Background: Traumatic hand injuries represent approximately 20% of emergency department visits; yet, access to emergency care remains inadequate. Recent surveys from several states report a wider availability of hand specialists providing elective care than emergency care. The authors aim to examine this phenomenon in the state of New Jersey and whether there is a national trend toward disproportionate availability between emergency and elective hand coverage. Methods: A survey was conducted of all New Jersey hospitals, excepting university hospitals, in August 2014. To assess the availability of hand surgery coverage, the following questions were asked: (1) Does your hospital provide elective hand surgery? and (2) Is there a hand specialist/surgeon on call always, sometimes, or never? Results: A total of 58 hospitals were called, with a 67.2% response rate ( n = 39). The majority (87.2%) of hospitals offered elective hand surgery, whereas only 64.1% provided immediate 24/7 hand coverage. Only 38.5% of hospitals located in the same county as a level I trauma center provided 24/7 emergency hand care, whereas 76.9% of hospitals in counties without any level I trauma center did ( P < .05). Cities with a higher poverty level were less likely to provide emergency coverage than cities with a lower poverty level (47.4% vs 80.0%; P < .05). Conclusions: There is a discrepancy between emergency and elective hand care in New Jersey. Similar findings across the nation suggest a concerning trend of limited access to emergency hand health care. Alternative systems that can appropriately triage and treat patients are warranted.