Does it? Not only do those left hand only and right hand only orthopedic surgeons not want to have to come into the hospital every time someone injures their right or left hand, the hospital sure as heck does not want to have to pay them to be there.
My field is the same but on the chronic side. No endocrinologist wants to see every single patient with diabetes or thyroid disease. The cardiologist does not want to have to fill their day with routine blood pressure and cholesterol patients.
I've valued your input over the years you've been here, and when I was a pre-med and med student, your advice and posts burned bright in my memory.
(I've been around SDN for over 15 years now with various handles)
But you're just dead wrong about this.
Here's where you're right: the right-hand-ortho doesn't want to come in and isn't going to come in. But taking call at the hospital is required for him to have privileges (since OR time is precious and urban metro hospitals know they can leverage that to get fancy specialties to take call). He also needs MULTIPLE continuous referral streams.
Ultimately, that right-hand-ortho is also in competition with the OTHER right-hand-ortho across the street, so he'll also break his back much longer to take call at 4 different hospitals since he's hungry for volume too.
Remember, that right-hand-ortho is also hustling to outpace his peers in a keep-up-with-the-Joneses-and-Chans-and-Patels in that same VHCOL city, and thus wants to make more than what a depressed W2 average wage for his subspecialty (given the desirable geography).
He also doesn't even have to go to the hospital when consulted from the ED, because his group's PA will do the initial consult, discuss over text via pictures and x-rays. By the way, that PA-C used to work in the ED for a meager $110k per year, until she wisened up and realized she could go make $185k/year working in a subspecialty. Why would she waste her time in the ED when she can switch specialties on a dime and almost double her income.
This leads to what is actually needed in the ED for any of that. Does any of that need an ER doc? No, a reasonably trained EM PA-C can quickly identify "Oh this hand is injured, must call right-hand-ortho." If A, then B. Simple. You don't need medical school to know that the hand is injured. Doesn't matter how it's injured, what's injured, or any of that. In a zero-miss environment, you're just a consult monkey for the specialist.
And of course those volume-based specialists love the easy punts. Easy consult, easy money, send the PA to get it started.
EM is dead in any desirable urban metro.
But yes, we have plenty of use in the most rural of rural BFE hospitals. Our skill is truly cherished there. I will agree full on this point.
But who wants to spend an entire career traveling 2-3 hours to get to your rural site, away from your family, your home, your whatever in order to leverage that skill. Because I (and many others) don't want to live or raise a family in those areas.
Better to just start some woo-woo lifestyle medicine BS clinic in the metro and start doing reasonable HRT, weight loss, aesthetics and other easier and more desirable cash-pay services.
