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Training Backgrounds of Pediatric Hand Surgeons: Paucity of a Dedicated Pediatric Hand Fellowship
Thalia Le, BS
1, Wali U. Pirzada, BS
2, Anna Ringwood, BS
3, Skyler Palmer, BS
4; Timothy J Irwin, MD
5(1)Children's Hospital Colorado Anschutz Medical Campus, Aurora, CO, (2)Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, (3)Carnegie Mellon University, PITTSBURGH, PA, (4)Children's Hospital Colorado Anschutz Medical Campus, Denver, CO, (5)Children's Hospital Colorado, Aurora, CO
Introduction: Pediatric hand surgery sits at the intersection of two specialized fields: hand surgery and pediatric care. However, formal training pathways do not always reflect this dual expertise. While there are over 90 ACGME-accredited hand surgery fellowships in the United States, only six are pediatric-specific fellowships. It remains unclear how many practicing pediatric hand surgeons have received specialized pediatric fellowship training, given the limited availability of such programs. As pediatric patients receive increasingly complex surgeries at high-volume specialty centers, the training backgrounds of their surgeons warrant closer examination. This study investigates whether pediatric hand surgeons at leading pediatric orthopedic institutions receive formal pediatric hand training and explores how institutional fellowship offerings and training pathways shape the pediatric hand surgery workforce.
Methods: We reviewed the top 50 pediatric orthopedic institutions in the U.S. using public directories and institutional websites. We identified pediatric hand surgeons and collected data on residency and fellowship training, academic rank, leadership roles, and scholarly productivity. Institutional factors included fellowship availability and department chair background. We used standard statistical methods to compare results between orthopedic- and plastic-trained surgeons.
Results: Among 477 pediatric orthopedic and plastic surgeons, 177 were identified as pediatric hand surgeons. Only 15.3% completed a dedicated pediatric hand fellowship while the rest (84.7%) trained through general orthopedic or plastic hand fellowships. Most surgeons completed residency in orthopedic surgery (65.0%), followed by plastic surgery (33.3%), general surgery (1.1%), and combined training (0.6%) (
p < 0.0001). Pediatric hand fellowship-trained surgeons were more likely to be found at top-ranked programs, with 24.4% at top 25 institutions and 7.4% at bottom 25 institutions (
p = .0017). H-index positively correlated with academic rank across specialties. However, after adjusting for years since residency, there was no significant difference in mean H-index between orthopedic and plastic surgery-trained surgeons. Four of the six pediatric hand fellowships were located within the top 50 institutions. Pediatric orthopedic or general hand fellowships were also significantly more common at top-ranked institutions, offered by 80% of the top 25 compared to 48% of the bottom 25 (
p = 0.018).
Conclusion: Despite the complexity of pediatric hand surgery, most surgeons lack specialized pediatric hand training. Higher-ranked institutions offer more specialized fellowship-trained surgeons, yet the workforce largely depends on generally trained hand surgeons. Pediatric hand surgery is predominantly practiced by orthopedic-trained surgeons. Nonetheless, scholarly productivity and academic rank are comparable between orthopedic and plastic-trained surgeons when accounting for years in practice.
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