Hand microvascular trauma call is uncomfortable. To awaken at 1:23 am, treat hand-saw injuries until 5:08 pm, and then freshen up to start the elective hand practice at 7 am is not easy. It’s particularly difficult when the load of trauma call falls on few. In the typical life of a surgeon who takes call and cares for upper-extremity trauma, there are no “off hours” within the typical “business day.” It is part of our duty as surgeons to share the load. As physicians, we have the option to decide whether we wake from the buzz of a sudden unexpected pager alert or the scheduled alarm clock. Although either way, we assist in the well-being of local, regional, and national communities and we must start to consider cases of unplanned treatment as part of our regular business day.
In the 2014 Orthopaedic Surgeon Census, one of the most frequently cited orthopaedic subspecialties was hand surgery.1 Despite this seemingly large pool of hand surgeons, we face an alarming shortage of available physicians in emergency settings. A national study by the American College of Emergency Physicians noted that our overall emergency system operates with a “failing grade” of D+, specifically in patient accessibility to care.2 Several studies have explored the causes of this problem; one of which suggested that, in the particular field of hand surgery, states with lower per-capita income are underserved.3 Ultimately, it is quite clear that an issue exists with patient accessibility to hand surgeons in emergency settings—but why?
The reality of available hand surgeons on call may help illuminate a part of the answer. In New Mexico, seven surgeons are registered as hand surgeons.4 Two of these seven hand surgeons take hand call. The reasons for this are multifactorial. In our situation, the outlying hospitals would not provide compensation for call. Hand call was deemed part of the contract salary but not a required contract duty, and therefore the surgeons declined to cover. This uneven ratio is not particular to New Mexico.3,5 The reasons for opting out of hand call are many and cannot be all enumerated here. We get it. The ideal set up to be an on-call hand surgeon is tough to come by. However, it’s even tougher to have the entire load carried by a fraction of those capable.
Instead of focusing on which particular hand surgeon is or is not on call, we must move forward to a solution. How can we promote hand call to hand surgeons in these underserved regions of the United States? There has been a move toward the establishment of dedicated hand centers. However, west of the Mississippi, they are few and far between.
Ultimately, the change requires a unified, joint effort from state-wide providers and hospitals. It requires the understanding that we are not only working together to care for patients with hand injuries, but we are helping each other by sharing the time and mental effort necessary to be accessible 24/7. It does not matter whether we work for a hospital or in private practice. When hand trauma hits the emergency room, having a list of available helpers is critical. We, together, are that list.
Hand surgeons are spread thin. We joke that we need thirty-hour days. Our lives are dedicated to the well-being of others, yet the reality is that doctors are humans. Few humans bubble with excitement at the prospect of waking up at 3 am on Christmas morning to treat a patient with an amputated thumb. However, doesn’t it make sense to share the load? We chose to be physicians and help others—be it planned or unplanned.
Sahar Freedman contributed to this blog post.
- American Academy of Orthopaedic Surgeons. Orthopaedic surgeon quick facts. http://www.aaos.org/CustomTemplates/Content.aspx?id=6408&ssopc=1. Accessed August 30, 2016.
- American College of Emergency Physicians. America’s Emergency Care Environment: A State-by-State Report Card. Irving, TX: American College of Emergency Physicians; 2014. http://www.emreportcard.org/uploadedFiles/EMReportCard2014.pdf. Accessed August 30, 2016.
- Rios-Diaz AJ, Metcalfe D, Singh M, et al. The distribution of specialist hand surgeons across the United States. Plast Reconstr Surg. 2016;137(5):1516-22. doi: 10.1097/PRS.0000000000002103.
- American Association for Hand Surgery. Find a hand care provider. http://handsurgery.org/locator/. Accessed August 30, 2016.
- Chung SY, Sood A, Granick MS. Disproportionate availability between emergency and elective hand coverage: a national trend? 2016:16;e28. http://www.eplasty.com/index.php?option=com_content&view=article&id=1712&catid=15&Itemid=116. Accessed September 13, 2016.