What is Trauma Surgery? Dr. Darko Shares His Story

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What is Trauma Surgery? Dr. Darko Shares His Story

Session 28

Dr. Nii Darko is a community-based trauma surgeon. He’s also an osteopathic physician. Listen to his journey and what you consider if you’re interested in medicine and specifically trauma surgery.

Dr. Darko has also been on The Premed Years podcast back in Session 196, and he is the host of the podcast called Docs Outside the Box.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:05] An Early Interest in Trauma Surgery

Practicing for almost five years now, Dr. Darko looks back to how he first got interested in trauma surgery. As a seventeen-year-old, Nii had the opportunity to shadow a trauma surgeon in Newark, New Jersey.

The first trauma case Nii saw was a person who got shot. Nii watched as a whole chorus of nurses and different medical staff helped the patient. The trauma surgeon he was shadowing was at one corner of the room conducting the staff, which to him seemed like an orchestra—this concerted type of chaos. The patient was taken into the operating room, and when the doctor came out, he talked with the family. The doctor came out of this operating room like a big superhero who just saved the day. From that experience, Nii got hooked.

The doctor came out of this operating room like a big superhero who just saved the day.Click To Tweet

Fast-forward to residency around ten or twelve years later. Nii noticed that general surgeons were doing everything, including trauma. To Nii, the appeal of trauma surgery was that you don’t know exactly what’s injured, and you have to use all of these detective-type qualities to figure out exactly what’s going on. So Nii felt trauma surgery was the best mix for him. He could take care of patients who need things like appendix or gall bladder surgery, and at the same time use his superman qualities in high-adrenaline and highly stressful situations.

The fun part about trauma is you don't know what's coming through the door.Click To Tweet

[04:40] Traits that Lead to a Good Trauma Surgeon

Nii cites patience as a crucial trait for trauma surgeons. Oftentimes, with trauma, you don’t know what’s going on, and a lot of things are going on at the same time.

Another important quality is leadership. You need to understand that trauma surgery puts you in highly stressful situations. You need to have the ability to take a step back, be patient, and at the same time, have the ability to direct people respectfully. Nii stresses the fact that no man is an island, particularly in medicine, and although you’ll be making decisions on your own, you are leading a team. If you can lead them effectively, it’s always going to end up, for the most part, with good results for the patients.

No man is an island, particularly in medicine and although you'll be making decisions on your own, you are leading a team.Click To Tweet

Considering Specialties Besides Trauma Surgery

Nii initially wanted to be an obstetrician, as he was greatly inspired by Bill Cosby of the Cosby Show, who played an obstetrician who was a positive African-American doctor figure. In fact, in medical school, Nii was the first-year representative for the OB/GYN club, but he quickly realized afterward that it wasn’t for him.

Orthopedic surgery was also in the running for a short period of time for him, but everything fell by the wayside when he did a rural general surgery rotation in the middle of Kansas. He knew from then on that general surgery was for him.

[06:58] A Day in the Life of a Trauma Surgeon

Nii gets into the hospital by seven in the morning. First, they have a sign-out period where they talk about all the patients on the list, anything major that occurred the night before, and the plan for the next 12-24 hours.

From 8 am to 7 pm, Nii handles various duties, whether it be a patient evaluation at the trauma bay or someone on the general floor. By 7pm, they do the sign-out process again, and whoever is on at night handles anything that needs to occur at night. So Nii has a twelve-hour shift. Then they do it all over again the next day.

Types of Patients Treated in Trauma Surgery

Nii treats patients from all walks of life—children, elderly patients, and patients in their late teens and 20s. As a trauma surgeon, the majority of patients he sees are in their teens, 20s, and 30s, which he describes as the “invincible years.” People think they’re invincible during those years, so they do more reckless stuff.

Additionally, he sees a huge boom of geriatric patients consisting of the baby boomer generation. As these folks get older, they are more prone to falls, making them the second-largest patient population he deals with.

