Study finds hand surgeons scarce for emergency surgery

Wrist, hand and finger trauma are the most common injuries presenting to emergency departments nationwide, yet only 7 percent of Tennessee hospitals have a hand specialist on call 24/7 to treat these patients, according to a Vanderbilt study published online today in the Annals of Plastic Surgery.

Patients from Tennessee, Arkansas, Mississippi and Alabama are traveling long distances to Vanderbilt University Medical Center for treatment and follow-up care.

Wesley Thayer, M.D., Ph.D., assistant professor of Plastic Surgery, and of Orthopaedic Surgery and Rehabilitation, surveyed 119 Tennessee hospitals that have both an operating room and an emergency room and found that 58 percent of these hospitals do offer at least basic emergency coverage for hand injuries while 42 percent offer no emergency coverage at all for these injuries.

Thayer added that roughly 80 percent of the hospitals surveyed offer elective, or non-emergent hand surgery.

"I was surprised that most Tennessee hospitals are able to offer elective hand surgery but only 7 percent of them have a hand specialist on call 24/7 to treat emergency injuries to the hand," Thayer said. "There are a lot of injuries that actually need to come here to Vanderbilt, but I just hate it when I feel like somebody has traveled an incredibly long way for an that probably could have been treated locally."

Thayer said he commonly sees injuries such as an open fracture - a cut with a broken bone beneath it - that any trained hand specialist could repair, on average, in less than two hours.

"These injuries are common to the blue-collar working man or woman, industry workers getting fingers caught in presses or rolling machines, weekend warriors with a skill saw hurt while doing home repairs, or getting a hand caught in a belt or fan blade while working on the car," Thayer said.

Not even Memphis, one the largest cities in the Southeast, has a hand specialist on call 24/7, although wrist, hand or finger injuries account for 11.6 percent of all traumatic injuries treated in emergency departments, according to the study.

"I believe this is almost certainly a national problem because we frequently have requests from, for example, Arkansas, Mississippi, or Alabama, where a patient needs a finger replanted, or at least evaluated for a potential replant, and there is no one available in the whole state to consider a replant."

Thayer suggests one way to combat the problem would be for hospitals to have dialogue between their emergency departments, trauma services and hand services to set up cross coverage for call that might make it more convenient for patients to get care in a local setting.

"The real concern that I have is that, for some reason, there might be an evolution of hand surgery away from providing emergency care, where people are simply providing elective hand surgery, having a busy, successful practice, but might not, for one reason or the other, be providing their community with emergent hand surgery."

The study also found an increased private insurance payer mix in hospitals that have hand surgeons available for call. Also, hospitals that have more than four hand surgeons have a 67 percent chance of having someone on call 24/7.

"I certainly don't want people to get the idea that I feel like there are people out there who are refusing to treat these cases; I actually think that there are not enough hand surgeons in the community," Thayer said.

"I really think the solution is simple. I think that hospitals should have trained hand specialists on call at their hospital, particularly if they are going to offer elective ."

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