The problem with the acute care surgery model is that it relies on a specially trained cadre of physicians who are essentially performing shift work, even if some of that work continues beyond their prescribed shift.

It comes down to numbers. There just aren’t enough acute care surgeons who are willing to work in smaller communities and rural areas. For instance, the University of Iowa established an acute care surgery program, but they have only enough surgeons in the program to cover day shifts. Other surgical specialists are taking on emergencies at night.

This model also doesn’t satisfy patient expectations in smaller communities. In areas like mine, patients expect me to spend time in the office, and to perform elective as well as emergency procedures. It would be unacceptable for a patient to ask, “Where is my doctor?”

The other issue the model creates is a potential gap in training. This represents a further subspecialization of our field and has the potential to further erode general surgery training. Already I cannot recruit a surgeon fresh out of a residency because their training experience does not parallel what they will need to practice in my environment.

I think the acute care surgery model has a lot of potential in large, academic settings where they have the manpower to do this. It fills coverage gaps created by physician shortages and gives trauma surgeons increased operative exposure. And it may also help make surgical residency more attractive to medical students.

A lot will depend on how this model is developed in the years to come, but right now the model only makes it tougher to find adequately trained surgeons to come to small, rural communities and provide the comprehensive, around-the-clock care that is needed.

Dr. Caropreso is a general surgeon in Keokuk, Iowa, and the American College of Surgeons’ governor for the state of Iowa. He also serves on the American College of Surgeons’ advisory council for rural surgery.