areas, like the one where I practice, I think that general surgeons will continue to be the providers patients rely on in emergencies.

The problem with the acute care surgery model is that it relies on a specially trained cadre of physicians who are essentially performing shift work, even if some of that work continues beyond their prescribed shift.

It comes down to numbers. There just aren’t enough acute care surgeons who are willing to work in smaller communities and rural areas. For instance, the University of Iowa established an acute care surgery program, but they have only enough surgeons in the program to cover day shifts. Other surgical specialists are taking on emergencies at night.

This model also doesn’t satisfy patient expectations in smaller communities. In areas like mine, patients expect me to spend time in the office, and to perform elective as well as emergency procedures. It would be unacceptable for a patient to ask, “Where is my doctor?”

The other issue the model creates is a potential gap in training. This represents a further subspecialization of our field and has the potential to further erode general surgery training. Already I cannot recruit a surgeon fresh out of a residency because their training experience does not parallel what they will need to practice in my environment.

I think the acute care surgery model has a lot of potential in large, academic settings where they have the manpower to do this. It fills coverage gaps created by physician shortages and gives trauma surgeons increased operative exposure. And it may also help make surgical residency more attractive to medical students.

A lot will depend on how this model is developed in the years to come, but right now the model only makes it tougher to find adequately trained surgeons to come to small, rural communities and provide the comprehensive, around-the-clock care that is needed.

Dr. Caropreso is a general surgeon in Keokuk, Iowa, and the American College of Surgeons’ governor for the state of Iowa. He also serves on the American College of Surgeons’ advisory council for rural surgery.