A 12-Year Analysis of Demand and Supply for Hand Surgery Training in the United States

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 United States.

This was a cross-sectional analysis of US hand surgery fellowship applicants from 2012 to 2023. Data were obtained from the National Resident Matching Program. Primary outcomes were annual number of hand surgery fellowship applicants, training positions, training programs, and unfilled training positions. Temporal trends were assessed with linear regression.

The annual number of hand surgery programs (73 to 93 [27.4% increase]; P < 0.001) and training positions (150 to 193 [28.7% increase]; P < 0.001) increased over the study period, while the annual number of applicants remained unchanged (199 to 198; P = 0.431). The applicant to training position ratio decreased over the study period (1.3 to 1.0; P = 0.001). The overall match rate increased (73.4% to 95.5%; P < 0.001), along with the mean number of submitted ranks per applicant (8.2 to 14.9; P < 0.001). The distribution of US allopathic graduates (91.9%), US osteopathic graduates (4.6%), and international medical graduates (3.5%) was similar over the study period. The rate of applicants matching at their first-choice fellowship increased over the study period (28.1% to 38.4%; P = 0.003), and the rate of unmatched applicants decreased (26.6% to 4.5%; P < 0.001).

There was consistent growth in the number of hand surgery programs and training positions without a commensurate increase in the number of interested applicants. Increased recruitment efforts are necessary to ensure adequate demand for available training positions in hand surgery.