Long-term Career Outcomes and Associations With Academic Careers, Leadership, and Publication Volume After Hand Fellowship

BACKGROUND: We aimed to characterize career outcomes among fellowship-trained hand surgeons in the United States with a focus on academic careers and factors associated with leadership roles and post-fellowship publication volume. METHODS: Of 94 programs in the American Society for Surgery of the Hand directory, 24 had publicly available online data for graduates between 2010 and 2019. We defined academic surgeons as current faculty within university-affiliated departments. Leadership roles included departmental/practice, education, or residency/fellowship positions. Bivariate tests and multivariable mixed-effects negative binomial and logistic regression were used to identify associations with career and publication outcomes. RESULTS: Of 508 graduates, 394 (79.9%) were men, and 393 (77.4%) graduated from an orthopedic surgery residency program. Of these, 25.9% became academic hand surgeons, of whom 26.2% were women, and 18.2% held leadership roles, of whom 30.7% were women. Being a woman, completing integrated plastic surgery residency compared with orthopedic surgery or general surgery, and increased publication volume by the end of fellowship were associated with working in academic surgery. Being a woman, increased years since graduating fellowship, graduating from a fellowship in the Midwest compared with the West, and increased publication volume by the end of fellowship were associated with having a leadership role. CONCLUSIONS: We identified several factors associated with academic careers and leadership roles in hand surgery. Future qualitative studies on modifiable factors, such as mentorship, training program infrastructure, and individual surgeon goals, are required to better understand ways to support trainees who want to pursue academia, leadership roles, and publications.