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hand surgery for the general surgeon

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pogo

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I was suprised to see that there is a hand surgery fellowship for general surgeons. There are only 2-3 in the country and they are also open to orthopedic and plastic surgeons but I just found this strange as I never considered hand surgery as a fellowship following general surgery. My thought would be that they may be easier for a general surgeon to get into seeing as there are plenty of programs just open to orhto and plastics. Does anyone know of any general surgeon who has done a hand fellowship?
 

droliver

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I think there are a bit more then 2 or 3 fellowships that will take you without subspecialty training in PRS or Orthopedics prior. A number of people in the past used to do one after 3-4 years of general surgery to make themselves more competative for Plastic Surgery fellowships. There are a number of fellowships that don't regularly fill anymore as interest in hand surgery has waned among Plastic Surgeons & Orthopedists and a lot of these places would consider you even if they'd prefer a fully trained Plastic Surgeon or Orthopedist. The Kleinert Institute here in Louisville is the largest Hand Fellowship program and Upper Extremity practice in the world. It is not that rare to have a General Surgeon or two (they take people from any of the common backgrounds) among the 24 or so fellows a year they take. I even remember a DO General Surgeon who was doing a year here prior to starting one of the few Osteopathic Plastic Surgery programs. There are also a number of well-known programs in other countries you can do which are fairly prestigious. In particular, Dr. Wayne Morrison's in Melbourne,Australia is one of the most famous. BTW he's a very interesting and funny guy whom I've just spent the last few days with
 

maxheadroom

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Just to add to Ollie's comments, Hal Kleinert, the founder/guru of KKA at Louisville is a general surgeon, who never did PRS/Ortho training. He's one of the buzz-word men in Hand.

Most hand fellowships appear to be open to general surgeons. Hand serves as a good transition for people making the leap to PRS, much like Burn.

Ollie, cool that you had the chance to kick it with Morrison. The stories of the Aussies are amazing (and probably true).
 

pogo

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so is the hand fellowship strictly hand or do they also get training in elbow, and shoulder, I got my previous info from the "Green book" which lists all fellowships and residencies, and it only had three that were listed as general surgery fellowships, but hey I hope you are right, the more oppurtunities the better
 

maxheadroom

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There are "upper extremity" fellowships for orthopods. Lots of hand fellowships will do peripheral nerve in all the UE. Lots of plastics guys will do non-joint elbow work (lat epicondylitis & the like). For true upper extremity, though, you need to do ortho.
 

unregistered

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Docoliver, is it still possible to do just 3-4 years of GS and then go into a Hand fellowship? Is this route very competitive (ie, how many applicants per spots)?
 

droliver

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I've seen at least 3-4 here over the last few years doing it to apply for Plastic Fellowships. It would depend a lot at smaller programs (1 fellow a year) on how many people wanted to do it somewhere, again hand for the most part is having trouble filling at many places & some programs would take a warm body
 

Soma13

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Can a general surgeon who has just completed a hand fellowship find adequet job oppurtunities since he/she hasn't had training in plastics or oetho.
 

droliver

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The money has dried up (as with most insured procedures) & makes taking an additional year of training less financially attractive. Also there's nothing that mandates a CAQ (certificate of added qualifications) in hand to practice hand surgery & some of the credentialing issues in the past for privledges have become less contentious. In fact, many hospitals are now desperate for someone to cover hand call as a # of people have abandoned it (especially in Plastic Surgery) and refuse to take ER call for it.
 

Soma13

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So, do you think it would be hard for a fellowshipped trained general surgeon to land a good position in hand surgery??

P.S. What is the lifestyle of the hand surgeon like?? It sounds from the tone of your posts that it's nothing to be desired.
 

jayman

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yeah...i'm curious about this, too...
if anyone has any info...chime in.
 

droliver

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Hand surgery has a pretty unpredictable schedule. You end up with a lot of traumatic related injuries in most practices which happen at all hours, many of which require urgent or emergent treatment. When you add to this the reimbursement declines, its not surprising that it is MUCH less popular these days.

Hand surgery itself is quite interesting. The anatomy of the hand is unmatched anywhere in the body for its complexity of both anatomy and function.
 
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