70% of his job consists of true trauma cases, such as car accidents, gunshot wounds, stab wounds, and critical care, while 30% of his job is general surgery. Only about 10-15% of his patients that come through the trauma bay get taken to the operating room for operations such as removing a spleen, fixing a liver laceration, or a washout of an exposed bone.

A very small percentage of patients get taken to the operating room, which is a significant shift from the trauma surgery that our generation knows from most TV shows in the ’70s and ’80s. Because of how advanced technology now is, those days are way behind us. Now, you can study someone, take a look in their abdomen or chest, and have more information before you take them to the operating room.

[12:08] Taking Call as a Trauma Surgeon

In terms of taking call, Nii works in a two-week-on-two-week-off model, which is basically where he and another surgeon alternate call for two weeks at a time. During his two weeks off, Nii has no administrative work, no hospital work, and no patients.

So Nii works hard in Central Pennsylvania for two weeks, and then he’s able to get home for two weeks to see family. This is an attractive kind of schedule for people who really care about being able to travel or do things with their families that they may not be able to do in a regular type of job. That said, Nii describes his two weeks on as tough. You can do it, but it’s not for everybody. However, Nii likes his schedule overall.

Two Weeks On, Two Weeks Off

When his patients come back during the two weeks that Nii is off, all the surgeons have an agreement that they’re no longer his patient—they become the patient of the surgeon who is on. So, Nii doesn’t need to be bothered during his time off.

Nii sees this as the wave of the future. It may not be necessarily two weeks on and two weeks off, but more and more specialties are taking on this type of work model with varying number of days on and off, where they’re working as a team. Considering the number of patients one person has to see, and considering how Millennials and Generation X value work-life balance, this type of schedule is becoming a lot more attractive to people.

It may not be exactly 'two weeks on and two weeks off,' but more and more specialties are taking on this type of work model with varying number of days on and off, where they're working as a team.Click To Tweet

Again, Nii stresses how tough those two weeks on are. Oftentimes, you may not be able to see loved ones during that time. But during the two weeks off, you can catch up. It’s not for everyone. Nii has missed a lot of important life events, and he honestly says there are times he questions if this is all worth it. But all humans have that type of thought process at some point.

Nii is not complaining, but this is real talk. This is bringing to light something people have not talked about before, and it may be manifesting in bad behaviors in the operating room. So it’s important to have these type of discussions now.

[17:35] Residency and Fellowship for a Trauma Surgeon

Nii did five years of general surgery residency, which includes training in a whole bunch of various areas of surgery, such as general surgery, surgical oncology, ENT, neurosurgery, and a little bit of orthopedic surgery.

Afterward, he was allowed to practice general surgery, and he decided to do a one-year fellowship where he did additional training at University of Florida’s Ryder Trauma Center. He got as much experience in trauma as he could, as well as critical care experience. After his training, he became board-eligible to practice trauma surgery and critical care surgery, as well as general surgery.

How Competitive Is Trauma Surgery Residency?

Nii describes trauma surgery as not a very competitive residency for a host of reasons:

  1. A lot of people are nervous about the hours you work with trauma.
  2. It’s very stressful.
  3. A lot of programs offer trauma, so it’s not as competitive as vascular surgery or some of these other subspecialties with fewer programs, such as laparoscopic surgery or bariatric surgery.

For the most part, people may think of trauma surgery as not being too competitive, but it is very hard to get into the top trauma centers like the University of Miami, Grey Memorial Hospital, USC in California, or Shock Trauma in Maryland.

For the most part, trauma surgery is not too competitive as a specialty, but it *is* very hard to get into the top trauma centers.Click To Tweet

[Related episode: Looking at the Match Data for General Surgery.]

[19:55] How to Be a Competitive Applicant in Trauma Surgery

From a medical student’s perspective, Nii cites the key things for becoming a very competitive applicant to general surgery. First, set the groundwork by being an excellently trained general surgeon.

