Sir: Hand surgery is a unique and competitive subspecialty that attracts candidates from various surgical backgrounds.1,2 It requires the mastery of skills from the disciplines of neurosurgery, orthopedic surgery, and plastic surgery.3 The ideal hand surgery fellowships include a comprehensive curriculum that equips graduating fellows of all residency backgrounds with a multitude of treatment approaches and diverse technical skills. To receive this type of complementary training, residents pursuing a hand fellowship need to be cognizant of the differences between programs, both in breadth of disease encountered and overall treatment philosophy. Both the article by Sears et al.4 and the associated editorial by Sammer5 should be read carefully by all applicants to hand surgery fellowships (regardless of residency background) to facilitate a critical self-assessment of what the applicant is seeking in a fellowship. Sears et al. demonstrate agreement among program directors that a strong wrist experience is a critical component of training.4 Nevertheless, there are differences of opinion regarding the relative importance of areas such as elbow and shoulder surgery (which were emphasized by orthopedic surgery–trained fellowship directors) and burn reconstruction and microvascular surgery (which were emphasized by plastic surgery–trained fellowship directors). Although accreditation standards unite fellowship programs under a general set of required competencies, the program director’s influence on the curriculum shapes the experiences gained by the fellows. Hand surgery fellowships that acknowledge and embrace these differences in training philosophy provide a comprehensive, collaborative, and synergistic experience for their fellows.5 For example, fellows that receive sound training in the principles of hand surgery will not only learn about the acute management of a scaphoid fracture, but will be able to use their diverse skills to offer treatments that are both traditionally “orthopedic” in nature (such as intercarpal or wrist arthrodeses) and “plastic surgery” in nature (such as vascularized bone grafting), should the need arise.6 Integration of treatment philosophies and technical training for hand surgery will be mutually beneficial to both orthopedic surgeons and plastic surgeons. This will ensure that Sterling Bunnell’s vision for the hand surgeon to be a “composite surgeon for a composite problem” will not be lost as our profession evolves.3 DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Christopher J. Dy, M.D., M.S.P.H. Peter D. Fabricant, M.D., M.P.H. Department of Orthopedic Surgery Hospital for Special Surgery New York, N.Y. Brian White, M.D. Department of Orthopedic Surgery University of South Florida Tampa, Fla. Ajul Shah, M.D. , Anup Patel, M.D., M.B.A. Section of Plastic and Reconstructive Surgery Yale School of Medicine New Haven, Conn.