Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: Unequal access to hospital specialists for emergency care is an issue in the United States. The authors sought to describe the geographic distribution of specialist hand surgeons and associated factors in the United States. METHODS: Geographic distributions of surgeons holding a Subspecialty Certificate in Surgery of the Hand and hand surgery fellowship positions were identified from the American Board of Medical Specialties Database and the literature (2013), respectively. State-level population and per capita income were ascertained using U.S. Census data. Variations in hand trauma admissions were determined using Healthcare Cost and Utilization Project national/state inpatient databases. Risk-adjusted generalized linear models were used to assess independent association between hand surgeon density and hand trauma admission density, fellowship position density, and per capita income. RESULTS: Among 2019 specialist hand surgeons identified, 72.1 percent were orthopedic surgeons, 18.3 percent were plastic surgeons, and 9.6 percent were general surgeons. There were 157 hand surgery fellowship positions nationwide. There were 149,295 annual hand trauma admissions. The national density of specialist hand surgeons and density of trauma admission were 0.6 and 47.6, respectively. The density of specialist hand surgeons varied significantly between states. State-level variations in density of surgeons were independent and significantly associated with median per capita income (p < 0.001) and with density of fellowships (p = 0.014). CONCLUSIONS: Specialist hand surgeons are distributed unevenly across the United States. State-level analyses suggest that states with lower per capita incomes may be particularly underserved, which may contribute to regional disparities in access to emergency hand trauma care.

Original publication

DOI

10.1097/PRS.0000000000002103

Type

Journal article

Journal

Plast reconstr surg

Publication Date

05/2016

Volume

137

Pages

1516 - 1522

Keywords

Career Mobility, Certification, Emergency Service, Hospital, Fellowships and Scholarships, General Surgery, Hand Injuries, Health Services Accessibility, Healthcare Disparities, Humans, Income, Models, Theoretical, Orthopedics, Patient Admission, Surgery, Plastic, Trauma Centers, United States, Workforce