KK: From an emergent transport or transfer standpoint, it’s probably just a small number that you would say, “Listen, I need to see them tonight.” What would some of those things be?

SL: The mangling injuries usually need to get to somebody who can give definitive care pretty quickly. Finger or thumb amputations also. The research says that if you get them within 24 hours, it’s the same as if you get them on within two hours, but understandably, it is a very high-end and anxiety-inducing injury for the patient, their family, and the initial provider who is seeing them.

KK: I want to circle back for a minute on the workforce. Do you and the ASSH really feel like you have met the workforce needs for hand surgery in the United States?

SL: As far as I know, we aren’t doing any initiatives to try to grow the number of hand surgeons. We are trying to make sure that those communities that may be too small to support a hand surgeon full-time know where their nearby hand surgeons are, how to get to them, and when they need them.

KK: Roughly how many graduates are coming out of hand fellowships every year?

SL: That number is around 150 per year.

KK: Tell me, from either your personal perspective or things that you’ve heard, what are some of the things that are frustrations about the emergency physician–hand surgeon relationship?

SL: I think there’s both the academic training institution perspective and then there’s the community perspective. I am mostly in an academic institution. The complaint we often get is the sometimes seemingly ultra-low threshold to call somebody with the rationale of, “oh, they need to learn how to do this because they are a resident in training,” or, “we’ve got 27 other things to do.” We sometimes will get some calls for a paronychia or a rule-out paronychia, or calls about a minimally displaced boxer’s fracture that just needs a splint and a clinic visit. Those can be very frustrating. I want my residents to learn, but at the same time, they don’t need to see their twelfth one at two in the morning. From the community standpoint, I know that there’s certainly a higher level of intervention that the attending emergency physicians are willing to do. We need to make sure that the emergency medicine residents know, if they are in the community, they’re supposed to be reducing the metacarpal fracture. They’re supposed to be draining the paronychia, and they need to be able to do a straightforward distal radius reduction.