Primary Residency Training Pre-determines Post-fellowship Clinical Practice in Board-certified Hand Surgeons: N/A - Not a clinical study

Abstract

There is no financial information to disclose. This study seeks to identify the relationship between the type of residency training (general, plastic, or orthopaedic 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 2011-2015 were obtained with permission. Data on type of residency training, practice type (private, private-university, hospital, or other), the percentage of hand surgery in practice, and the time to application from fellowship and CAQ completion were collected. The total number of cases as well as the number of cases in each key clinical category were collected from surgical case logs. Categorical variables were evaluated with chi-squared tests and continuous variable with Mood’s median tests and Kruskal-Wallis tests; the numbers of surgical cases were analyzed with Poisson regression. All statistical analysis were performed with STATA (v. 13.1, Mac). From 2011-2015, a total of 451 hand surgeons applied for ASSH membership. 73.8% were orthopaedic surgeons (16.0% plastic surgeons and 10.2% general surgeons). After excluding outliers, the median time to application after fellowship graduation and completion of the CAQ was 5 and 1 years, respectively, and was similar between groups. Plastic surgeons were more likely to be in an academic practice (48.3% versus 17.0% for orthopedics and 7.7% for general surgery, P < 0.0001). General surgeons were most likely to be in private practice (71.8% versus 59.2% for orthopedics and 39.7% for plastic surgery). Plastic surgeons had the smallest and most variable proportion of their practice dedicated to hand surgery (77.5%, SD 18.7%). Orthopaedic surgeons had the highest volume of cases (median 306, P < 0.0001). Out of all applicants, deficiencies in joint contracture (40.7%), congenital (80.5%), and microvascular surgery (47.6%) were the most common. Orthopaedic 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. General surgeons did notably fewer bone and joint, tendon and muscle, and congenital cases relative to both plastic and orthopaedic surgeons. See Figure 1 for detailed results. •Orthopaedic, plastic, and general surgery-trained hand surgeons early in their career seek varied practice types and have different clinical case profiles.•Differences in case profiles may be due to surgeon interest and/or training experience.•Evaluation of training curriculums for hand fellows should ensure that graduates are adequately exposed to the full range of hand surgery.