Abstract
BACKGROUND: Hand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010-2023). MATERIALS AND METHODS: We queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME). RESULTS DISCUSSION AND CONCLUSIONS: From 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6 % increase, R = 0.97, p < 0.001); plastic surgery, 14 to 19 (35.7 % increase, R = 0.91, p < 0.001); general surgery, 1 to 2 (50 % increase, R = 0.71, p = 0.004). The number of available fellowship positions commensurately increased by 38.8 % over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (R = 0.32, p = 0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (R = -0.74, p = 0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (R = 0.98, p < 0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022-2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.