Confessions of a Dinosaur

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Let me begin by expressing my gratitude to the Eastern Association for the Surgery of Trauma (EAST) for the invitation to present this address. I am extraordinarily proud of our President, Dr. Nicole Stassen, who was a Fellow in Surgical Critical Care and Trauma at the University of Louisville for 2 years, and then was one of my partners for several more years before assuming the current position in Rochester, NY. For senior academic surgeons, there is no greater joy than watching our younger associates succeed, and Dr. Stassen has succeeded beyond measure. Oriens is Latin for “the East” and also may refer to Venus, the Morning Star. This lecture is alleged to impart “light to the EAST.” I am unsure it will shed any light but will offer my perspectives based on my long interest in workforce issues related to the provision of surgical care for the injured and those who require emergency surgical treatment.
When delivering an invited lecture, there are two potential strategies. The first I would categorize as a “preaching to the choir” lecture. For those who did not grow up in a rural environment where that phrase was common, the Urban Dictionary defined this phrase as “trying to convince those who are already convinced.” The second strategy might be to go “against the grain” and offer views that might be contrary to current beliefs held by a group. I have often tended to contrarian views so this talk may be the converse to some views currently held about “trauma surgery, acute care surgery (ACS), and/or surgical critical care.”
As to the title and the use of the word “dinosaur,” I would refer you to the Merriam-Webster definition number three: “one that is impractically large, out of date or obsolete.” This leads me to my first confession: I am a “dinosaur.” In that regard, the trauma surgery I practiced is no longer practical or possible but there may be some kernel of wisdom to be gained from the experience of my generation. While I readily admit to being a “dinosaur,” I would deny being a “troglodyte” defined as “a person characterized by outmoded or reactionary attitudes.” I have had concerns about workforce issues for some time but am not attempting to recreate the past but share thoughts about future directions for the field of trauma and its disciplinary twin “acute care surgery.”
I will briefly discuss four main themes: (1) a brief history of “trauma surgery” from the “dinosaurs” perspective; (2) review my view of the evolution of acute care surgery; (3) discuss issues with training and practice of trauma/ACS; and finally, (4) discuss the possible (theoretical) impact of new payments models on the field.
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