Since the inception of emergency medicine in the 1960s and its subsequent establishment as a medical specialty in 1979, the emergency physician has long been seen as the “jack of all trades, master of none.” From this we have grown to the “master of resuscitation,” and further to “the master of nearly anything,” through a host of both board-prepared and certificate fellowship programs.

Many emergency physicians find themselves drawn to the intensive care unit (ICU) as a hospital-based specialty where we can use our resuscitative skills and broad knowledge base to continue the care of critically ill patients through their emergency department (ED) stay and into their recovery phase. There are four tracks by which emergency physicians can become critical care board certified—internal medicine, neuro-critical care, anesthesia, and surgery.

Surgical Track Fellowship

The surgical track fellowship is a two-year commitment where emergency physicians train  alongside surgeons to learn how to care for trauma, postoperative, and neurologically-injured patients. Emergency physicians in these programs also spend time training in the medical, neurological, and cardiovascular ICU. These programs provide board certification through the American Board of Surgery (ABS) and allow physicians the training and flexibility to work in any adult ICU.

Additionally, the training we receive allows us to integrate seamlessly into any trauma service. Several trauma systems in the United States have emergency traumatologists fully incorporated into their trauma service who spend their on-service weeks either on the trauma service (leading trauma alerts and rounding on the trauma floor) or the surgical ICU service. If our path leads primarily home to the ED, the comprehensive training we receive during these two years serves to elevate the level of management for critically ill patients in the ED and provide critical care education to learners.

Compared to the internal medicine track, the surgical pathway is particularly attractive to  emergency physicians. It does not require inpatient internal medicine prerequisites and gives more diverse training in the surgical and trauma realm, which improves job prospects.

The anesthesia pathway is the same length and provides diverse ICU training, but the application cycle opens quite early (November of applicant’s second year of residency) and it is challenging to obtain prerequisites unless the applicant knows that this is their desired career path at the beginning of residency. The Neurological Critical Care pathway relegates these graduates to work primarily in a neuro ICU. These are not insurmountable challenges, but they do make the surgical pathway more attractive to some applicants.

Added Value

The Surgical Critical Care (SCC)-trained emergency physician also adds value from a systems perspective. According to a 2022 study by the Global ICU Needs Assessment Research Group, approximately 76 percent of ICUs internationally are mixed medical/surgical.¹ The training that emergency medicine/SCC fellows receive in the surgical, trauma, medical, neurological, and cardiovascular ICUs provide the breadth of knowledge necessary to truly excel in the mixed medical/surgical ICU setting, and provide the most comprehensive care to all critically ill patients.

Additionally, a hospital system can increase the surgical services provided to their community when there is a SCC-trained intensivist to provide postoperative care for those patients. The development of “ED-ICUs” in the past decade has also opened avenues for improvement in care and outcomes of critically ill patients, especially in EDs with high boarding rates.

When part of a trauma service, emergency medicine/SCC physicians have been shown to produce similar patient-centered outcomes as trauma surgeons, including similar blood transfusion rates, time to operating room, time to ICU, length of hospital stay, and mortality rates.^2-4 Although a surgeon must be available for backup in cases of operative trauma, the EM/SCC physician is otherwise trained to manage all other aspects of the trauma team from the trauma bay to the ICU to discharge from the trauma floor. This gives the acute care surgeons the freedom to increase clinic time and scheduled operative time, which increases the overall productivity for the surgical group.

In summary, SCC training programs are a valuable resource for emergency physicians, physician groups, hospital systems, and, most importantly, patients. The comprehensive training that is provided in all aspects of trauma and critical care medicine cannot be replicated and adds value and flexibility to emergency physicians’ careers.

SCC programs must continue to build infrastructure for the addition of emergency physicians to their programs and design these programs to maximize the benefit to the physicians and overall health systems.

Dr. Wheeler is an emergency physician and intensivist at West Virginia University Health System. She completed a Surgical Critical Care program from St. Luke’s University Health Network in 2025.

References

1. Nawaz FA, Deo N, Surani S, et al. Critical care practices in the world: results of the global intensive care unit need assessment survey 2020. World J Crit Care Med. 2022;11(3):169-177.
2. Ahmed JM, Tallon JM, Petrie DA. Trauma management outcomes associated with nonsurgeon versus surgeon trauma team leaders. Ann Emerg Med. 2007;50:7–12, 12 e11.
3. Grossman MD, Portner M, Hoey BA, et al. Emergency traumatologists as partners in trauma care: the future is now. J Am Coll Surg. 2009;208(4):503-509.
4. Kelley KC, Alers A, Bendas C, et al. Emergency trauma providers as equal partners: from “proof of concept” to “outcome parity”. Am Surg. 2019;85(9):961-964.