Hand Fellowship after gen surg

[desimd77]

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A field that I recently found out that is available for Gen surg residents for fellowship is Hand Surgery. It is also a fellowship available for Ortho and plastics. The field is pretty cool, awesome lifestlye, great reimbursment, and you get to sit down while you operate.

I was wondering if anyone out there had some real world expereince with Hand surgeons that are GS trained. I've also heard that most gen surgeons see it as a cop-out. My ultimate fellowship would be a mix of soft-tissue tumors and hand surgery, but in all my google searchs i haven't found anything that matches.

I'm getting close to the time i need to figure out what i want to do after gen surg, and the fields that are the most appealing are IR, Hand, or some sort of soft tissue oncologic surgeon. Any thoughts would be appreciated.

thanks

 

[Winged Scapula]

This has been a frequently asked question. Doing a search for you, I have found:

http://forums.studentdoctor.net/showthread.php?t=461391&highlight=hand+surgery

http://forums.studentdoctor.net/showthread.php?t=479589&highlight=hand+surgery

http://forums.studentdoctor.net/showthread.php?t=352336&highlight=hand+surgery

http://forums.studentdoctor.net/showthread.php?t=666895&highlight=hand+surgery

There are many others.

It appears that you don't want to do general surgery but don't want to spen more than 1 year in fellowship. The problem with BOTH Hand and IR after general surgery is finding a job.

With Hand, you can't do any general Ortho or Plastics, no upper limb work. The General Surgery groups don't want to cover your hand patients and the Ortho/Plastics groups don't want someone who isn't as well trained as they are (face it - they will do a lot more hand during residency, even without the fellowship, than you will) and who can't cover their general cases. Can you get privileges at a hospital to do only Hand? Will you have to take non-Hand call? Do you realize what a PITA the patients can be, how bad the lifestyle *can* be? Patients are often trauma or workman's comp.

Same goes with doing an IR fellowship after GS. Are you employable? You can't do any diagnostic radiology. I have seen Vascular surgeons who do catheter based interventions and work with IR (my former Chief of Vascular was also faculty for IR department), but do not know if they do fellowships. According to the NRMP, IR fellowships are only open to graduates of radiology residency programs; perhaps there are some non-ACGME programs or your attending was misinformed.

If I were you, I'd check and see what the job market is like for these fields - you don't want to spend a year training and find that you are unemployable, uninsurable. Ask around your local hospitals what training you need to get Hand and IR privileges.

 

[maxheadroom]

The field is pretty cool, awesome lifestlye, great reimbursment, and you get to sit down while you operate.

Not to rain on your parade, but if you're looking for lifestyle and reimbursement, Hand ain't where it's at. Cool, yes. Great anatomy. Some patients who can have a huge improvement in their quality of life.

Lifestyle, thought, is difficult. Hand surgery call can be brutal. At my current hospital, one of the most common cases to go to the OR at night is Hand/upper extremity trauma.

Reimbursement is not great. Workman's comp used to make things reasonable, but lots of states are cutting their WC payout rates.

I love Hand surgery. I love Hand anatomy. I love brachial plexus reconstruction. All of these things, however, do not make for a great lifestyle or good money.

 

[BlondeDocteur]

And I'll comment on IR since I'm doing it this month-- right now the fellowships aren't filling and they're accepting mid-year or finished GS residents. However, as WS pointed out, there are no jobs. IR is a CAQ out of diagnostic radiology. Without being able to really read scans, MRIs and ultrasound-- not the weenie way non-radiologists read them, but really read them-- you're useless. In addition, all the private practice jobs require a mix of DR and IR (often up to 75% of the former), and IR-only academic gigs would require board certification as you'd be precepting radiology residents, teaching fellows, etc. The bottom line is that you can do it for your own edification, but you're unlikely to make yourself employable.

 

[BlondeDocteur]

whoops, I just noticed there's a separate IR thread. My bad.

It's a fun field-- they let me do loads as a med student, and I'm developing some very useful ultrasound-guided central line placement skills, but I can't imagine putting in dialysis catheters or emoblizations for the rest of my life.

There was a hilarious moment today when a patient looked up at the fellow and asked "at what point in medical school do you say, **** it, I want to be the doctor who just puts in ports all day?" The fellow was a bit taken aback.

