When I was a resident, the trauma surgeon was the go-to person for anything complicated. It seemed like they could do everything, and do it well. That’s what drew me to the field. There was a confidence, decisiveness, and scope that made trauma surgery feel like the pinnacle of surgical mastery.

For most of my career, I’ve worked as a trauma and critical care surgeon, from busy academic Level I trauma centers to community hospitals designated as ACS Level II or III. It’s been a journey filled with purpose and challenge. I have been fortunate to have mentors that really pushed me to have robust and broad-based general surgery practice over years, especially as I’ve witnessed a steady and undeniable transformation in trauma surgery into a non-operative service. The specialty that once centered around high-stakes operations and dramatic rescues has become increasingly non-operative, more about systems and support than scalpels.

That evolution became particularly real to me during a recent patient interaction during trauma rounds. After reviewing the plan for the day with a patient, he looked at me (calm, alert, attached to monitors) and asked, “What exactly is it that you are doing for me?” It was a simple, sincere question. And I didn’t have a good answer.

A moment that made me stop and reflect

His question caught me off guard. My day had been full: writing notes, ordering imaging, consulting other specialties, and managing ICU patients. Yet, when it came time to explain my role in his care, I struggled.

The honest answer (though I didn’t say it) might have been something like this: “I did your admission history and physical, I placed orders, orthopedic surgery is managing your injuries, and I’ll be writing your discharge paperwork.” Of course, it’s more than that. We coordinate care. We anticipate complications. We monitor and reassess constantly. But that moment forced me to confront a deeper truth: the work we do as trauma surgeons today often lacks the clarity, visibility, and decisiveness that once defined the specialty.

It wasn’t just an awkward exchange. It was a moment of clarity, a realization that the traditional identity of trauma surgery is becoming harder to define, and even harder to explain to the very patients we care for.

A specialty in transition

Trauma surgery once evoked a very specific image: A surgeon rushing into the ER, scrubbing in for an emergency laparotomy, controlling hemorrhage, suturing torn vessels, and saving lives under extreme pressure. That kind of high-intensity, hands-on work was the norm, not the exception. But that world is changing, and fast.

Non-operative management is the new norm

One of the most profound shifts has been the rise of non-operative management. Injuries that once required urgent surgery (like blunt liver or spleen trauma) are now often treated with monitoring, transfusions, and interventional radiology. The scalpel is being replaced by catheters and CT scans.

This is good for patients. Outcomes have improved. But it means trauma surgeons are often not the ones performing the definitive intervention. We become managers and coordinators rather than doers.

Expanding teams, fragmented roles

Modern trauma care is multidisciplinary by design. Emergency medicine, orthopedic surgery, neurosurgery, interventional radiology, and intensive care all play key roles in trauma management. That collaboration is a strength, but it also means that the trauma surgeon is no longer the undisputed leader of the trauma bay.

Instead, we serve as quarterbacks or air traffic controllers, ensuring that everyone is aligned. It’s critical work, but less visible, and harder to quantify.

Demographic shifts and changing injury patterns

The trauma population has shifted as well. It’s no longer dominated by young, otherwise-healthy patients in high-speed accidents. Today, we see more elderly patients with multiple comorbidities, suffering from low-velocity injuries like ground-level falls.

Managing these patients requires nuance, restraint, and often, conservative care. It’s good medicine, but it doesn’t always feel like “trauma surgery” in the traditional sense.

The modern trauma surgeon’s daily reality

During a typical day on service, I review labs, adjust ventilator settings, coordinate with consultants, follow up on imaging, and ensure that protocols are being followed. I manage sepsis, optimize nutrition, and talk to families about goals of care.

These are all vital responsibilities. But they’re also a far cry from the high-adrenaline, hands-on procedures that once defined trauma surgery in the popular imagination.

And so when a patient asks, “What exactly are you doing for me?” it’s hard not to feel the weight of that question.

A changing identity and its consequences

This shift in identity has real implications: for training, for job satisfaction, and for the future of the specialty.

Burnout is common in trauma surgery. The hours are long, the pace is relentless, and the emotional weight of caring for critically-injured patients is immense. But when the operative component of the work is also diminishing, it adds a layer of professional uncertainty.

In some centers, “emergency general surgery” (EGS) or “acute care surgery” has been proposed as the answer, a way to maintain operative skills and preserve surgical identity. But in practice, the volume and complexity of EGS cases can vary widely. I once interviewed at a Level II trauma center where five trauma surgeons shared just 100 operative cases over an entire year. And they weren’t doing complex elective procedures either, mostly minor interventions.

When the hands-on, technical aspect of surgery diminishes, the work can start to feel like administrative coordination (essential, but not why most of us chose this path).

So is trauma surgery a dying field? Or simply one in transition

I don’t believe trauma surgery is dying. I believe it’s evolving, and we, as surgeons, must evolve with it. Today’s trauma surgeons are not just skilled technicians. We are systems thinkers. We manage complexity. We lead teams. We navigate critical care, social determinants of health, ethics, resource limitations, and discharge planning, often all in a single shift.

We save lives, yes, but we also improve quality of life. We prevent complications. We support families. We guide patients through some of the most vulnerable moments of their lives. That may not always involve dramatic interventions, but it is deeply meaningful work.

Still, this evolution raises important questions:

• How do we maintain operative proficiency in an increasingly non-operative field?
• How do we preserve the appeal of trauma surgery for trainees?
• How do we clearly define and communicate our value to patients and colleagues?

I don’t have easy answers to those questions. But I believe the future of trauma surgery depends on us confronting them honestly and adapting with purpose.

A personal turning point

I finally came to the realization that this type of work isn’t for me and the level of frustration has become untenable. As I write this, I have just one trauma call left before I step away from this field for good. I’ve been fortunate to build a robust elective practice alongside my trauma responsibilities, and that will be my focus moving forward.

Leaving trauma surgery doesn’t feel like abandonment; it feels like a natural transition. I’ve given years to this work, and I’m proud of what I’ve contributed. But it’s also time for the next chapter, one that offers greater balance, practice satisfaction, consistency, and a different kind of fulfillment.

Still, I’ll always carry the lessons and perspective that trauma surgery gave me: humility in the face of unpredictability, respect for the fragility of life, and the importance of clear, decisive thinking under pressure.

Honoring the past, embracing the future

Trauma surgery may no longer look the way it did decades ago. The days of rushing from the OR to the ICU to the ER, hands bloodied, and barking orders, may be fading. But that doesn’t mean the specialty is any less vital, only that its role is changing.

And change isn’t always bad. We should embrace the opportunity to redefine what it means to be a trauma surgeon (not as a solo hero, but as a leader in coordinated, compassionate, high-stakes care). The challenges ahead are real, but so are the opportunities to innovate, collaborate, and teach the next generation.

To those still in the trenches: Your work matters, even if it’s harder to see.

To those just beginning their journey: Your skills will evolve, and so will the field. Stay flexible, stay curious, and stay committed.

And to the patient who asked, “What exactly are you doing for me?”: Thank you. You helped me understand myself, and this field, more deeply than I ever expected.

Farshad Farnejad is a general and critical care surgeon.