title: Orthopedic surgeons are less likely to see children now for fracture care compared with 10 years ago.
abstract: OBJECTIVE
  To assess availability of timely orthopedic fracture care to children.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedic Surgery, University of California, San Francisco, CA, USA.
authors.forename: Coleen S
authors.initials: CS
authors.lastname: Sabatini
authors.forename: Kira F
authors.initials: KF
authors.lastname: Skaggs
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kay
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D002648:Child; D050723:Fractures, Bone / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D015141:Los Angeles; D008484:Medicaid; D009985:Orthopedics; D014481:United States