Understaffed and overworked: The stark reality of acute care surgeon staffing in the United States, an Eastern Association for the Surgery of Trauma multicenter study

Abstract

OBJECTIVES – Rightsizing the workforce to clinical demand requires a balance of work intensity, productivity, and a definition of clinical full-time equivalent (cFTE). We hypothesized a shortage of acute care surgeons based on a 204-shift per year (average, 17 per month) definition of a 1.0 cFTE established in our prior mixed-methods study (two service weeks plus five calls per month). METHODS – This multicenter study used mixed methods, integrating clinical schedules (CY2022), work relative value units, and qualitative insights from semistructured interviews (July 2023 to June 2024). Schedules were converted to shifts (8–14 hours). Hospitals were short-staffed when shift demand exceeded supply based on each surgeon's cFTE. Interviews explored clinical demand and staffing challenges. Descriptive analysis and a deductive-inductive thematic analysis were performed. RESULTS – Forty Level I/II hospitals representing 412 acute care surgeons (287 cFTEs) from 25 states were included. Seventy-nine percent of hospitals were short-staffed. Compared with well-staffed hospitals, short-staffed hospitals had fewer cFTEs (6.5 [interquartile range (IQR), 3] vs. 8.6 [IQR, 3], p < 0.05), a higher demand for clinical work (1, 889 [IQR, 933] vs. 1, 388 [IQR, 674] shifts, p = 0.05) and a higher work relative value unit/cFTE (8, 779 vs. 7, 456, p = 0.12). The aggregate clinical demand exceeded available surgeon capacity by 21% overall. Based on volume, a 1.0 cFTE is needed for every 285 (IQR, 169) trauma admissions. There was a deficit of 75 cFTEs across the centers. Key themes identified were related to the value of acute care surgery and balancing unpredictable demand, intensity, and efficiency. CONCLUSION – There appears to be a shortage of acute care surgeons in the United States when a definition of 204 shifts per year cFTE is applied. Hospitals face significant financial and administrative barriers to workforce expansion despite the overabundance of clinical volume. Future research is needed to ascertain the effects of expanding the existing workforce on both clinical outcomes and surgeon well-being. LEVEL OF EVIDENCE – Prognostic and Epidemiologic; Level III.