A national survey of 74 US acute care surgery (ACS) division chiefs (conducted December 2024) assessed how advanced practice providers (APPs) are staffed, utilized, and trained across trauma, surgical critical care (SCC), and emergency general surgery (EGS) programs.
96% of centers had daytime APP coverage, but only 49% had nighttime coverage. Median APPs per center was 14 (most in trauma, n=5). Patient-to-APP ratios were highest in trauma (median 11) and lowest in SCC (median 6). APPs performed chest tubes (trauma 59.6%, SCC 54.4%) and central lines (trauma 43.9%, SCC 66.7%); 24.6% of trauma and 40.4% of EGS APPs assisted in the OR.
- Survey respondents were predominantly from university-affiliated, Level I trauma centers (81%), limiting generalizability to community or lower-acuity settings. - Descriptive design with no outcomes data; cannot assess quality, safety, or efficiency of APP integration. - Division chiefs reported on behalf of their programs, which may introduce reporting bias about APP roles and workload.
Nearly all major ACS programs rely on APPs during the day, but fewer than half have nighttime coverage — a gap worth addressing as APP roles expand. Surgical leaders should evaluate barriers to off-hours APP staffing and work toward standardized training and workload benchmarks.
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