orthopedics vs general surgery

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hosdurga

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Just wondering how many people would consider a general surgical residency followed by a orthopedic fellowship (like hand etc. ) If this career path is taken is there jobs out there for these doctors too?

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Hand is about the only "ortho" fellowship possibly open to those completing a Gen Surg residency. Bear in mind however, that Hand fellowships open to those with Gen Surg, Ortho and Plastics training but some may be restricted to only Ortho or Plastics trained residents.

But yes, I have (am) considered it and there are jobs out there although Hand is not as popular as it once was.
 
Doesn't seem to make much sense to me for a General Surgeon to do Hand, unless sometime during their residency they suddenly discovered the joy of the MGH tendon repair (it is a thing of beauty). General Surgeons get very little hand training during residency, so they have to learn a whole lot in their year of Hand fellowship. Most PRS and Ortho residents get very good hand experience, so they don't have to do a fellowship if they want to do the basics (CTR, Ganglion, Dupy's release, etc).

That being said, I think Kleinert was General Surgery-trained.
 
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Originally posted by maxheadroom
General Surgeons get very little hand training during residency, so they have to learn a whole lot in their year of Hand fellowship. Most PRS and Ortho residents get very good hand experience, so they don't have to do a fellowship if they want to do the basics (CTR, Ganglion, Dupy's release, etc).

That being said, I think Kleinert was General Surgery-trained.

And that is the reason, I am told, that general surgery residents are not preferred for Hand fellowships - they simply are starting behind the 8-ball when compared to Plastics and Ortho guys.
 
Actually today it has more to do with job prospects after a fellowship. Very few jobs exist for upper-extremity only practices, most groups do either some other orthopedic or General Plastic Surgery work. If you aren't capable of covering the other work, you aren't as valuable to many people.

It's not very hard to find a hand fellowship as a general surgeon, there are dozens that don't fill each year anymore as reimbursements have changed & the field is not as attractive. Many fellowships have shut down in recent years (as have a number of microsurgery fellowships for similar reasons)

Max- both Drs Kleinert & Kutz were general surgeons, but those guys trained in the 1950's & early 60's respectively (and are still very active). In his former life Dr. Kleinert was a general/vascular surgeon of some reknown locally I hear. Out of the other 12 or so partners in KKA the others are about about 70:30 plastic: ortho background with one more general surgeon in the mix.
 
Ollie,

Knew that Kleinert was old (my chair, who isn't exactly young, was one of his first fellows), but didn't realize that he was still active. Good for him. Must be clean living and plenty of mint juleps.

What do you see the job market being like for PRS/Hand fellowship-trained people? I'm back and forth on academics vs community practice. Fortunately, I have plenty of time to decide. I guess I haven't really be exposed to any PRS (community practice) who do much hand, while I know lots of orthopods who do hand in the community.

I'd like to get into a practice where I do something like 1/3 hand, 1/3 recon, and 1/3 cosmetic. Quite a dreamer, eh? We'll see.
 
I am currently in a community based residency program where we have both plastics and ortho-trained hand surgeons. In our community the standard is set that the plastics guys for mostly nails, trigger fingers, carpal tunnel releases, etc, where the ortho guys do the replants, radial head replacement, and more involved cases in addition to the bread and butter hand. This may be only in my community, but that is the trend here.
 
max- if you have an interest in hand, the good news is that there are tremendous oppurtunities in that. The bad news is that the opputunities exist because plastic surgeons have abandoned hand surgery (and reconstructive surgery for that matter) en mass b/c the reimbursements have gotten destroyed. There are many jobs looking for people to do hand, but in general these are "bad" jobs. With the increase in competition for the cosmetic $$$ it is getting harder for many people to continue to do the broad-based practice you aspire to outside academia which will not pay you very well compared to your peers. As for Dr. Kleinert practicing such a long time put it this way.... I'll be the second generation in my family to get hand training from him this coming winter. He has gone to part time now, but still works more then most people do.


Ortho2003- the breakdown on hand surgery in community practice I've seen in several cities has been pretty consistant. The orthopedists do most of the wrist fractures & are comfortable with the bread and butter hand (carpal/cubital tunnel releases, trigger fingers, rheumatoid, simple tendon work). Most people from an orthopedic background are very uncomfortable with the vascular & nerve work ( replants included) and have deferred those to plastic surgeons if they're available. Where I live now (Louisville) has a wierd dynamic because the largest hand group in the world is here (along with 24 fellows a year) & sucks up almost everything of any complexity (and almost 100% of the trauma). In Birmingham (my home & future place of work) more and more of the traumatic hand is being funneled into the University because almost no one will do it anymore b/c of the reimbursement:lifestyle ratio is low & getting lower.
 
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