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A 12-Year Analysis of Demand and Supply for Hand Surgery Training in the United States
Jason Silvestre, MD
1; Charles Daly, MD
2; Dane N Daley, MD
21Perelman School of Medicine, Philadelphia, PA; 2Medical University of South Carolina, Charleston, SC
Background: The consistent recruitment of quality applicants is critical to the integrity of the US surgical workforce. This study assesses the demand and supply for hand surgery training in the US.
Methods: This was a cross-sectional analysis of all applicants for US hand surgery fellowship training. Data were obtained from the National Resident Matching Program from 2012 to 2023. Primary outcomes of interest were annual number of hand surgery fellowship applicants, training positions, training programs, and unfilled training positions. Secondary outcomes were match rates, distribution of fellows by medical school training, number of submitted ranks, and where applicants matched on their rank lists. Temporal trends were assessed with Cochran Armitage and linear regression tests.
Results: The annual number of hand surgery training positions increased from 150 to 193 (28.7% increase, P<0.001) while the annual number of applicants remained unchanged over the study period (199 to 198, P=0.897). The annual number of hand surgery fellowship programs increased from 73 to 93 (27.4% increase, P<0.001) while the applicant-to-training position ratio decreased from 1.3 to 1.0 (P<0.001, Figure 1). The number of annual unfilled training positions ranged from 1 to 11 with no trend over the study period (P=0.936). The overall match rate increased (73.4% to 95.5%, P<0.001, Figure 2) along with the mean number of submitted ranks per applicant (8.2 to 14.9, P<0.001, Figure 3). US allopathic graduates constituted most hand surgery fellows (91.9%) followed by US osteopathic graduates (4.6%) and international medical graduates (3.5%) with no significant trends over the study period (P>0.05, Figure 4). More applicants matched at their first-choice (28.1% to 38.4%, P<0.001), second-choice (10.6% to 15.7%, P<0.001), and third-choice (5.5% to 9.1%, P<0.001) fellowships over the study period while the rate of unmatched applicants decreased (26.6% to 4.5%, P<0.001, Figure 5).
Conclusions: There has been consistent growth in the number of hand surgery training positions and programs in the US without a commensurate increase in the number of interested applicants. Ongoing surveillance is needed to ensure adequate demand for available training positions in hand surgery.
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