Surgery News - November 2007 - (Page 2)

NEWS SURGERY NEWS • N O V E M B E R 2 0 0 7 Veto Unleashes Approval Sought for Fellowship More Wrangling Over SCHIP Acute Care • from page 1 B Y A L I C I A A U LT Else vier Global Medical Ne ws ongress and the Bush administration headed back to the negotiating table in October after the House of Representatives failed to override President Bush’s veto of the State Children’s Health Insurance Program reauthorization legislation. The House voted 273-156 to override the President’s SCHIP veto, but that was 10 votes short of the needed two-thirds majority. The vote was split down party lines, with 229 Democrats and 44 Republicans voting in favor of override, and 154 Republicans and 2 Democrats voting against. With the failure to overturn the veto, the House took up a new SCHIP package on October 25, voting 265-142 in favor. However, there were no new Republican converts, making it doubtful that the bill would survive another presidential veto. At press time, the Senate was preparing to take up the legislation. SCHIP expired on Sept. 30, but a continuing resolution ensures that the program is funded through Nov. 16. The White House said it had appointed a team to negotiate with Congress to make sure at least 500,000 children who currently are eligible for SCHIP, but not receiving benefits, would be enrolled in the program. “If enrolling these children requires more than the 20% funding increase proposed by the President, we will work with Congress to find the necessary money,” according to a statement from the White House. About 6 million children are enrolled in SCHIP. The congressional proposal would have increased funding by about $7 billion a year, adding as many as 4 million children to the SCHIP rolls. The American Medical Association said it was committed to expanding coverage. “The number of uninsured kids has increased by nearly 1 million over the past 2 years, and action must be taken to reverse this growing trend,” said Dr. Edward Langston, AMA board chair, in a statement. ■ care surgeon “envisions a surgeon that rently perform trauma pulmonary could manage any acutely ill patient, lobectomies, subclavian artery repairs, trauma or nontrauma, with any surgi- and popliteal artery repairs. A total of 201 (91%) out of 221 cencal issue that requires operative management within 24 hours,” according to ters with trauma groups consisting Dr. Cothren, an ACS Fellow. If the sur- only of trauma surgeons performed vey is any indication, many trauma some elective surgery. Trauma surgeons at level II and III centers around the country could benefit from trauma surgeons trained in an centers (most of which were not at academic/university institutions) perAcute Care Surgery fellowship. The survey was originally sent to formed substantially more of all types of 714 level I-III U.S. trauma centers list- elective cases, except for decortications ed by the American Trauma Society. and spine exposures, than did trauma Response rates were 92% for level I, surgeons at level I centers. In addition, few level I trauma surgeons 72% for level II, and 59% for performed elective vascular level III hospitals. Only 49 procedures such as abdomi(10%) of 515 centers renal aortic aneurysm repair ported that their trauma (4%) or peripheral arterial surgeons perform the full bypass (4%), compared with range of thoracic, vascular, about 40% or more of surand abdominal trauma progeons at level II and III facilcedures that served as index ities. procedures in the survey Lack of training, lack of (pulmonary lobectomy, cardiac repair, hepatic An expert in doing mentoring, and/or local lobectomy, trauma Whip- elective surgery in hospital factors may explain ple, carotid artery, subcla- one field is not an why trauma surgeons at some level I centers no vian artery, superior mesenexpert in doing teric artery/vein, emergency surgery longer do complex cases, abdominal aorta/inferior in that same field. she speculated. “Mentorship by a seavena cava, and popliteal DR. JURKOVICH soned trauma surgeon is artery repair). A higher percentage of level I centers arguably the most critical component (18% [31 of 169]) reported that their of the current model of training for trauma surgeons perform the full range many emerging trauma/acute care of thoracic, vascular, and abdominal surgery/surgical critical care surgeons,” trauma cases than did level II (6% [11 Dr. Cothren and her colleagues wrote of 187]) and level III centers (4% [7 of in the manuscript of their study. But “the decades-old paradigm of training 159]). At the 221 centers in which members by mentorship, by virtue of numbers of the trauma group consisted of only alone, is unlikely to be