APPs Play Critical Role in Supporting Trauma Teams

I am not a surgeon. I am a physician assistant (PA) or advanced practice provider (APP). I am just a PA.

I say “just” not to belittle my profession, but to illustrate that my experience and accomplishments are not specific to the letters behind my name but rather were made possible through the environment and team with which I have worked and grown.

This is a story about partnership, specifically the power of effective partnership between surgeons and APPs. Central to this partnership is the ability of APPs to function at the top of their scope, both clinically and administratively.

In this viewpoint article, I address two concepts critical to my career as a trauma APP. First is the power of physician-APP partnerships in clinical care and education. Second is the power of this partnership in advancing the science of patient care. As a final thought, I offer strategies for sustaining successful collaboration between these two important roles.

I want to acknowledge my sincere admiration for the trauma team. A trauma team must operate on a foundation of trust, determination, confidence, and cohesiveness. Sometimes we win, and sometimes we lose. And when you endure that reality with a team, they become family.

Trauma surgeons have inspired me from the beginning of my career, as they lead teams that are adaptable, ready to go at any given moment, unflappable under pressure, and experts at making difficult decisions in seconds. I have learned that trauma teams don’t say “no” and rarely shy away from a complicated situation.

To be a part of that environment, to be a player on that team, to have discovered a sweet spot where APPs and surgeons work together effectively and collaboratively—that has been a dream come true for me.

Privilege of the Podium

As the first nonsurgeon to give a named lecture at the Southwestern Surgical Congress (SWSC), I could feel in my chest both the weight of pressure and lightness of excitement that comes with the realization that something special is about to happen.

As famously quoted by tennis legend Billie Jean King: “Pressure is a privilege.” Of all the opportunities I have had at the podium, none surpassed the privilege of that podium on April 23, 2024, when I delivered the Edgar J. Poth Memorial Lecture.¹ To stand with a microphone in front of a room of surgeons and speak about what the optimal surgeon-APP partnership looks like and the goal of effectively advancing trauma care felt like a career pinnacle in my 15 years and counting as a trauma APP.

My journey began with a trauma APP fellowship in 2010 and the SWSC organization where I delivered my first scientific oral podium presentation in 2013, which addressed the efficacy of weight-based enoxaparin for venous thromboembolism prevention in obese trauma patients. Five minutes before I took the stage, someone mentioned that no APP had ever been at the SWSC podium.

Doubt crept in, but it was quickly replaced with a sense of belonging and community. We are surgical providers who are passionate about advancing patient care through science and collaboration.

After a few moments, I didn’t think twice about my credentials. I was transformed by the sense of camaraderie that permeated that space. Genuinely surprised to be one of the only APPs in the room, I was determined to blaze a path forward for us, specifically in the research arena.

Over the past decade, I have found myself at the helm of various trials and analyses and have had the privilege of speaking from many scientific podiums. And while over the years I have seen more APPs at the scientific podium, it is important to support even more APP participation in this area.

APP-Based Team Model

The real key to my success as a trauma APP and researcher is the support and mentorship of my surgeon colleagues. I am a product of my team in Salt Lake City, Utah, where I have been nurtured to function at the top of my APP scope.

At Intermountain Medical Center, an ACS-verified Level I trauma center serving the Salt Lake Valley and broader Intermountain West in Utah, our team consists of six trauma surgeons, 13 APPs, and various residents (e.g., surgical, emergency medicine). We are an APP-based team—originating in the 1990s from a visionary trauma surgeon who was clearly ahead of his time.

Our APPs are involved in all aspects of trauma care, from the bay to the door. Practicing at the top of our scope, we serve in both clinical and administrative roles (see Table 1). And all of this occurs equitably with physician residents.

This APP-led model works well to provide high-quality trauma care, largely because of the consistent APP presence and commitment to our protocols and practices that support the revolving door of residents. It also works because trust (and thus autonomy) is inevitably built between the surgeons and APPs.

Postgraduate Training for APPs

Since 2010, our team has supported a trauma and critical care fellowship for APPs, of which I was the first graduate. We are one of the few postgraduate programs for APPs with a focus on inpatient trauma care.

