Surgical critical care and private practice surgeons: a different world out there!
BACKGROUND
Few graduating residents seek surgical critical care (SCC) fellowships; fewer than half of positions fill. We hypothesized substantial differences exist in practice patterns and attitudes between SCC surgeons in academic practice (ACs) and in private practice (PVTs).


METHODS
A survey instrument was sent to 1,544 board-certified SCC intensivists in North America.


RESULTS
Of those invited, 489 responded (32% response rate). Respondents were mostly men (88%) and Caucasian (86%), with a mean age of 48 years; 60% were ACs, 28% were PVTs, and 12% reported "other;" 94% currently practiced SCC. PVTs (50%) were more likely than ACs (18%) to provide SCC for only their own patients, less likely (24% versus 74%) to function as an "ICU attending," and less likely to work with residents (36% versus 91%) and fellows (4% versus 60%; all p < 0.001). PVTs (48%) spent more time performing elective operations than ACs (27%; p < 0.001). They were more likely than ACs to relinquish management of SCC patients to medical consultants: infectious disease (34% versus 12%), cardiology (31% versus 12%), and pulmonary (23% versus 3%; all p < 0.001). Conflicts with medical specialists were a bigger problem for PVTs (43%) than for ACs (17%; p < 0.001).


CONCLUSIONS
Private practice surgical intensivists are more likely than academic intensivists to provide critical care for only their own patients and to use consultants to avoid conflicts.
Cohn
Stephen M
SM
Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX.
Price
Michelle A
MA
Stewart
Ronald M
RM
Corneille
Michael G
MG
Myers
John G
JG
McCarthy
Janet
J
Jonas
Rachelle B
RB
Hargis
Stephanie M
SM
Dent
Daniel L
DL
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002321:Career Choice; D003422:Critical Care; D005260:Female; D013502:General Surgery; D006801:Humans; D007325:Institutional Practice; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011331:Private Practice; D014481:United States