The Diminishing Presence of Plastic Surgeons in Hand Surgery: A Critical Analysis

BACKGROUND: A growing trend of diminished presence of plastic surgery within the field of hand surgery has been observed in the membership of the American Society for Surgery of the Hand, applications for Certificate of Added Qualifications in Surgery of the Hand, and applications for hand surgery fellowships. METHODS: The American Society for Surgery of the Hand resident education subcommittee has investigated this trend, collecting data from the Association of American Medical Colleges, the American Board of Orthopaedic Surgery, the American Board of Plastic Surgery, the National Residency Matching Program, the Accreditation Council for Graduate Medical Education, the American Society for Surgery of the Hand, the American Association of Hand Surgery, and the Certificate of Added Qualifications in Surgery of the Hand and from an online survey of plastic surgery-trained hand surgeons in the United States. RESULTS: These data indicate that the subspecialty of hand surgery enjoys growing popularity with increasing fellowship applicants annually; uses an effective, fair, and multidisciplinary match; and demonstrates continued and healthy growth in its premier academic society. Despite these positive indicators, the percentage of new plastic surgery diplomates obtaining Certificate of Added Qualifications in Surgery of the Hand has decreased from 10 percent (20 applicants per year) to 4 percent (8 applicants per year), the percentage of examinees for the Certificate of Added Qualifications in Surgery of the Hand originating from plastic surgery training backgrounds has decreased from 30 percent to 15 percent, the percentage of the overall body of actively practicing plastic surgeons in the United States that hold Certificate of Added Qualifications in Surgery of the Hand qualifications is steadily decreasing (now to 10 percent), and the plastic surgery membership in the American Society for Surgery of the Hand is demonstrating negligible growth despite the overall expansion of the American Society for Surgery of the Hand. CONCLUSIONS: This report serves as a detailed and systematic account of these findings, a balanced interpretation, and a proposal of specific potential solutions. These include recommendations for changes in the structure and content of plastic surgery training programs and the National Residency Matching Program hand surgery fellowship designations.