The Role Of A Trauma Surgeon
Physical trauma is injury caused by impact. Be it the crushing of bones in a road traffic accident or penetrating open wounds in stab victims, these patients need help fast, and ultimately in the form of a surgeon.
Trauma care is a multi-disciplinary care pathway, requiring ‘whole patient’ care, which in the case of poly-trauma patients, can involve large teams of people with emergency medicine consultants often being their leader and coordinator.
With a growing number of specialist major trauma centres (MTCs) around the UK, the need for specialist trauma surgeons is also required to provide the highest level of care.
However, a major hurdle to becoming a ‘Trauma Surgeon’ in the UK is that the post currently does not exist1.
Can I Be A Trauma Surgeon In The UK?
Trauma is not a standalone speciality in the UK and there is no agreed definition of what constitutes a Trauma Surgeon amongst the surgical specialty organisations. In countries such as the United States and South Africa, which have higher rates of major trauma and penetrating trauma, you will find a much larger market for a specific trauma surgeon job role (2).
In the UK, major trauma cases are managed by a team of general surgeons, neurosurgeons, vascular surgeons and orthopaedic surgeons and then at later reconstructive stages, plastic surgeons. The Royal College of Surgeons are aware of the lack of a dedicated training pathway for surgeons acting as the resuscitative surgeon in higher volume major trauma centres and have introduced the Major Trauma Workforce Project (3).
This plans to improve training and create roles for ‘Major Trauma Consultants’ who have surgical training in general, vascular and resuscitative surgery in order to amend these gaps.
Currently, being a trauma surgeon in the UK refers to the GMC recognised speciality of Trauma & Orthopaedics (T&O). T&O consultants are trained to manage musculo-skeletal injury and fragility fractures as part of their general spectrum of practice. Trauma work largely involves broken bones rather than the care of polytrauma patients.
For the purpose of this guide, the route to becoming a T&O Consultant will be outlined. However, if you aim to access trauma surgery via a general surgery or vascular surgery route then please see our guides on how to become consultants in these specialties.
What Does A Trauma & Orthopaedic Surgeon Do?
T&O consultants make up 28% of surgical consultants in the UK, making them one of the largest specialities alongside general surgery. These surgeons, widely known as ‘bone doctors’ are highly trained in not only the mineralised matrix that is bone but also the whole musculoskeletal system.
This covers a spectrum of disorders, which ranges from the immediate trauma of broken bones, tendon rupture and infection, to the more insidious nature of arthritis, bursitis and even tumours.
With the flexibility of this speciality comes a mix of surgical and interventional work. Orthopaedic surgeries such as pinning together broken bones and replacing hip and knee joints require longer recovery times and inpatient stay. Interventions like joint arthroscopy, a minimally invasive technique for diagnosis and reparation of joint structures such as cartilage and ligaments, can be done in an outpatient day surgery.
Orthopaedic surgery represents the specialty with the most gender imbalance with women making up 5% of orthopaedic consultants, although the uptake of women in T&O specialty training posts is on the rise(4).
Going into the future, as the population ages and as the UK faces an obesity pandemic, so does the number of people requiring joint replacements, and the demand for surgeons with the ability to perform them. The recent technological advances regarding minimally invasive techniques, biomaterials and diagnostic techniques such as 3D imaging means that there is exciting scope for growth in this rewarding yet demanding specialty.
A Typical Week
Time as a T&O surgeon is split between the operating theatre, outpatient clinics and the emergency department, with the biggest commitment being the operating theatre. During a typical week, operating sessions make up roughly 40% of working hours and can be dedicated to planned elective procedures or put aside for an unknown intake of trauma cases.
As a T&O consultant must always be available to cover the trauma workload, on- call rotas can be more demanding than other surgical specialities, with approximately 1 week in 6 being a consultant’s designated on call. This is especially the case for surgeons working in busy and intense MTCs or contrarily those working in smaller hospitals in smaller teams.
Though the EU Working Time Regulation limits the working week to 48 hours, the orthopaedic surgeon must have the strength and stamina to undertake long operating hours, particularly when fixing complex fractures. The hammering and nailing of bones into correct alignment is not a job wanting botched.