capable of protrauma surgeons, these surgeons per- ducing the number of surgeons that formed less than 65% of each of the dif- will be necessary in the future.” The AAST has been working with ferent complex trauma procedures that Dr. Cothren and her associates ac- the American College of Surgeons counted for in the survey (58% of tho- since 2003 to develop an Acute Care racic, 50% of vascular, and 65% of Surgery fellowship. Now that program complex abdominal trauma cases). Less requirements have been developed, the than one-half of trauma surgeons cur- AAST will verify that a program has ad- equate resources, appropriate volume and number of cases, teaching expertise, and educational opportunities before approving a fellowship. As a part of the AAST-approved program, Acute Care Surgery fellows will have to spend 9 months in an on-site surgical critical care residency that has been approved by the Accreditation Council for Graduate Medical Education. The other 15 months of the 2-year fellowship would involve a combination of trauma, elective, and emergency general surgery. Upon completion of the fellowship, trainees are expected to be competent in emergency surgical operations in the chest, abdomen, and extremities; they are not expected to be experts in neurosurgery or orthopedic surgery, said Dr. Jurkovich, an ACS Fellow and professor of surgery at the University of Washington, Seattle, in an interview. Denver Health Medical Center is seeking AAST approval for its Acute Care Surgery fellowship. An Acute Care Surgery fellowship at the University of Nevada, Las Vegas, and possibly four other programs, may be AAST-approved by July 2008, said Dr. Jurkovich. Some “superspecialists” contend that surgeons trained in an Acute Care Surgery fellowship will not be as good at managing cases as they are in their particular field, according to Dr. Jurkovich. But “there simply aren’t enough superspecialists to manage all these emergencies. And being an expert in doing elective surgery in some field does not make you an expert in doing emergency surgery in the same field. ” “I certainly would agree that if there really were superspecialists who are widely available, willing, and able to come and show up for every surgical emergency that occurs in whatever their field is, that would be ideal,” he added. If fellowship trainees have good mentors, programs that handle trauma and emergency surgery cases with or without on-call specialists “are excellent training models,” he said. ■ SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Mark S. Allen, M.D., FACS, Cardiothoracic Surgery, Minnesota John H. Armstrong, M.D., FACS, Trauma and Mass Casualties, Florida Hunt Batjer, M.D., FACS, Neurological Surgery, Illinois Mark R. Belsky, M.D., FACS, Orthopedic Surgery, Massachusetts David G. Burris, M.D., FACS, Trauma and Uniformed Services, Maryland Gregory S. Cherr, M.D., ACS Resident/Associate Society, New York Fred A. Crawford, Jr., M.D., FACS, Cardiothoracic Surgery, South Carolina William J. Hoskins, M.D., FACS, Obstetrics and Gynecology, Georgia James W. Jones, M.D., Ph.D., Ethics, Texas Natalie C. Kerr, M.D., FACS, Ophthalmology, Tennessee William M. Kuzon, Jr., M.D., Ph.D., FACS, Plastic Surgery, Michigan Robert Madoff, M.D., FACS, Colorectal Surgery, Minnesota James Markmann, M.D., FACS, Transplantation, Pennsylvania Jack W. McAninch, M.D., FACS, Urology, California Robert Morell, M.D., Anesthesiology, Florida James P. Neifeld, M.D., Surgical Oncology, Virginia Richard A. Prinz, M.D., FACS, Endocrine Surgery, Illinois David W. Rattner, M.D., FACS, Minimally Invasive Surgery, Massachusetts Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgery, Rhode Island Kevin K. Tremper, M.D., Ph.D., Anesthesiology, Michigan Patricia L. Turner, M.D., FACS, Information Technology, Maryland Thomas Wakefield, M.D., FACS, Vascular Surgery, Michigan Mark Weissler, M.D., FACS, Otolaryngology, North Carolina Steven E. Wolf, M.D., FACS, Trauma (Burns and Mass Casualties), Texas SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Society News Group, a division of Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label) to Circulation, SURGERY NEWS, 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211. SURGERY NEWS (ISSN 1553-6785) is publish

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Surgery News - November 2007 Contents Black Patients Fare Worse Than Whites After Liver Surgery Survey Suggests Need For Acute Care Surgery New Law Bolsters FDA Funding, Authority Working Together Oncology: Marginal Evidence? Trauma: Screening Scrutinized News From the College: Healy Takes Helm

Surgery News - November 2007

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