At least to the "regular" orthopedic surgeon.
I have a ganglion cyst on my right wrist. I have had surgery previously to have this cyst removed, but it returned about 6 months ago. I have put off going to the doctor to have it looked at, but it is causing me enough discomfort at this point that I finally went in. The orthopedist ran some x-rays, took one look, and said "I am not touching your wrist. You need the hand specialist."
Apparently, not only is there scarring from the first surgery but there is "significant" joint damage from the RA and a regular orthopedic surgeon can't perform surgery.
So, on the down side, I have to see the specialist who only performs surgeries at the Kaiser in Panorama City. On the up side, further proof that I am special!