Hand Surgery Referral Pattern Preferences Among Primary Care Physicians in Academic Centers in the Southeastern United States.

Board-certified hand surgeons undergo an additional 1 year of fellowship training after completing 1 of 3 residencies, either orthopedic surgery (OS), plastic surgery (PS), or general surgery (GS). The purpose of our study was to examine primary care physician’s referral patterns for hand surgery in the Southeastern United States.
Primary care physicians across 38 academic medical institutions in the Southeastern United States were queried. A survey questionnaire was sent to their corresponding email address. The Questionnaire allowed the surveyor to enter demographic information and their choice in referral, either to OS, PS, or GS, for each particular hand pathology.
Two-hundred twenty-eight of 1526 surveys were completed (15% response rate). One-hundred twenty-four were male respondents, and 105 were female. For treatment of arthritis, 94.7% selected OS; 5.3%, PS; and 0%, GS. For treatment of nerve decompression, 84.0% selected OS; 14.4%, PS; and 1.6%, GS. For treatment of nerve injuries, 64.2% selected OS; 34.6%, PS; and 1.2%, GS. For treatment of tendon injuries, 84.4% selected OS; 15.6%, PS; and 0%, GS. For treatment of congenital deformities, 55.1% selected OS; 44.9%, PS; and 0%, GS. For treatment of fractures, 98.8% selected OS; 1.2%, PS; and 0%, GS. For treatment of sports-related injuries, 99.2% selected OS; 0.4%, PS; and 0.4%, GS. For treatment of soft tissue masses, 65.5% selected OS; 23.0%, PS; and 11.5%, GS. For treatment of soft tissue coverage, 8.6% selected OS; 87.7%, PS; and 3.7%, GS. For treatment of skin cancer-related problems, 8.2% selected OS; 72.4%, PS; and 19.4%, GS.
Referrals for arthritis, nerve decompressions, tendon injuries, fractures, and sports injuries are more likely to be referred to OS. Referrals for soft tissue coverage and skin cancers are more likely to be referred to PS. Nerve injuries and congenital deformities referrals were similar between orthopedic and PS. Further research should be conducted to determine why referral patterns vary among specialties with similarly trained hand surgeons.