Hand Surgery

[fedor]

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About 10 years ago all I ever heard about was hand surgery. It seemed like it was one of the most prestigious fellowships to get and hand surgeons considered themselves as among the highest skilled surgeons.

Now, it seems the orthos and plastic surgeons I know have no interest in hand surgery. The only people I know interested in hand surgery are general surgeons looking for a 1 year hand fellowship before applying to plastics.

Why the big change? Am I just perceiving the status of hand surgery 10 years ago inaccurately because at the time I was still a lay man?

I think the reduction in reimbursements for hand surgery as well as the burdens of call are what is making hand less and less desirable over the years.

This is just my non-surgical guess, so I would like to hear what you experts think.

 

[tripod]

correct
low reimbursements, relatively high liability. People tend to use their hands a lot and get upset when they don't get full function back.

Besides, esp for plastic surgeons, there are other procedures (ahemcosmeticscoughcough) that they can perform that pay them 10x as much as a hand surg. Add in the lack of ER calls and sick trauma pts and you have a whole list of reasons why hand surg kinda fell into the crapper

on the plus side, you get to sit down during most of the surgeries and 85% of them can be done in like 1/2 an hour.

 

[maxheadroom]

I'll just agree with Tripod. Hand surgery is lots of fun. You get to sit down. The cases tend to be short. You can make a huge difference in someone's life (on a non-live or die basis). But reimbursements are falling. Call just plain sucks, especially as emergency physicians become more and more fearful of lawsuits.

There aren't many people in plastics (my field) outside of academics who are interested in hand, mostly because of the combination of reimbursement and call. If you have a university-supported salary and residents to do your bullsh$t work in the ED, this isn't such a problem. Then you can spend your days doing sympathectomies and bypasses for ulnar hammer syndrome without being called in for nailbed lacs, extensor tendon lacs, and boxer's fractures.

Hand is mostly a stepping stone to plastics for the general surgeon or a niche specialty for orthopods. Plastics guys use it as a way to start their practices, but escape from it as soon as their elective practice picks up.

 

[njbmd]

Hi there,
Most of the guys who do hand surgery at my program are orthopedic surgeons. The general surgeons have no interest in hand surgery. There is one plastic surgeon who does some hand work but the vast majority is done by the orthopedic folks.

njbmd 🙂

 

[TIGER STYLE]

Can a hand surgeon that was general surgery trained do distal radial/ulnar fractures or even higher stuff if he was trained to do them in his fellowship? ie.."hand/upper extremity fellowship"...

 

[maxheadroom]

Can he? Yes. Will he get the referrals/consults? Probably not. They're trying to introduce distal radius into PRS training against most of our wishes. I get enough hand and wrist fractures -- I have no wish to play orthopod anymore than that.