Acute care surgery is a new specialty 
that needs its own label, lecturer says

L. D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSl(Hon), FCS(SA)(Hon), FRCSGlasg(Hon)
L. D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSl(Hon), FCS(SA)(Hon), FRCSGlasg(Hon)

Despite an ever-increasing number of surgeons turning to specialization, acute care surgery has emerged as a broadly accepted surgical specialty with a growing number of acute care surgery fellowship programs in the U.S. According to L. D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSl(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), the acute care surgeon is the next-generation general surgeon, with trauma surgery as the cornerstone.

“Trauma is the beacon and the template for all of the other elements of acute care surgery. If you look at the prioritization of patients, the system orientation, and all the other elements of acute care surgery, trauma is the key discipline,” said Dr. Britt, the Henry Ford Professor and Edward J. Brickhouse Chairman of Surgery, Eastern Virginia Medical School, Norfolk, VA.

On Tuesday, Dr. Britt will deliver the annual Scudder Oration on Trauma, Trauma: Still the Cornerstone of Acute Care Surgery. His lecture will explore the development of acute care surgery and the need to properly label and brand surgery’s newest and most critical specialty.

Acute care surgery developed out of the clear need for surgeons trained and dedicated to providing acute—often emergency—surgery, Dr. Britt explained.

“The evolution of acute care surgery emanated from trauma,” Dr. Britt said. “The need, the discipline, was not being addressed by general surgeons. They didn’t want to come out at two and three in the morning. We finally realized that’s what we are doing, providing emergency general surgery along with trauma and critical care. It was a logical step to broaden our scope of practice.”

Broadening the scope of practice to embrace what is realistically already part of the job is one thing, but achieving professional recognition and building educational programs is a very different task, he noted.

“We realized that we needed a new category, a new specialty. And a new category needs a new name,” Dr. Britt said. “We know that if you don’t put the right name on your category, the right brand, you lose the future.”

Branding is as important in the surgical world as it is in retail, Dr. Britt said. A successful label is clear, concise, and leaves no doubt. Pediatric surgeons, cardiac surgeons, urologic surgeons, and other surgical specialties carry labels that precisely describe the training and expertise involved. Acute care surgery is no different.

“We are acute care surgeons, not trauma and acute care surgeons,” Dr. Britt said. “Trauma and acute care surgery is more than redundant; it is confusing. Trauma is not a separate category for us, trauma is the very bedrock of what we do as acute care surgeons.”

Proper labeling is not just an idle exercise for a new specialty. It is critical to long-term survival, said Dr. Britt, citing an example from the retail world—the athletic sneaker, a new category of shoes that appeared in the 1960s and 1970s. The new specialty product was first introduced by Keds as Super Keds. But simply adding the Keds label to a new type of shoe failed to ignite the market. That took an upstart company called Nike.

“The rest is history,” Dr. Britt said. “I don’t want to repeat the Keds mistake. Acute care surgery is a new specialty and needs a new label. With trauma as the cornerstone, acute care surgery is the next generation of general surgery.”

The Scudder Oration on Trauma honors Charles Locke Scudder, a founding member of the American College of Surgeons (ACS) and a major contributor to the surgery of trauma.