It is well documented that postgraduate training for APPs produces highly skilled, competitive, and confident providers in any given specialty.^2-3 Unique to our program is a required research project, leading to many graduates presenting at national meetings and publishing in peer-reviewed journals. Promoting a research mindset and an academic culture that is inclusive of APPs has been central to the ongoing partnership among our surgeons, APPs, and resident physicians.

Unfortunately, for most APPs practicing in surgical and critical care specialties, postgraduate training is the exception. Despite rigorous standards set by the ACS for trauma center verification, there remains a gap in specialty training for APPs. Many begin clinical practice with limited exposure to acute surgical diseases and traumatic injuries, often lacking the confidence and support necessary for success. This lack of experience can lead to poor retention, and it hinders collaboration.

While trauma fellowships for APPs do exist, they are limited in number and are not a feasible option to adequately train all APPs in our specialty. The 2022 ACS Leadership Survey assessed demographics, patterns, and opinions across a spectrum of issues facing today’s surgeons, including the use of APPs in clinical practice.

Although the majority of respondents were satisfied with the competency of APP graduates entering surgical practice, 69% believed APPs should be required to complete some type of surgical training prior to clinical practice. Furthermore, the majority of respondents noted that it is extremely important for the ACS to be involved in establishing requirements and verifying APP surgical training programs.

Establishing a Trauma APP Certification

The first Trauma APP Certification Course is being developed. This national, skills-forward educational program is designed for nurse practitioners and PAs entering trauma care or transitioning from another specialty.

Designed to establish a standardized baseline of trauma knowledge and procedural competency, the course combines high-yield didactics with immersive hands-on skills training. Content includes injury patterns, diagnostics, acute interventions, and critical trauma decision-making. Course objectives focus on improving clinical readiness, enhancing procedural proficiency, and promoting provider confidence in trauma settings. The course will launch at the 2025 ACS Trauma Quality Improvement Program Annual Conference as a 2-day preconference workshop. Upon successful completion, participants will receive a Trauma APP Certificate of Completion along with Continuing Medical Education (CME) credits.

Surgeon-APP Partnerships Are Recipe for Success Are Recipe for Success

That first podium was a doorway into a world few APPs had entered. My training taught me there were no limits on how APPs could function—at the bedside and beyond. I have since learned that APPs are still commonly underused and underestimated. But in reality, being underestimated is like having a superpower. It creates momentum. It inspires change.

And change is happening—our national surgical organizations are creating space for APPs on panels, in leadership, and in specialty training.

The most common question I hear is “How do you retain APPs?” Best practices for APP retention are summarized in Table 2. A panel presented at the 2023 Eastern Association for the Surgery of Trauma Annual Scientific Assembly on how to advance the use of APPs in trauma care highlighted the fact that APPs have become essential to trauma teams in the US. The presenters also acknowledged that optimal APP use is not well defined and is highly variable.⁴

We can all agree that APPs are needed to support trauma and emergency general surgery programs. But I hope I can convince you to develop a broader perspective for what APPs could add to your surgical program. Think beyond the bedside. Think outside the box. This message is as much for surgeons as it is for APPs and residents in training. Let us not underestimate what we are capable of in partnership. In the spirit of trauma care, the whole is greater than the sum of its parts. Physicians and APPs are better together, and we can go further for our surgical programs and for our patients.

Disclaimer

The thoughts and opinions expressed in this column are solely those of the authors and do not necessarily reflect those of the ACS.

Annika Kay is an APP on the trauma and surgical critical care team and assistant professor at Intermountain Medical Center in Salt Lake City, UT. She also serves as fellowship faculty and leads all APP research initiatives at the institution.

References

1. Kay AB. Edgar J. Poth Memorial Lecture: The power of partnership. Am J Surg. 2024;238(12):115990.
2. Messing J, Peters M, Vota A, Seneff M, Sarani B. A residency style transition to practice program in trauma and critical care: The George Washington University Hospital experience. J Am Assoc Nurse Pract. 2021 Jan 8;33(11):1017-1023.
3. Will KK, Williams J, Hilton G, Wilson L, Geyer H. Perceived efficacy and utility of postgraduate physician assistant training programs. JAAPA. 2016;29(3):46-48.
4. Lasinski AM, Shaughnessy A, Reynolds B, Forsythe R, et al. Advancing the practice of trauma: Utilizing advanced practice providers to improve patient outcomes through a collaborative team approach. Trauma Surg Acute Care Open. 2024;9(1):e001281.