has been declining steadily since 1985. Other specialties
with even fewer providers believe they can no longer
meet community demands for their services.* As a
result, the chasm between expectations for access to
emergency surgical care and the surgeon workforce
available to provide such care continues to increase.
The ACS recognizes the need for emergency surgical
care.† Hospitals, as mandated by the government, have
entered into contracts with the community to provide
care, sometimes with limited involvement of the actual
care providers in the negotiations. Surgeons feel deeply
obligated to care for all individuals who require care.
However, the surgeons attempting to provide this care
must also be practical in the face of increasing demands.
To be able to provide emergency care in a sustainable fashion, surgical practices must remain fiscally
viable, professionally attractive, and competitive
in retaining and hiring surgeons. The challenges to
this effort are myriad. Emergency surgical care may
involve greater risks than care provided during elective, scheduled operations due to an inability to ensure
preoperative patient optimization. Emergency surgical
patients often have a high risk for complications due
to advanced disease states, associated risk factors, and
underlying patient comorbidities. Patients and their
families may have unrealistic expectations for postoperative outcomes due to an underappreciation of the
urgent nature of the surgical disease. The time-sensitive
need for intervention may limit the ability to counsel
patients and their families on possible outcomes and
include input from primary care and other physicians.
Occasionally, the acuity of the disease process prompts
a patient or family desire to “do everything” when a
more palliative approach may be more appropriate.
Due to the nature of patient presentation, emergency
surgical care needs to be available on a 24/7 basis. On-call requirements may have a negative impact on the
surgeon’s time with family and the ability to provide
community service outside of the profession.
The obligation to provide emergency surgery call
care must be balanced with the means to do so; cost
shifting to the surgeon is an unacceptable option.
Unfortunately, this service is increasingly being mandated, and compensation should be appropriate to the
commitment. Hospitals and communities must work
with surgeons to ensure that lifesaving emergency surgical care continues to be available.
The College recommends that health care payors and
institutions commit necessary and appropriate support
to surgeons for emergency coverage of surgical care.†
Whatever model is chosen to provide this patient service, it must account for the disruption involved with
being on call regardless of whether actual service is
required. Compensation for the service provided must
be based on fair value for the risks involved and time
*American College of Surgeons. Statement on the Surgical Workforce.
Bull Am Coll Surg. 2007; 92( 8): 34-35.
†American College of Surgeons. Statement on Emergency Surgical
Care. Bull Am Coll Surg. 2007; 92( 5): 27.
To be able to provide emergency care in a sustainable
fashion, surgical practices must remain fiscally viable,
professionally attractive, and competitive in retaining and
hiring surgeons. The challenges to this effort are myriad.