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Background: Although the ACGME requires fellowship programs to exhibit proficiency in 6 broadly defined domains for accreditation, no standardized set of core competencies exist by which all hand surgery fellowship programs must abide by. As a result, recently published studies have demonstrated significant variations in exposure to essential skills and knowledge between orthopedic and plastic surgery based hand surgery fellowship programs. In order to determine whether significant disparities also exist post fellowship between orthopedic and plastic surgery residency trained hand surgeons, clinical practice patterns were studied.
Methods: A 20-question survey regarding training and practice patterns was created and distributed electronically to members of the ASSH and AAHS. The responses of orthopedic and plastic surgery residency trained hand surgeons were compared using descriptive statistics.
Results: 982 hand surgeons, 76% orthopedic and 24% plastic, responded representing a 39% response rate. The number of years in practice did not vary considerably amongst surveyed surgeons (15.6 years for orthopedic vs. 16.2 years for plastic surgeons). 41% of plastic surgery hand practices were academic-based compared to 25% for orthopedic based practices while 67% of orthopedic based practices are private practices compared to 44% for plastic surgery based practices (p<0.0001). Significantly more orthopedic hand surgeons were found to work in multi-practitioner private practices than plastic surgeons (54% vs. 30% respectively, p<0.0001). Plastic trained hand surgeons mostly operated in hospitals (60%) while orthopedic hand surgeons mainly utilized ambulatory surgical centers (56%). Orthopedic hand surgeons performed a higher percentage of hand cases in their practice (86% vs. 71% respectively, p<0.0001). Both orthopedic and plastic trained hand surgeons named carpal tunnel release, trigger finger release, and ganglion cyst excision as the most common procedures performed. Plastic surgeons were found to perform more congenital hand (56% vs. 35%, p<0.05) and digital replantation cases (53% vs. 22%, p<0`.05) but significantly fewer ORIF distal radius fractures, operative repair of carpal bone fracture/dislocations, cubital tunnel releases, and operative treatment of basiliar joint arthritis than orthopedic hand surgeons. Plastic surgeons were more likely to want to increase their volume of hand cases (50% vs 43%).
Conclusion: Despite being ACGME accredited hand surgery fellowship programs, orthopedic and plastic surgery based fellowships vary considerably in terms of exposure and emphasis of basic skill sets. Dichotomies between orthopedic and plastic surgery residency trained hand surgeons continue to manifest post fellowship through significantly different clinical practice patterns.