Orange Julius,
I feel that I need to clarify a few things. First of all, Hand Surgery after General Surgery is very possible if you are very motivated in residency to learn hand and upper extremity during your general surgery years. I am a 4th year general surgery resident who fell in love with hand surgery during my plastic surgery months and have pursued a fellowship in hand surgery. Despite the misinformation you are receiving in the responses to your post, Hand surgery has become much more competitive. I just finished interviewing and have actual statistics for you, not archaic FREIDA info. So far this year, there are approximately 170 registered applicants (ortho, plastics, and general) for the hand surgery match. Last year, 135 applicants returned a rank order list for 122 spots. 111 applicants matched (18% unmatched). This is in stark contrast to 3 years ago when only 70 applied. This year's match should be even more competitive. I was not treated differently for being a general surgery resident but I do have a lot of experience in hand and upper extremity. The problem with GS residents is that we typically don't have much experience with fracture fixation. There are ways of strengthening this if you are willing to put in the extra time and are at a GS program that is flexible. Of course there are programs that only want ortho residents but those programs do mainly ortho upper extremity. Nowadays, the best fellowships incorporate all aspects of hand including ortho, plastics, and microvascular. Also, if you are trying to get a hand fellowship to strengthen your application for plastics, then you will be frowned upon. These programs want to train Hand surgeons not plastics applicants. These GS residents who are trying to write a ticket to plastics by doing a hand fellowship are easily seen through.
I respectfully disagree with the statements that you will find no jobs in metro areas. This is simply not true. I know of many offers in big cities (Chicago, Denver, Atlanta, LA, Minneapolis, Houston, Dallas, etc.) for fellowship-trained HAND SURGEONS. I have a friend (GS trained) who is finishing her hand fellowship and got offers just about everywhere and decided on Denver. Another friend is in LA. I have not even begun my fellowship yet and have numerous opportunities. Are they less than what an ortho trained would have, sure. But there are so many jobs out there and hand surgery is evolving so much that even the ortho-trained guys have little time to do anything other than hand. Even a lot of the big ortho groups now want a 100% hand surgeon. There are a lot more than "a few hand surgery groups" in the country! The future of hand surgery is no longer ortho, plastics, or general surgeons doing hand. It is HAND SURGEONS doing hand. I also like the fact that I can focus on hand surgery and not worry about also taking call for general or ortho or plastics.
Interestingly enough, I have listened to lectures at both the ACS meeting and ASSH meeting the last couple years regarding the future of hand surgery. Within the next 5-10 years, there will be a path out of GS similar to the 3+3 or 4+2 plastics. GS interest has dramatically increased and is pushing for this. Remember, General Surgery founded hand surgery. GS is making a serious comeback in hand surgery. Don't let other people's misinformation deter you if you are motivated and enjoy this field. Despite what Navysurgeon says, if you like the field go into it. Don't choose surgical oncology or vascular because of his (incorrect) suggestion that you won't make money. Hand surgeons are extremely well-payed and have a generally good lifestyle. It sounds like you need to speak with some hand surgeons and not people that don't know what they are talking about.