Show your interest in general surgery from the beginning, whether that means going to conferences or shadowing general surgeons. You’re going to be doing a general surgery rotation in your third year of medical school, but you may want to add an additional rotation as a third- or fourth-year med student, as a sub-internship in general surgery or trauma surgery. Get excellent letters of recommendation and do well on your board exams.

Tips for the General Surgery Residency

Once you become a general surgery resident, make sure to have an open mind. Make sure you’re giving every rotation that you’re doing enough attention and always learn as much as possible. Be open to the idea that maybe you thought you wanted to do trauma surgery but you’re actually really interested in surgical oncology or what have you.

Make sure to have an open mind. Make sure you're giving every rotation that you're doing enough attention.Click To Tweet

During your second or third year of general surgery residency, start getting yourself involved in research or doing some additional trauma surgery rotations. Get yourself involved in co-authoring a chapter in a textbook if you’re at a large institution that does that. For Nii, University of Miami had opportunities for not only medical students but also for general surgery residents to attach themselves to one or two general surgeons who were writing textbooks with 25 to 30 chapters.

So there are plenty of opportunities to set yourself up for success, but the takeaway point is to focus on getting into a general surgery residency, and then as a resident, find ways to show your interest and commitment to trauma surgery.

[22:40] Choosing a Trauma Surgery Fellowship

Nii says he wouldn’t have done anything differently with how he chose his trauma surgery fellowship. When Nii applied, he was a fourth-year surgery resident at Grey Memorial Hospital. A lot of trauma was done at this hospital; there were trauma surgeons who had trained at various places. What he did was query all of those surgeons, asking them about the program they attended and why they think it’d be good for him to train there.

Aside from getting advice from the trauma surgeons in his hospital, Nii also went online and looked up more about those different programs. He even called up the program directors when he could.

Nii wants people to understand that medicine is an extremely small world, and as you start to get into subspecialties like trauma surgery, it’s a very, very small world. For instance, their chairperson knew the trauma director at Miami, and they ended up getting introduced in that way. Nii he got to talk to this trauma director about the program at Miami, so he applied and ended up working for him.

Medicine is an extremely small world, and as you start to get into subspecialties like trauma surgery, it's a very, very small world.Click To Tweet

Additionally, when you apply, you get the opportunity to interview at these places if given an interview. This is an opportunity for you to showcase how well you speak and think in person, not just how you look on a piece of paper. It also gives you the opportunity to interview the program. Ask them how well they train their residents or fellows, how well they do on their board exams, how much experience they get operating on X or Y, and how much time they get off.

[25:00] His Hustle to Allopathic Residency as a DO

Nii is a DO, but he went to an allopathic residency program for general surgery. Based on the NRMP Match Data for 2017 for Surgery programs, out of 1,276 positions filled, only 64 were filled by osteopathic students.

When asked about how it was for an osteopath to get into an allopathic residency, Nii explains how much he hustled. He had to grab opportunities and not wait for someone to give it to him. Nii knew he wanted to do general surgery, and he was open to doing a general surgery residency at an osteopathic program. He went through interviews at all these different DO programs, and at the same time he decided to interview at MD programs.

Nii got a phone call from three or four general osteopathic surgery programs that they matched outside of the match, which is part of their culture. They sometimes just agree to take a certain person before the match.

So Nii had no other places available to him to get into a DO general surgery residency. But since he got to interview at allopathic programs, too, he still had that chance within allopathic programs. He ended up doing a last-minute sub-internship at Morehouse School of Medicine in the Medical Intensive Care Unit (MICU).

Getting His Foot in the Door with Trauma Surgery

When he got to the sub-internship at Morehouse, he made it very clear that he was doing the MICU rotation because he tried to get into the SICU (Surgical Intensive Care Unit) rotation and it wasn’t available. He actually got lucky because he had a very good pulmonology critical care physician. Nii honestly told that physician that he enjoyed the intensive care unit but at the same time he was really interested in being a surgeon.