 

[agranulocytosis]

whoops, I just noticed there's a separate IR thread. My bad.

It's a fun field-- they let me do loads as a med student, and I'm developing some very useful ultrasound-guided central line placement skills, but I can't imagine putting in dialysis catheters or emoblizations for the rest of my life.

There was a hilarious moment today when a patient looked up at the fellow and asked "at what point in medical school do you say, **** it, I want to be the doctor who just puts in ports all day?" The fellow was a bit taken aback.

But for real, 3-hour rounds can make someone say that.

 

[Winged Scapula]

There was a hilarious moment today when a patient looked up at the fellow and asked "at what point in medical school do you say, **** it, I want to be the doctor who just puts in ports all day?" The fellow was a bit taken aback.

That's hilarious.

 

[maxheadroom]

I'll go ahead with my standard answer regarding General Surgeons and Hand Surgery . . .

Hand is complex. It's a lot to learn in a year when you haven't had the lead-in of Plastics or Ortho training. The treatment modalities are very different from GenSurg. ORIF, nerve and tendon repairs, distal radius fractures, wrist scopes, arthroplasties, brachial plexus . . . there isn't much over lap from GenSurg to ease the transition.

Jobs in Hand are plentiful, but they're either with Plastics or Ortho groups. Sure, there are a few Hand-only practices that will hire you, but there aren't many of those. As has been mentioned multiple times, those groups want you to be able to take either Plastics or Ortho call to spread out the pain. If you can't do that, you aren't much good to them.

Hand is a good way to get into a Plastics Independent residency if you aren't a good candidate, but you need to realize that you might not get into Plastics. If that's the case, do you really want to be a Hand Surgeon?

I love Hand surgery. I love the anatomy and function of the upper extremity. The call sucks. The pay isn't as good as lots of other things that I could do (aesthetics would be nicer). But, I like what I do and in general I like my patient population.

 

[busthwt]

what type of procedures can you do and not do as a general surgeon trained in hand? I was wondering because most hand fellowships have a multidisciplinary approach and seem to incorporate upper extremity vs just focusing on the hand.

 

[SocialistMD]

I know this is going to piss some people off, but the only general surgery trained people I've ever seen do a hand fellowship were the people who were using it as a bridge to gain a plastics fellowship. I just haven't heard of anyone from general surgery doing it for any other reason, likely because of what has been mentioned by the plastics contingency. You can't really do much in hand without the plastic surgery background.

 

[Winged Scapula]

I know this is going to piss some people off, but the only general surgery trained people I've ever seen do a hand fellowship were the people who were using it as a bridge to gain a plastics fellowship. I just haven't heard of anyone from general surgery doing it for any other reason, likely because of what has been mentioned by the plastics contingency. You can't really do much in hand without the plastic surgery background.

Agreed...at one point I was considering Hand as I thought it a good mix of everything I liked; loved my med school rotation at KK and even replaced Burns during residency with Hand. Unfortunately, the realities of the job market reared their ugly head and yes, I've only heard of others using it as a stepping stone to PRS.

 

[orthohand]

Hi
this is a common question gen surgery resident entertain during there residency .
as pointed out most of the general surgery residents doing hand fellowship are using it as a stepping stone to get plastic surgery .

The disadvantage is when you begin u r fellowship .
general surgery resident have minimal to nill exposure of hand during there reisdency compared to Ortho( they are the best placed ) and Plastics .

But you have to know this , hand surgery as a fellowship was developed by a guy named Bunnell ( who was a general surgeon) . His dictum during second world war , that any body( GS, ortho, Plastics , Neurosurgery) wanting to do hand surgery should be comfortable dealing with , soft tissue, nerves, vessels and bone irrespective of the primary training . thats what you get in hand fellowship . General surgery resident may start with a disadvanatge but by end of fellowship are pretty comfortable with all the tissues handling .

As far as jobs and reimbursement . youy cannot practice both gen surger and hand toghter . But you can do Gen ortho+hand or Platics and Hand .

very few hospital have just hand call ,
and in the beginning 4-5 yrs - u will be heavily dependent on trauma and ER .

Irrespective of your primary board certification - all hand fellowship trained surgeons are equal and there is good need for hand coverage .

i hope this helps