The Route To Becoming A T&O Consultant
After having completed two years of foundation training begins the eight-year journey to becoming a T&O consultant. Below are major milestones in this training pathway:
Choose between Core Surgical Training Vs Run Through Speciality training
Core Training (CT1-CT2) – If you know a career in surgery is for you but aren’t quite convinced you want to be a T&O consultant just yet, then core surgical training offers a greater breadth of surgical teaching and the option to still go into a variety of surgical specialties at the end. Competition in 2019 meant that there were 1896 applicants for 648 posts across the UK. If at the end of core training you have decided you want to do T&O specialty training, then you have to apply for nationwide ST3 posts which is even more competitive with 519 applications for 167 posts.
Run Through training (ST1-ST8) - If you are certain after foundation years you want to be a T&O consultant then you can start specialty training straight away. This also waives the need to compete against applicants joining from core training at ST3 level and is accompanied by greater job security.
Pass the MRCS exam - Trainees wishing to continue their surgical training at specialty level must complete their membership of the Royal College of Surgeons exam (MRCS) by the end of their CT2/ ST2 year
Develop a subspecialty interest - Nearing the end of specialty training, it is recommended to start choosing a subspecialty. Subspecialties that exist in T&O include but are not limited to specific joints in the body – eg shoulder, joint reconstruction – eg hip or knee, orthopaedic oncology, paediatric surgery and complex trauma surgery. If wanting to pursue a subspecialty in major trauma, it is recommended to obtain a post at a MTC, with MTCs in London often the busiest they offer a bespoke and readily exploitable training environment. Additionally, during the 5 years of speciality training, many trainees also take the time to complete an MD or PhD in an area of interest to make their applications more competitive for future consultant posts.
Completion of training - In the final two years of higher surgical training, specialty trainees must take the Fellowship of the Royal College of Surgeons (FRCS) exam. On completion of specialty training, trainees are awarded a Certificate of Completion of Training (CCT) or Certificate of Eligibility for Specialist Registration (CESR), they will be added to the GMC's specialist register and will be eligible to apply for a consultant post or a fellowship for further, more specialised training.
Top tips for a competitive training application:
Show commitment to the specialty. As a medical student, complete electives and student selected components in orthopaedics. As a foundation doctor, try and complete closed loop audits, take part in research or attend conferences that demonstrate your interest.
Keep your logbook up to date. Surgical logbooks are crucial throughout surgical training. The earlier you start these the better- even if in medical school.
Be present. It is difficult to learn away from the operating theatre. Even if you are not scrubbed in, a lot can be learnt from close observation of your seniors and also by earning their respect.
As a consultant from 1 April 2019, you'll earn a basic salary of £79,860 to £107,668 per year, depending on the length of your service. Consultants can also supplement their salary by working in private practice if they wish. The opportunities available will depend on their specialty areas and the time they wish to spend on this outside of their NHS contracted hours.
Orthopaedics is a specialty with some of the highest potential for private practice. According to an analysis by Independent Practitioner Today consultant orthopaedic surgeons earned an average of £128,000 per year from private practice.
JRSM reported in 2008 that private income for orthopaedic surgeons was 1.4x their NHS income, second only to plastic surgeons (1.9x)5.
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Related Job Sources With BMJ Careers
Other Complete Guides By BMJ Career
Tai N, Ryan J, Brooks A. The neglect of trauma surgery. BMJ. 2006;332(7545):805-806.
Bircher M, Tai N. Trauma Systems in England [Internet]. Rcseng.ac.uk. 2014 Available from: https://www.rcseng.ac.uk/-/media/files/rcs/standards-and-research/standards-and-policy/service-standards/major-trauma-surgery/rcs--trauma-systems-in-england.pdf
Bircher M, Tai N, Brooks A, Ong T. Major Trauma Workforce Sustainability [Internet]. Rcseng.ac.uk. 2016 [cited 21 June 2020]. Available from: https://www.rcseng.ac.uk/-/media/files/rcs/standards-and-research/standards-and-policy/service-standards/major-trauma-surgery/major_trauma_workforce_sustainability-p2.pdf
Working life (trauma and orthopaedic surgery) [Internet]. Health Careers. 2020 [cited 21 June 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/trauma-and-orthopaedic-surgery/working-life
Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. Journal of the Royal Society of Medicine [Internet]. 2008 [cited 14 June 2020];101(7):372-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442143/table/tbl3/