A Different Way to Structure Trauma Call: Lessons from Providence Regional Medical Center Everett (WA)
- 4 days ago
- 5 min read
One of the biggest questions facing Level II trauma centers today is how to structure trauma surgeon coverage. As patient volumes increase, surgeon burnout becomes more common, and emergency general surgery (EGS) demands continue to grow, many hospitals are asking whether the traditional "one surgeon on call" model is still sustainable. Yesterday's post described the most typical trauma call structures in American hospitals.
Providence Regional Medical Center Everett (PRMCE) in Washington offers one example of a different approach.
For more than a decade, the hospital has operated a dedicated Acute Care Surgery service that combines trauma surgery, EGS, and surgical critical care into a single, integrated team. Rather than asking a surgeon to juggle trauma call from home while trying to maintain an elective practice, PRMCE has invested in a model where surgeons are physically present in the hospital around the clock and focus exclusively on acute care surgery during their shifts.
The result is a service designed around patient care, physician wellness, and operational efficiency.
The Trauma Call Staffing Model at PRMCE
PRMCE is a busy Level II trauma center serving a large suburban region. The Acute Care Surgery service is staffed by a physician group consisting of 10 full-time surgeons, supplemented by several per diem military physicians.
Every surgeon is double board-certified in both General Surgery and Surgical Critical Care, allowing each physician to function interchangeably across the service.
Coverage includes:
Two trauma surgeons in-house 24 hours a day
Twelve-hour shifts (day and night)
No home call
No residents
Robust Advanced Practice Provider support
Although each surgeon has a primary responsibility during the shift, they function as a team. Typically:
One surgeon manages trauma activations and the surgical ICU
One surgeon leads the Emergency General Surgery (EGS) service
Both surgeons routinely assist one another when operative volume or patient acuity increases
This flexibility is possible because every physician possesses the same training and skill set.
Advanced Practice Providers (APPs) Extend the Team
The physician staffing model is supported by a robust APP team. During the day, three APPs are present:
One dedicated to EGS
One dedicated to Trauma
One floating APP who assists in the operating room and provides bedside support wherever needed
At night, one APP remains in-house to answer calls, assist the surgeons, and provide additional coverage across both services.
Rather than functioning independently, the APPs are fully integrated into the Acute Care Surgery team, allowing physicians to stay focused on high-acuity decision making while maintaining continuity of care.
Busy Shifts -- But Time Off Is Truly Time Off
This is not a light-duty service. When surgeons are working, they are exceptionally busy. A typical 12-hour shift may include:
3-4 operative cases
More than 40 patients on the service
Response to all trauma activations (full and modified)
ICU management
EGS consults
However, because there is no home call, physicians are able to disconnect completely once their shift ends.
Each physician covers approximately 157 twelve-hour shifts per year, averaging 13.1 shifts per month.
The remaining days belong to the physician -- not interrupted by overnight pages, emergency operations, or ICU phone calls.
That predictable schedule has created something increasingly rare in acute care surgery:
Excellent work-life balance without sacrificing patient coverage.
More Than Trauma Surgeons
One of the most interesting aspects of the PRMCE model is the value the Acute Care Surgery service provides beyond trauma.
Because surgeons are continuously present in the hospital, they support numerous hospital-wide services, including:
Airway emergencies and code responses
Massive Transfusion Protocol (MTP) management
Bedside central venous access
Bedside procedures including skin biopsies and paracentesis/thoracentesis as appropriate
Surgical assistance for other specialties
Overnight admission and management of orthopedic patients when orthopedic surgeons are not in-house
Backup support for the obstetrics team
This broad operational role makes the Acute Care Surgery service an important resource across the hospital—not just for injured patients.
Benefits for the Hospital
From an administrative perspective, the model provides several advantages.
1. Continuous Surgeon Availability
Patients have immediate access to experienced general surgeons without waiting for someone to drive to the hospital or worrying about the trauma surgeon being encumbered.
2. Improved Teamwork
Because surgeons work side-by-side throughout the shift, communication is immediate and collaboration becomes routine rather than exceptional.
3. Operational Flexibility
Since every physician is qualified in trauma surgery, EGS, and surgical critical care, staffing can adapt to changing patient volumes without creating specialty silos.
4. Recruitment and Retention
Perhaps the most striking outcome is the stability of the workforce. The physician group has experienced remarkably little turnover, and the APP team has remained similarly stable. In a specialty where recruitment has become increasingly difficult, creating a schedule physicians want to stay in may be just as important as recruiting new surgeons.
5. Reduced Reliance on Locum Tenens
Maintaining a fully staffed, in-house Acute Care Surgery team has largely eliminated the hospital's need for locum tenens trauma surgeons, providing greater continuity of care while avoiding the significant costs and operational disruptions associated with temporary physician staffing.
An Evolving Model
Although this staffing structure has existed for more than ten years, the service today is much busier than when it began.
Trauma volume has increased.
EGS demand has grown.
Hospital-wide procedural responsibilities have expanded.
Despite that increased intensity, the core design has remained the same: dedicated in-house physicians working defined shifts with no home call responsibilities.
The model has proven capable of adapting as the program has matured.
Could This Work Elsewhere?
No single trauma call model is right for every hospital. Community hospitals, rural centers, academic medical centers, and high-volume urban programs all have different staffing needs, financial constraints, and surgeon availability.
However, PRMCE demonstrates that investing in an integrated Acute Care Surgery service can produce benefits that extend well beyond trauma designation requirements.
When surgeons are fully dedicated to trauma, EGS, and surgical critical care during their shifts (and free from clinical responsibilities when off duty) the result can be better physician sustainability, strong team culture, high retention, and enhanced support for the entire hospital.
As trauma centers across the country continue to rethink physician coverage in response to workforce shortages and rising patient volumes, models like this provide an important example of what modern acute care surgery can look like.
The Bottom Line
Sometimes, the best trauma call model isn't simply about covering trauma. It's about building a hospital-wide acute care surgery service that creates value every hour of every day. PRMCE’s unique and innovative approach works for surgeons, benefits the hospital, and, most importantly, preserves patient safety and timely care.
This article was written in collaboration with Shaina Schaetzel, MD FACS, Trauma Medical Director at PRMCE.
