Acute care surgery is essential for effective trauma and emergency care but faces sustainability challenges.

• Current staffing models vary—traditional vs. time delineated—affecting workload and academic involvement.
• Compensation often relies on work relative value units, which don’t reflect the full scope of ACS responsibilities.

Sustainable staffing and fair compensation are crucial for maintaining quality care and supporting hospital missions.

• Addressing inconsistencies in terminology and lacking board certification can boost the specialty’s resilience.