To The Editor:

In regard to the recent orthopedic forum article "Access to Emergent Musculoskeletal Care: Resuscitating Orthopedic Emergency Department Coverage."(1), I agree that there is a "looming crisis" regarding emergency coverage of orthopedic patients however, my perspective is different from the authors. I practice as a solo general orthopedic surgeon in rural Oklahoma. To more fairly discuss "community hospitals" "dumping" one should present both sides of the problem.

There is a crisis in our country's rural areas with a shortage of physicians. In my opinion, this is a result of a worse payer mix and intolerable call schedule. Could it be that metropolitan doctors with aggressive advertising followed by aggressive financial triage "dump" lower paying patients back to the community hospial? My hospital simply cannot afford to compensate me for emergency services. They are lucky if they can compensate my orthopedic vendors.

I have received calls for "dumping" patients from metropolitian doctors, which, interestingly, were not uninsured patients but Medicare/Medicaid patients--the same payer mix from which I derive my income. Never in my orthopedic career have I received a call for "dumping" private insurance patients from my community during office hours. It is possible that "90% of orthopedic emergency procedures which could be handled in the community" is the same percent of elective procedures that could be performed locally.

We, as orthopedic surgeons, must band together, respectfully understand each other's plight on this critical issue. If fight each other with ignorance and assumptions based on practice location and age we have lost the battle in which case there are no winners and only casualties.

Reference:

1. Bosse MJ, Henley MB, Bray T, Vrahas MS. An AOA critical issue access to emergent musculoskeletal care: resuscitating orthopaedic emergency-department coverage. J Bone JOint Surg Am. 2006; 88:1385-93.

To The Editor:

The Conclusions of "Access to Emergent Musculoskeletal Care" seem undermined by incorrect assumptions. In the "Overview", the authors state, "Likely, a survey of the AAOS membership would have similar findings" (to a survey of AOA (American Orthopaedic Association) and OTA (Orthopaedic Trauma Association) members.

There are no data to support this assumption, and it seems unscientific that the Journal of Bone and Joint Surgery would publish a manuscript based upon such an assumption. Rather, there are data that indicate that unlike OTA members, most AAOS members are not orthopaedic trauma subspecialists, and unlike most responding OTA and AOA members, most AAOS members are not in academic practice.

I could contribute to the problem by expressing my own opinions regarding "Access to Emergent Musculoskeletal Care". I will not; it is not my area of expertise.

Rather, I implore readers to consider that, pending a manuscript based upon a survey of members of the AAOS rather than a survey of members of the AOA and OTA, the overview published in the June issue of JBJS may not be scientifically valid.