title: Profitable versus unprofitable expansion of trauma and critical care surgery.
abstract: BACKGROUND
  The American Association for the Surgery of Trauma has proposed that the specialty of trauma and critical care include emergency surgery. We assessed whether this change will have an impact on the financial challenges that this specialty confronts, including inadequate reimbursement for efforts exerted.
  
  
  METHODS
  Over a 2-year period, we collected financial data on 6 trauma and critical care surgeons. Three included emergency surgery as part of their practice, but no private elective component. The other 3 included both emergency surgery and a private elective component.
  
  
  RESULTS
  Trauma and critical care surgeons who had included emergency surgery but no private elective component had significantly lower charges (5,941,482 US dollars vs 9,209,535 US dollars), collections (1,439,913 US dollars vs 2,973,319 US dollars), generated relative value units (50,440 vs 80,327), generated reimbursement per relative value units (28.55 US dollars vs 37.02 US dollars), and margins (0.20 US dollars vs 1.48 US dollars) than their counterparts who had an elective surgery component.
  
  
  CONCLUSIONS
  The addition of emergency surgery did not improve the financial viability of trauma and critical care as a specialty. Without significant hospital or governmental financial support, the only viable financial option is to develop a substantial private practice that cross-subsidizes the practice of trauma and critical care. The appropriate professional bodies should incorporate changes in work processes that will allow the specialty to survive professionally but also financially.
authors.affiliation: Department of Surgery, University of Louisville University of Louisville and the Trauma Program in Surgery, University of Louisville Hospital, Louisville, Kentucky 40292, USA. jlrdor02@louisville.edu
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Rodriguez
authors.forename: Hiram C
authors.initials: HC
authors.lastname: Polk
mesh_terms: D003422:Critical Care / Q000191:economics*; D005377:Financial Management, Hospital / Q000191:economics*; D013502:General Surgery / Q000191:economics*; D006801:Humans; D008505:Medical Staff, Hospital / Q000191:economics; D010820:Physicians / Q000191:economics*; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*; D014481:United States