Then every now and then, he would request to round with the trauma surgeons. He eventually maneuvered that into seeing what they do in trauma. He basically got his foot in the door and hustled his way into making sure they know him.

Going into Surgery as an Osteopathic Medical Student

As a result of this networking, he got accepted into the general surgery residency program at Morehouse. It turns out, that program had never taken an osteopathic medical student before. But by the time he graduated, he was the best resident that had ever come through the program. Nii thought they may think that because he’s a DO, he’s different, but he went above and beyond and he crushed it.

They think that because I'm a DO, I'm a little bit different, but I went above and beyond and I crushed it. Click To Tweet

Nii’s advice to medical osteopathic students out there is that if you want to get it, then go get it. And if you have to get into a general surgery program in the allopathic world, then go and be as aggressive as possible, and take the opportunities that are presented to you. Kick the door open and don’t wait for someone to give you an opportunity, otherwise you’re going to be on the outside looking in.

Kick the door open and don't wait for someone to give you an opportunity—otherwise, you're going to be on the outside looking in.Click To Tweet

[31:40] Doing Additional Training as a Trauma Surgeon

As a trauma surgeon, your subspecialty is called Trauma Critical Care. You can go and get some additional education, too, like taking additional courses in ultrasound. This is very useful if you’re trying to figure out if someone is bleeding in their abdomen or has blood anywhere else. Using it is cheap, quick, and it doesn’t require moving the patient to a CT scan where their blood pressure can drop or they can end up dying of a collapsed lung.

You can get additional training in pretty much anything. It won’t get you additional certification, but Nii explains it’s always good to have that additional training in your back pocket. You never know when you’re going to use it. If you want to get any type of additional training that would get you certified in something else, you may have to do an additional fellowship aside from trauma surgery, such as laparoscopic surgery or plastic surgery.

It's always good to have that additional training in your back pocket because you never know when you're going to use it.Click To Tweet

Other Specialties You Collaborate with as a Trauma Surgeon

In trauma, Nii often works with orthopedic surgeons for broken bones, neurosurgeons for head and spinal cord injuries, and plastic surgeons, oral, and maxillofacial surgeons for broken bones in the face, missing teeth, broken noses, and broken sockets. Other specialties they work a lot with include cardiothoracic surgeons.

Opportunities Outside of Clinical Medicine for Trauma Surgeons

Trauma surgeons can play a role in EMS. For example, if EMS is called to a scene and a patient is found down, an EMT may bring that patient to the ER and allow the ER physicians to work that patient up. But if the patient has a bunch of bruises on the head or the rest of the body that may suggest they’ve fallen, a trauma surgeon may be able to educate EMS as to what to do first in those situations. So there is a potential role for trauma surgeons as consultants and educators to EMS.

You can also create your own type of experience. You can do a podcast like Nii, where he interviews ordinary doctors who do extraordinary things. And as with any other specialty, the world is your oyster. Nii says that as a doctor, you just have so many opportunities to do anything you want. There are so many ways you can branch out.

As a doctor, you just have so many opportunities to do anything you want. There are so many ways you can branch out.Click To Tweet

[36:38] Is Trauma Surgery Lucrative?

Nii trained in Atlanta, Georgia. From that experience, he found trauma surgery to be a financial burden on their hospital. This is because the majority of trauma patients at their facility were indigent populations. If a patient with polytrauma comes through without insurance, it’s a huge expense for the hospital.

But when Nii ended up becoming a trauma surgeon, he started practicing in areas where people have insurance to pay for the treatments. He hadn’t realized that trauma surgeon could be so lucrative for a hospital and for the providers. At the hospital he’s currently at, trauma surgery is not a financial burden. It’s the biggest money maker in the hospital.

