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little_detailsHello! I have three questions, all about the work of trauma/critical care/acute care surgeons in the US:
1) Would it ever be feasible for a TACS attending at an academic Level I trauma center to take semi-regular lunch breaks when on day shift (obviously assuming there’s no major trauma needing resuscitation and/or immediate operation, and assuming they have adequate support from residents, etc.)? What if it was decreed necessary by their doctor or their psychologist?
Narratively the goal here is to get the character outdoors near the hospital at a regular-ish time for ~30 minutes at least a few days a week, on at least some weeks. Judging from what I’ve read from people in this specialty on reddit it sounds as though this might (???) be achievable at some hospitals, especially if their setup happens to be rotating weeks of ICU / non-ICU trauma / EGS / admin-and-research, but given the apparent prevalence of hospital workers in acute care specialties not getting any breaks whatsoever I really can’t tell.
2) At what point is the TACS attending no longer involved in a patient’s care if the patient ends up requiring a long-term (at least several months) hospital stay to recover? Would it be as soon as the patient is stable enough to be out of the ICU? My understanding is that since trauma surgeons are largely doing non-surgical critical care and may often be in charge of the ICU they might be managing an operative trauma patient for a while post-op, but I’m not clear on at what point that patient stops being their problem.
3) To whom would a TACS attending (again, at an academic Level I) report to within the hospital hierarchy? Would it be the chief of the trauma service(?) (And would that person be the same or different from whoever they would need to clear FMLA leave or vacation time with?)
Any information or corrections on any of this greatly appreciated! Thank you!
1) Would it ever be feasible for a TACS attending at an academic Level I trauma center to take semi-regular lunch breaks when on day shift (obviously assuming there’s no major trauma needing resuscitation and/or immediate operation, and assuming they have adequate support from residents, etc.)? What if it was decreed necessary by their doctor or their psychologist?
Narratively the goal here is to get the character outdoors near the hospital at a regular-ish time for ~30 minutes at least a few days a week, on at least some weeks. Judging from what I’ve read from people in this specialty on reddit it sounds as though this might (???) be achievable at some hospitals, especially if their setup happens to be rotating weeks of ICU / non-ICU trauma / EGS / admin-and-research, but given the apparent prevalence of hospital workers in acute care specialties not getting any breaks whatsoever I really can’t tell.
2) At what point is the TACS attending no longer involved in a patient’s care if the patient ends up requiring a long-term (at least several months) hospital stay to recover? Would it be as soon as the patient is stable enough to be out of the ICU? My understanding is that since trauma surgeons are largely doing non-surgical critical care and may often be in charge of the ICU they might be managing an operative trauma patient for a while post-op, but I’m not clear on at what point that patient stops being their problem.
3) To whom would a TACS attending (again, at an academic Level I) report to within the hospital hierarchy? Would it be the chief of the trauma service(?) (And would that person be the same or different from whoever they would need to clear FMLA leave or vacation time with?)
Any information or corrections on any of this greatly appreciated! Thank you!
(no subject)
Date: 2026-01-05 12:21 pm (UTC)Traveling so stay tuned for more later. I hate typing long paragraphs on a phone. Please ask any necessary clarifying questions.
1) yes, but unlikely to be doctor decreed; we work through all injuries and illnesses and only stay down when we literally cannot get up. More likely to be a administrative meeting responsibility--some hospital or state/natl committee; dir of periop services, trauma admin meeting, QI, research updates, something--that this person takes as a zoom call outside, then lingers to chat/do whatever you need them to do. Is this post COVID though? Pre-COVID they would be in person meetings, and they could linger walking back. A couple times a week you could just have them do it with no excuse! Easiest on ICU, then trauma, then EGS. EGS is usually the real monster and very operative: most of our procedures last at least an hour and many several. Of note many hospitals prohibit OR scrubs outside for infection control reasons and this is why I never go outside during the day. You'd have to overcome a lot of inertia. I could use those 2.5 minutes changing and the 3 minutes walking to my office to my clothes to do something else!!! Make it worth my while!!!
2) nah, generally, once we touch them, they are ours forever. We run the trauma and EGS floor services, too. Exception would be if all their surgical or trauma stuff is fixed and they have some lingering medical issue: vent wean, perhaps, or ESRD stuff. Medicine will not accept a transfer for "disposition issues" at most academic institutions. At a private place the surgeons abuse them more, but not at an academic level 1.
3. Yeah division chief, then surgery dept chair. For FMLA and LOA you would also need some admin people, but div chief and dept chair are the real deciders--faculty affairs or similar would be the admin group to get approval from at an academic center where you're employed by the medical school, for example. If non academic would be some hospital committee, I guess. CMO? I actually don't know.
