title: Two careers in one: an analysis of the earning power of certification in surgical critical care.
abstract: BACKGROUND
  The core of general surgery supports multiple disciplines, each of which entails similar operative care for different diseases. The purpose of this study was to compare variations of practice patterns of four general surgeons to define the general surgical core that each shared in common, and to determine the effect of subspecialization in surgical critical care on the scope of practice and efficiency of revenue production.
  
  
  METHODS
  The charges and collections of four members of the same surgical faculty were analyzed for the 6 months beginning July 1, 2000. Three members practiced general surgery with additional specialization in surgical oncology, surgical endoscopy, and trauma/critical care. The fourth covered all aspects of general surgery, including in-house trauma call, but not surgical critical care. Data were stratified by Current Procedural Terminology code and categorized as operative, bedside care (which included minor procedures), and evaluation/consultation care. Scope of practice was defined as the proportion of operative cases represented by the 10 most frequently performed procedures. General surgical core was defined as those cases that were preformed by all four surgeons at the same frequency. Efficiency of revenue generation was defined as collection rate for these procedures divided by the established, budgeted collection rate for each practitioner. All results were compared using chi(2) with significance accepted at p < 0.05.
  
  
  RESULTS
  Fifteen operative procedures were performed with equal frequency by each surgeon and represented a broad spectrum of surgical disease. These procedures constituted a similar proportion of operative practice for all specialists (mean, 45.2%; 90% confidence limit, 3.5%), yet occupied 70% of the trauma surgeon's 10 most frequent surgical procedures versus 36% for the surgical oncology and surgical endoscopy. Charges generated by the provision of surgical critical care, especially in bedside procedures commonly performed in the intensive care unit, exceeded all of the other three surgeons and equaled the revenue generated by operative care. Although overall revenue-generating efficiency was less for the trauma surgeons (57% of eventual collections vs. 67%, chi(2) p = 0.1), immediate reimbursement for critical care was higher than for any other clinical services.
  
  
  CONCLUSIONS
  These data demonstrate that subspecialization in surgical critical care provides valid additional earning capacity to surgical practitioners. Reimbursement is at least as good as for traditional operative care, and fees generated can actually exceed revenue from operative care. With impending decreases in global reimbursement, and attempts to unbundle operative fees, this additional capability becomes an important consideration in potential career choice, as well as a major component in the fiscal stability of trauma programs.
authors.affiliation: Department of Surgery, University of Florida Health Sciences Center, Jacksonville, Florida 32209, USA. miren.schinco@jax.usl.edu
authors.forename: Miren A
authors.initials: MA
authors.lastname: Schinco
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Tepas
authors.forename: Kathy
authors.initials: K
authors.lastname: Johnson
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Griffen
authors.forename: Henry C
authors.initials: HC
authors.lastname: Veldenz
mesh_terms: D003422:Critical Care / Q000191:economics*; D003953:Diagnosis-Related Groups; D004470:Economics, Medical; D006801:Humans; D013038:Specialization; D013514:Surgical Procedures, Operative / Q000191:economics*; D014947:Wounds and Injuries / Q000601:surgery