Gen Surg vs. Ortho to do Hand?

Can anyone speak to the similarities/differences between doing a general surgery residency vs. an orthopaedics residency to go into hand? Just wondering as far as reimbursement, odds of obtaining a fellowship, respect from peers, types of cases you can cover, anything else you can add would be great. Thanks!

Do you mean plastic surgery to go into hand? I have never heard of a general surgeon getting a hand fellowship.

I guess that answers the question regarding "respect from peers"! From what I understand, the most common paths to a hand fellowship are via ortho or plastics, but that there are a few dedicated hand fellowships from general surgery (at least one at Parkland, Tampa, and Louisville). According to some plastics fellows, some of the applicants who don't match into plastics after gen surg will do a year of hand and reapply. I seem to remember that the Indiana Hand Center took a general surgery resident into their hand fellowship recently (maybe a current fellow).

I could be wrong, though, if this doesn't sound familiar to you.

We have a hand surgeon at my residency program who completed the hand fellowship at the Kleinert Institute in Louisville. It seems that he had no difficulty obtaining a fellowship for this. As far as types of cases he can cover: it seems that he is very good at pretty much all carpal and metacarpal fractures, phalangeal fractures, distal radius/ulna, and two-bone forearms. Also, he is able to do wrist arthroscopy, tendon repairs, etc... basically anything distal to the elbow. He is capable of doing cases proximal to the elbow; however, he seems reluctant to do so when he's in a proctice with orthopaedic sureons who are more familiar with that region.

General surgeons do have hand questions on in-training and board exams. It seems reasonable to persue a career in hand surgery after a general surgery residency.

Well, if you are really interested in hand surgery, I would suggest doing an orthopedic residency. You'll be doing some hand and other work similiar to hand (foot) etc... for five years. You'll also get great training in fracture care and how to utilize appropriate plates/screws/etc...

Other issues to consider are job related. Many orthopedic groups like to hire their own. Meaning, they would prefer an orthopedic trained hand surgeon to a plastic surgeon. It allows more options for call etc.. An orthopedist could cover everything and could fix hip fractures etc.. if needed. While a plastic surgeon would be limited to hand/upper extremity issues.

And of course the biggest reason, is that you won't have to do butts and guts.

From what I've heard, there have been a few residents to come through UMass's Hand Fellowship from general surgery and then reapplying to Plastics or Ortho.