Original Article
Orthopedic Surgeons are Less Likely to See Children Now for Fracture Care Compared with 10 Years Ago

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Objective

To assess availability of timely orthopedic fracture care to children.

Study design

Fifty randomly selected orthopedic practices were contacted twice with an identical scenario to request an appointment for a fictitious child with an arm fracture, once with the staff told that the child had private insurance and once with Medicaid. Access to appointments on the basis of insurance was compared with rates 10 years earlier.1

Results

Forty-five practices were contacted successfully. An appointment was offered within 7 days to a child with private insurance by 42% of the practices (19/45) and to a child with Medicaid by 2% of the practices (1/45; P < .0001). There was no difference in timely access (appointment within 7 days) for children with Medicaid in this study (2%) compared with 10 years ago (1%; P = 1.0). There was a significant decrease in timely access for children with private insurance in the past decade, with a rate of 42% (19/45) in this study, compared with 100% (50/50) 10 years ago (P < .0001).

Conclusion

There has been a substantial decrease in the last decade in the willingness, availability, or both of orthopedic surgeons in Los Angeles to care for children with fractures whose families have private insurance. Children with Medicaid continue to have limited access.

Section snippets

Methods

This study was approved by the institutional review board of the Keck School of Medicine/Children’s Hospital of Los Angeles. Fifty orthopedic surgeons’ practices were randomly selected by using a random number generator from the 136 orthopedic surgeons listed in the Los Angeles Medical Society Directory (2009 edition), the same database used in the 2001 published study. Physicians at tertiary pediatric centers were excluded from the study to assess access at the community level for a pediatric

Results

Of the 50 practices contacted, 5 did not return a minimum of 3 phone calls. Of the 45 practices successfully contacted, the privately insured patient was offered an appointment within 7 days (range, 0-7 days; mean, 1.94 days) by 42% (19/45) and between 8 and 20 days by 7% (3/45). Of the 45 practices successfully contacted, only one gave an appointment when the fictitious child was said to be insured through Medi-Cal (1/45, 2%). The appointment was offered 4 days from the time of the call.

Discussion

It is not surprising that there has been no improvement in access to timely orthopedic care for children with Medi-Cal insurance because there has not been a significant change in the past decade in reimbursement to physicians caring for this population. As stated approximately 10 years ago, “common sense dictates that if an office loses money on each visit of a patient with Medi-Cal, an office must necessarily limit the number of Medi-Cal patients it sees or face bankruptcy.”1 Both in this

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The authors declare no conflicts of interest.

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