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Current Climate of Hand Surgery Call: A Survey of ASSH Members
Randy Hauck, MD1; Brett Michelotti, MD1; Samer Rajjoub, MD2
1Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA; 2Surgery, Pinnacle Health, Harrisburg, PA

Background: Hand injuries account for a significant number of emergency room encounters per year. Qualified hand specialists are needed to address emergent concerns though there exists a recognized shortfall in hand surgeons providing emergency coverage. The goal of this study was to survey all active members of the American Society for Surgery of the Hand (ASSH) to determine the current practices of members with respect to emergency call.

Methods: All active members of the ASSH were emailed a survey assessing hand call practices. The email survey was sent twice and responses were collected. Variables of interest included surgeon age, primary specialty, and scope of practice, as well as several detailed questions regarding Emergency Department (ED) call coverage and compensation.

Results: 865 of 2843 (30.4%) members completed the survey. 78% of respondents provide Emergency Department coverage for hand injuries irrespective of primary specialty or practice type. 58% of respondents perform emergency microsurgery or replantation. Plastic surgery respondents take the most emergency microsurgery call (70%) as compared to 52% of orthopedic surgeons and 53% of general surgeons. Academic hand surgeons are almost twice as likely (94%) as their counterparts in solo private practice (53%) to accept Medicaid. 42% of respondents that provide ED coverage are compensated for taking call, which is higher when taking microsurgery call, and in 95% of these cases the hospitals provide the compensation. Hand surgeons in private practice are more likely than those in academics to be compensated for taking call. The percentage of respondents taking emergency call decreases with age, with age of sixty years being the cutoff for most practices.

Discussion: The majority of respondents in this study provide hand surgery emergency care (78%). Survey results suggest that the amount of call declines with age and respondents report that when compensated, providing microsurgery coverage compensates at a higher rate than general hand call. With an imminent physician shortage, hand emergency care will need to be continually reevaluated and potentially restructured.

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