Hand vs. Spine

Asking for thoughts from the peanut gallery.

I'm caught between pursuing a fellowship in Hand/Upper Ex or Spine, mostly because of the nature of the leadership and mentorship in my program.

I know that you can break it down in a number of ways: Hand cases are mostly short and dinky, Spine cases are long and both physically and mentally stressful; Spine surgeons right now are reimbursed extremely well and hand surgery reimbursements have been falling; spine call outside a major trauma center is extremely light and hand call varies but is probably more bothersome; spine patients stay in the hospital and hand patients rarely do; the complications in spine are anywhere from annoying to catastrophic and less so in hand; worker's comp factors heavily in both, etc. Spine has competition from Neurosurg, Hand has some from Plastics as well as Sports/Shoulder, if you want to do shoulder/elbow as well.

If you had to pick one or the other, thoughtfully, and this presupposes you could actually see yourself doing and liking both, how would you make your decision?

All thoughts welcome.

My husband just recently decided to go into spine. He enjoyed most of the other specialities also. Something that helped him decide is that because of insurance reasons/ costs for spine, only those who go and do spine fellowships actually do spine later. However, if he wanted he can still do minor hand cases, foot and ankle cases, joint replacements and general trauma call. So he decided to fellowship in spine so he doesn't close the door on spine because he really does enjoy it. Hope that helps.

that is a great point orthospouse. you definitely can still do general orthopedics as a spine surgeon and enjoy the rest of the field, where as if you are a hand guy, not going to be doing much if any spine but will get to general orthopedics as well. I think based on that reasoning alone I probably would pursue spine if you truly to enjoy it.