A National Survey of Hand Surgeons: Understanding the Rural Landscape

Area of Science:

• Orthopedic Surgery
• Public Health
• Rural Health Disparities

Background:

• Approximately 20% of the U.S. population resides in rural areas, potentially facing limited access to specialized hand surgery care, particularly in emergencies.
• There is a significant knowledge gap regarding the practice characteristics of rural hand surgeons, including case types, on-call duties, and employment structures.

Purpose of the Study:

• To characterize the practice patterns and challenges of hand surgeons in rural versus metropolitan settings.
• To identify potential areas for improving hand surgery access and care delivery in underserved rural regions.

Main Methods:

• A survey was distributed to members of the American Society for Surgery of the Hand.
• Data were collected on practice location (rural vs. metropolitan), employment status, and case referral patterns.

Main Results:

• Out of 2256 surveyed members, 471 responded, with 387 completing the survey. 19% identified as primarily rural-based.
• Rural hand surgeons were more frequently employed by community hospitals compared to their metropolitan counterparts.
• Metropolitan surgeons reported that a significant portion of transfers from rural facilities (46%) did not require emergency care, and 60% lacked a genuine need for specialty hand surgery.

Conclusions:

• Rural hand surgery practices are distinct, with surgeons often employed in community hospitals and managing a higher call burden.
• The presence of local hand surgery specialists can mitigate unnecessary patient transfers to metropolitan centers.
• Further research is needed to fully delineate rural and metropolitan hand surgery practice differences and to foster the development of rural hand surgery expertise.