Would welcome any opinions about Hand versus Joint as subspecialties for Fellowship choice. What made you choose one or the other? Real world practice considerations? Fulfillment?
Pros and Cons of "Hand" versus "Joint"?
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Disclaimer: I am gonna do trauma, but I have an interest in joints, especially hip arthroplasty, and hope to have an elective joints practice with trauma.
Hand
Pros:
Gentleman’s Surgery, you’re sitting down, not as taxing on your body. Variety of cases, can be something as easy as a CTR or TF, or as complex as a replant. Lifestyle can be exceptional, given how much hand call, if any at all. Outpatient surgeries, hence no rounding. Can essentially have all outpatient practice if take no hand call.
Cons:
Requires more finesse due to intricate anatomy, have little patience for that. Too much soft tissue. Hand trauma can be painful in my experience. Lifestyle can easily become bad if taking frequent hand call at a large hospital. Reimbursement is low compared to other specialties, but they make up for it by doing more cases. Looked as “hand weenies” by other orthos
Joints
Pros:
Pretty monotonous, so you can get really good at the small variety of cases you do. Pays well, and if you can get busy, it can be very lucrative. Anatomy is a bit more satisfying. Arthroplasty makes a lot of money for the hospital currently, so you really are the top dog in the hospital i.e you get what you want. Outcomes are great by and large, as hip and knee replacements are the most successful surgeries in all of medicine.
Cons:
Pretty taxing on your body, need a lot of strength. A long day with 5-6 cases is really tiring. Complications are devastating and can really wear on you. Can be very monotonous and boring (rinse and repeat). Attached to the hospital for the most part, though outpatient arthroplasty is evolving. Rounding. Lots of competition from other joints surgeons (always talking **** about each other).
a dated SDN discussion of Ortho Hand versus Plastics Hand:
Ortho Hand compared to Plastic Hand
question:
I'm a pre-med who will be shadowing some plastic surgeons this September. I noticed they do a lot of hand surgery, which I thought was primarily done by Ortho Surgeons. I'm wondering what's the difference between the two?
~~~~~~
answer from a resident (ortho?):
Last I heard, Hand surgeons were 70/30% ortho/plastics. After the hand fellowship, I would say both will have very similar practices in what they can do. The big variable is what they WANT to do which makes them different. I would also say that both routes are equally qualified to do hand surgery.
Ortho: More experience with wrist and elbow arthroscopy and operative fixation of fractures.
Plastics: More experience with microvascular/flaps and burns.
Those differences are just for when GOING into fellowship and I would imagine that at the end you would round out your training in whatever you are weaker in.
The way I would decide on which way to go is by everything else the specialty has to offer. So look at what ortho and plastics do OTHER than hand and decide what you like better. Also, I see a fair amount of ortho hand go all the way up to the shoulder. I have never seen plastics go higher than the elbow (doesn't mean that it doesn't exist) so that may be one thing that may sway you.
******
another answer:
There are 4 ways to practice hand surgery:
1) Ortho residency + 1 yr hand fellowship
2) Gen surg residency + Plastics fellowship + Hand fellowship
3) Plastics residency + hand fellowship
4) Gen surg residency + hand fellowship (rare)
The most common route is through an orthopaedic residency. It makes the most natural transition in my opinion (but im biased). I think the worst is the general surgery to hand fellowship. Those guys are using a drill for the first time during their fellowship and only then are learning the principles of osteosynthesis, which is not ideal.
******
from a plastics hand attending:
There's a big fallacious idea that Plastic Surgeons only do skin. With the exception of elbow scopes (which almost no Plastics/Hand surgeons do), all of the stuff that you attributed to Ortho Hand is a significant part of my Plastics/Hand practice. I do BBFFs, distal radius, intercarpal fusions, wrist scopes +/- arthroscopic TFCC debridements and repairs, and any other bony work that an OrthoHand guy does. I can do radial heads, but I send them to an Elbow guy who sends me Hand stuff.
*****
from another attending (2/2017):
If you know you want to be hand surgeon, you'd want the Orthopedics (versus Plastics) background ALL DAY LONG, particularly in most metro areas of any size.
It is by far the better background for specializing in common hand/wrist/UE surgery and it's (generally speaking) a much easier background to find a job focused in that field.
I think as a true Upper Extremity surgeon today, you need to be able to do shoulder and elbow procedures, which is not something a lot of plastic surgeons get, even in fellowship.
