Where Are the Hand Surgeons? Examining the Socioeconomic and Geographic Gaps in Patients’ Access to Care in the United States

Abstract

Purpose

The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.

Methods

We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.

Results

A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.

Conclusions

There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.

Level of Evidence

Cross-sectional study, III.