| Yhteenveto: | <h4>Background</h4> <p>Unequal access to hospital specialists for emergency care is an issue in the United States (US). The objective of this study was to describe the geographical distribution of surgeons with a Subspecialty Certificate in Surgery of the Hand (SCSH) and associated factors in the US.</p> <h4>Methods</h4> <p>Geographic distribution of surgeons holding a SCSH 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 US census data. Variations in hand trauma admissions were determined using Healthcare Cost Utilization Project national/state inpatient databases. Risk-adjusted generalized linear models were used to assess independent association between hand surgeon density and hand trauma admissions density, fellowship positions density, and per capita income.</p> <h4>Results</h4> <p>Among 2,019 specialist hand surgeons identified; 72.1% were orthopedic (OS), 18.3% plastic (PS), and 9.6% general (GS) 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 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).</p> <h4>Conclusion</h4> <p>Specialist hand surgeons are distributed unevenly across the US. 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.</p>
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