Microsurgery is a small or nonexistent part of most high volume hand surgeons, with many orthopedists having never been trained in microsurgical reconstruction. Hand is an odd fit for Plastics in private practice, as you really need the whole infrastructure to do it well (in house x-rays, casting, & PT/OT) that usually only exists within an orthopedic group.
Now "Gentleman's Hand Surgery" (carpal tunnel, ulnar nerve transposition, and trigger fingers) is a little different in that you don't need the other staff and equipment in your clinic, but that can be hard to get the cases in most areas. This high volume simple outpatient cases are what churn the wheel of big hand practices.
#10droliver, Feb 5, 2017
Ortho Hand compared to Plastic Hand
question:
I'm a pre-med who will be shadowing some plastic surgeons this September. I noticed they do a lot of hand surgery, which I thought was primarily done by Ortho Surgeons. I'm wondering what's the difference between the two?
~~~~~~
answer from a resident (ortho?):
Last I heard, Hand surgeons were 70/30% ortho/plastics. After the hand fellowship, I would say both will have very similar practices in what they can do. The big variable is what they WANT to do which makes them different. I would also say that both routes are equally qualified to do hand surgery.
Ortho: More experience with wrist and elbow arthroscopy and operative fixation of fractures.
Plastics: More experience with microvascular/flaps and burns.
Those differences are just for when GOING into fellowship and I would imagine that at the end you would round out your training in whatever you are weaker in.
The way I would decide on which way to go is by everything else the specialty has to offer. So look at what ortho and plastics do OTHER than hand and decide what you like better. Also, I see a fair amount of ortho hand go all the way up to the shoulder. I have never seen plastics go higher than the elbow (doesn't mean that it doesn't exist) so that may be one thing that may sway you.
******
another answer:
There are 4 ways to practice hand surgery:
1) Ortho residency + 1 yr hand fellowship
2) Gen surg residency + Plastics fellowship + Hand fellowship
3) Plastics residency + hand fellowship
4) Gen surg residency + hand fellowship (rare)
The most common route is through an orthopaedic residency. It makes the most natural transition in my opinion (but im biased). I think the worst is the general surgery to hand fellowship. Those guys are using a drill for the first time during their fellowship and only then are learning the principles of osteosynthesis, which is not ideal.
******
from a plastics hand attending:
There's a big fallacious idea that Plastic Surgeons only do skin. With the exception of elbow scopes (which almost no Plastics/Hand surgeons do), all of the stuff that you attributed to Ortho Hand is a significant part of my Plastics/Hand practice. I do BBFFs, distal radius, intercarpal fusions, wrist scopes +/- arthroscopic TFCC debridements and repairs, and any other bony work that an OrthoHand guy does. I can do radial heads, but I send them to an Elbow guy who sends me Hand stuff.
*****
from another attending (2/2017):
If you know you want to be hand surgeon, you'd want the Orthopedics (versus Plastics) background ALL DAY LONG, particularly in most metro areas of any size.
It is by far the better background for specializing in common hand/wrist/UE surgery and it's (generally speaking) a much easier background to find a job focused in that field.
I think as a true Upper Extremity surgeon today, you need to be able to do shoulder and elbow procedures, which is not something a lot of plastic surgeons get, even in fellowship.
Microsurgery is a small or nonexistent part of most high volume hand surgeons, with many orthopedists having never been trained in microsurgical reconstruction. Hand is an odd fit for Plastics in private practice, as you really need the whole infrastructure to do it well (in house x-rays, casting, & PT/OT) that usually only exists within an orthopedic group.
Now "Gentleman's Hand Surgery" (carpal tunnel, ulnar nerve transposition, and trigger fingers) is a little different in that you don't need the other staff and equipment in your clinic, but that can be hard to get the cases in most areas. This high volume simple outpatient cases are what churn the wheel of big hand practices.
#10droliver, Feb 5, 2017
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How are you planning on making this happen? I'm interested in a very similar idea: I really enjoy a lot of the bread and butter trauma cases (like hips, forearms, plateaus) but have no real interest in the pelvis, which is what I think you'd mainly do a trauma fellowship for. My thinking is do a joints, hand, or sports fellowship, then take a fair amount of trauma call at like a level 2. Then even if there weren't trauma cases to do, pound away at my elective cases.
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Will likely take a job at a level 2 center, although I have an offer at a level 1. Level 2 guys shipping out quite a bit of trauma to the university, will keep that. Will hopefully do some anterior hips/shoulder arthroplasty on top of trauma as no one in the group is doing them.
