Table III.
Challenges of the ACS model from 18 key informants*
| Coded theme | Representative quotations |
|---|---|
| Not enough manpower | “I think the weakness is manpower. There’s just not enough of us and that’s an old story—I don’t know that there’s an institution in this country that has enough people, which is probably why well trained trauma surgeons can pick their jobs.” |
| “The problem is just it’s the staffing. You know it’s continuing to find people that are willing to do it and want to do it that can be compensated appropriately, and enough people to take calls so the call is not burdensome or excessively burdensome.” | |
| “We’re still running a traditional service where you’re trolling around— making rounds of fifty patients. You can’t really bond with them as much as you might like to. And, if the family’s not in the room when you go by it’s kind of not happening that day.” | |
| Poor continuity | “The weakness number one is I would say continuity of care…people and physicians, and referring physicians expectations that we have one surgeon, “I know my doctor, I know my surgeon. I am going to see this surgeon, preoperatively. He’ll do my operation and I’ll see him postop. We have to live up to this and we don’t.” |
| “I think that the downside of our practice pattern is the continuity at the attending level, which is, I think, a huge discussion nationally and a real ongoing challenge I think.” | |
| “I think the weaknesses don’t have the same degree of continuity of care as kind of the older system of care.” | |
| “If you are reinventing the wheel every day on rounds, things get lost.” | |
| Lack of OR availability | “I hope eventually we can get ourselves a real dedicated operating room so these things can move ahead more expeditiously—I think if someone comes in with an appendicitis and they have to wait 24 hours before it’s taken care I’m sure we don’t look too good…” |
| “What we don’t have is… one of the things we’ve talked about is we’d like to have a room to do add-ons.” | |
| “Our main problem, the gigantic problem is operating room time. We are fighting and struggling and have been for years. To have dedicated operating room time similar to trauma dedicated room times.” “It would be better—nice to have a little more access to the operating room” | |
| Intrusion of nonacute care surgeons | “Trust is difficult sometimes. It is not helped by a guy who thinks that being called for an emergency problem in the middle of the night is onerous and not what they like to do. I do not paint the other attendings as being evil. I just, again, people can tell when you do not embrace the problem or the situation. There is just no other way around it.” |
| “I think that we still struggle a little bit with the pluralistic model of private practice and full-time.” | |
| “The private surgeons still—for the most part—see us as the enemy. There is definitely, there was always that riff as oh, those are the employed surgeons and now those are those employed surgeons who do acute care surgery” | |
| “There are still some general surgeons who cover some, which is my other advice, is you would have to get rid of all those people on the call pool and make it the trauma critical care guys covering all that, that is my advice.” |
*
One respondent each representing geographic (New England, Northeast, Mid-Atlantic, South, West, Midwest) and practice (Public/Charity, Community, University) diversity among acute care surgery programs. OR, Operating room.