Ok i did type a lot on the phone. Please ask clarifying questions I am delighted by these, we are an arcane and confusing tribe who no one understands! Clearly you speak the lingo, tho!
(no subject)
Date: 2026-01-06 01:33 am (UTC)1) Honestly “a couple times a week with no excuse” might be the play for my scenario, but I will definitely give the administrative meeting options some thought, these are interesting possibilities! Could be pre- or post-COVID, precise timeframe isn’t terribly salient to the main plot. (And thanks so much for the detail about not being able to wear scrubs outside + which rotations this is more doable during, that’s super useful to know, absolutely going to make use of this information!)
2) Oh amazing, that’s actually even better for this story. If you don’t mind a couple follow-up questions on this one I’d love to clarify what the longer-term care part might look like—
—a) How does coordination with other specialists work after the initial stabilization? E.g. if the person needs further reconstructive surgery for damage to bones I’m assuming that would be handled specifically by an ortho, or there might be other care needed for specific organs/injuries that would require involving a specialist team (or a hospitalist for later stages of recovery)? Would love to know a little more about how that works with the trauma unit retaining primary responsibility for the patient. (I’ve also read that there might be clinic follow-up when the patient doesn’t have their own doctor(?) but wasn’t clear on who would actually be seeing the patient in that case.)
—b) A patient would still get physically moved from the ICU to a general ward after a certain point, though, right? Is this likely to be organized in any particular way for trauma?
3) Would you happen to know whether the specific reason for taking FMLA (esp. if it’s due to a medical issue) might be kept confidential from the division chief / dept. chair given that that authorization needs to come from the admin group? (I’m thinking of how at my job (law firm) FMLA stuff is done entirely through HR, who make it clear that if for any reason you don’t want to share the specific circumstances of your leave with your actual supervisor you don’t have to—I’d think that the ADA rule of [information not shared unless supervisors/managers need to know for necessary work restrictions/accommodations] would still apply in a hospital context, but that does assume the supervisor isn’t the first to know…)
No pressure to respond on any of this if it’s too time-consuming, super grateful for your detailed response already, thanks so much!! Absolutely amazing to be able to get a straight answer from someone in the know <333
"incidental finding"
Date: 2026-01-07 07:40 pm (UTC)All of this is to say: the majority of work that a trauma surgeon does on the trauma service is coordination of other teams. Ortho injuries are the most common operative injury by an order of magnitude, so we are usually harassing them about recs and when they are operating. But in most every hospital now, orthopedists only manage their own issues, not the patient generally: they have medicine do that. By contrast trauma surgeons are still generalists. Those of us who do trauma professionally (and a level 1 center means this for sure) are also critical care boarded and unlike our subspecialty colleagues, we know how kidneys work. Hearts and lungs, too. Even brains. Sorta.
A key part of this is we determine which surgery happens next and when, in the sense of clearing a patient for it: TBI is stable, patient is stable, etc.: now you can internalize your external fixator. On the other side of it, we harass subspecialists to actually do their cases. Plastics, for the love of god, just fix this man's facial fractures! Just because you don't want to disrupt your elective schedule is not a good reason to leave a man in the hospital on tube feeds for two weeks. Etc.
2b: patients are moved from the ICU to the ward or to a stepdown ward (intermediate ward; the difference is nursing ratios, really) when they no longer require the ICU level of care. In a trauma center, this decision is made by the ICU attending, who is usually a trauma surgeon or a critical care anesthesiologist who we work with. We will defer a bit to the floor team for readiness judgements IF they're going out to a non-trauma service (colorectal, thoracic, ortho, ENT) but if we're sending them to our partners we just send them. And yes, they are physically moved to a different place. Often ward beds are double occupancy, but this depends on the region.
3: Extremely unlikely the division chief wouldn't be told. We are a bit like high performance athletes except we eat garbage and don't take care of ourselves. The specifics of why I couldn't work and how long it might be probably actually matter. Our divisions are also extremely small compared to our shift coverage needs: typically anywhere from 6 surgeons to 15, and you have to cover 24/7 365. Plus, we get all of our medical care from our colleagues--not our trauma colleagues, hopefully, though! There is very little privacy. IF the FMLA was for a family member, potentially some details would be able to be private, but we are so used to talking to each other about medical issues and getting advice from each other that it's unlikely you'd keep anything a secret.
caveat this is at a place where we like each other and the vibes are good. hopefully your character is at such a place. not every place is like that. also, however, I fear all of this would apply anyway.
let me know if I've slipped into jargon or assumed something is understandable when it isn't! Also happy to alpha read the pertinent bits or beta read for these issues. I have done so a little for The Pitt and really enjoyed it! it's a good fic too here I shall rec it: https://archiveofourown.org/works/65241865