He wished he had known this earlier. He used to talk to physicians who tried to turn him away from trauma surgery because it’s not lucrative. But in his current situation, it seems like the administration can’t get enough of trauma surgeons and want more of them.

[39:00] What Do You Like Most and Least About Trauma Surgery?

The thing Nii likes the most about trauma surgery is being a jack of all trades. He enjoys stressful situations and being trained in all different areas. You get to orchestrate a lot of people and run a team. You’re seeing someone literally from the door as they come in, all the way to when they’re discharged, and you’re in charge of all facets of care. He finds this very fascinating, and it’s the reason he went into trauma surgery in the first place.

The thing he likes the least about trauma surgery is also the stress that comes with it—there’s a lot to handle. In other specialties, you get to triage it to another person, but you don’t have this option in trauma surgery. There is constant stress, which can eventually wear you down. Nii is still in his late 30’s, and he already feels the stress, so he knows he can’t continue like this into his 50s. It’s just not sustainable. But Nii loves this, too, so it’s like an addiction.

There is constant stress as a trauma surgeon, which can eventually wear you down.Click To Tweet

[40:45] Major Changes in Trauma Surgery

Nii explains that trauma in the ’80s and ’90s was known to be less operative compared to other specialties. Many trauma surgeons even lost the operative skills they’d acquired during residency. So a lot of trauma surgeons were not very good at operating. But a new field has come up called Emergency General Surgery or Acute Care Surgery.

Now a trauma surgeon can handle all the general surgery emergencies that occur in the hospital. This helps the general surgeons who have very busy elective services in the morning. The general surgeons won’t have to come in during the middle of the night anymore to take out an appendix. This is important because maybe at 7am they have a Whipple procedure, one of the most intricate surgeries in the abdomen. The general surgeons can perform better without taking call in the middle of the night.

Technology-wise, things continue to evolve further and further, as well.

[44:00] Would He Choose Trauma Surgery All Over Again?

If he had to do it all over again, Nii actually doesn’t know if he would choose trauma surgery again. His thought process has changed a lot from medical school and residency. He went from a gunner mentality to now more of focus on enjoying what he does. He no longer feels defined by being a physician.

There is more to Nii Darko than just being a doctor. And if he had that thought process in medical school, he may not have decided to go into general surgery. He may have decided to do something else, where he’d be able to take care of patients and at the same time have a lifestyle where he can get away.

Sure he does work two weeks on and two weeks off, but this kind of schedule may not be available for trauma surgeons at other institutions. With emergency medicine, for example, you work a certain amount of shifts per month and you’re guaranteed some time off. So if he had to do it all over again, he may have chosen something different.

I'm not defined by being a physician. There's more to me than just being a doctor.Click To Tweet

[45:40] Final Words of Wisdom

Nii’s advice to premeds, medical students, and residents looking at trauma surgery is to relax. Take a big deep breath. If you want to be a trauma surgeon, there are plenty of spots available.

From a premed standpoint, focus on getting into medical school and being the best student you can be. At the same time, take opportunities to shadow a general surgeon and contrast that with shadowing a trauma surgeon, so you can see the differences in how they practice.

From a medical student’s perspective, this is the time for you to really do as well as you can with your boards and your rotations. At the same time, start laying the foundation for your commitment to general surgery if that’s what you’re interested in.

Finally, as a resident, keep an open mind and give all of your rotations an equal share of your attention. At the same time, if you know for a fact that trauma surgery is what you really want to do, go and get it. Don’t let anybody keep an opportunity from you, and know that trauma surgery is extremely rewarding.

If you know for a fact that trauma surgery is what you really want to do, go and get it. Don't let anybody keep an opportunity from you.Click To Tweet

Although very stressful,  Nii enjoys his work every day. You deal with people in their most vulnerable states, and not many other specialties can say that they take care of patients every step along the way. So he is very grateful and humbled he has the opportunity to do this.

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