Ortho to plastics?

[bobbyseal]

What do people think of doing an ortho residency and then going into plastics?

An opinion of a plastics doc that I know said that the best hand surgeons out there either are ortho trained with a plastics hand surgery fellowship or plastics trained with an ortho hand fellowship.

Also, is hand surgery turning into a not so in demand part of plastics/ortho? I suppose as the populace moves off the farm and out of the mill to a desk job you'll have less and less cases coming in from trauma.

What's the opinion out there?

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[Winged Scapula]

I've heard the same (ie, good hand surgeons tend to have either Ortho and/or PRS training) and it is true that some programs prefer/require one or the other for basic training before going onto a Hand Fellowship. Consider that many, if not most PRS programs require at least 3 years of "general training" (which is usually defined as General Surgery not Ortho) before going onto PRS training. Hand fellowships simply require either a completed general, PRS or Ortho residency.

The popularity of Hand has waned somewhat although I'm not sure its the move from the farm/mill to the office that is to blame (after all, that happened wholesale many generations ago). Most Hand surgeons don't go into the field soley for the Trauma and there is still a fair bit out there to be had if you position yourself right (we don't get much penetrating here but we still have people whacking off fingers, hands, etc. right and left [pun intended]). The waning popularity supposedly has more to do with decreasing reimbursement, rising malpractice costs/fears than lack of farm implement related trauma (which still exists. Augers are terrible on hands and upper extremities.)

I start my Hand rotation tomorrow, so perhaps will have more to say on the subject (*and I expect that droliver will as well) later.

 

[maxheadroom]

The advice that you received is valid. One of the previous chiefs from my PRS program is doing a Ortho-hand fellowship. Several of the faculty have recommended ortho-hand training, just because it gives the plastician a little more distal radius experience than we typically get. And we get tons of peripheral nerve and micro experience in our program, so there's no need to relearn that.

Hand is falling off for several reasons. Declining reimbursement (especially for the non-workman's comp) is a big problem, especially when combined with the crappy call that can be associated with hand surgery. I've also heard several people who used to take hand call say that they quit because of the patient population -- you find yourself taking care of lots of undesirable people who will hold you responsible for their hand that doesn't work when they punched out a garage window and severed their ulnar nerve.

All of that being true, I like hand a lot, but probably won't pursue fellowship training/hand call when I get out. I just don't need the headache.

 

[maxheadroom]

Just an added note . . . your best chances of getting a plastics "fellowship" position (actually residency through the traditional/independent route) is as a fully trained general surgeon. The match numbers for BE/BC general surgeons are by far the best.