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J Hand Surg Am. 2019 Sep;44(9):799.e1-799.e9. doi: 10.1016/j.jhsa.2018.10.026. Epub 2018 Dec 18.

Primary Residency Training and Clinical Practice Profiles Among Board-Certified Hand Surgeons.

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Department of Surgery, Section of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery & Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL. Electronic address:
Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA.



This study seeks to identify the relationship between the type of residency training (general, plastic, or orthopedic surgery) and the clinical practice profiles of hand surgeons in the United States.


Membership applications to the American Society for Surgery of the Hand (ASSH) from 2011 to 2015 were analyzed. Data on type of residency training, practice type, the percentage of hand surgery in practice, and the time to application were collected. Total cases and the number of cases in each key clinical category were collected from surgical case logs.


From 2011 to 2015, a total of 451 hand surgeons applied for ASSH membership. Of these, 73.8% were orthopedic surgeons, 16.0% plastic surgeons, and 10.2% general surgeons. The median times to application after fellowship graduation and completion of the Certificate of Added Qualifications (CAQ) were 5 and 1 years, respectively and were similar between groups. Orthopedic surgeons are more likely to be in a private practice and perform the highest volume of cases. Plastic surgeons are most likely to be in an academic practice but perform nearly 20% of their cases outside of the field of hand surgery. Failure to meet the minimum case requirement in the joint contracture (40.7%), congenital (80.5%), and microvascular surgery (47.6%) categories were the most common for all applicants. Orthopedic surgeons were most likely to perform bone and joint, nerve, tendon and muscle, and tumor cases. Plastic surgeons were the most likely to perform skin and wound, congenital, and microvascular cases.


Orthopedic-, plastic-, and general surgery-trained hand surgeons early in their career have varied practice types and have different clinical case profiles. Differences in case profiles may be due to surgeon interest and/or training experience.


Promoting a collaborative relationship between hand surgeons of varied backgrounds is crucial to the training of future hand surgeons and the continued advancement of the field.


Education; fellowship; microsurgery; residency; training


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