By Brett James Lewellyn, MD 

I am now currently in my 9^th year of practice as a hand and upper extremity surgeon and this year I will be entering into my 5^th decade of life. The delay in the start of my career is courtesy of time spent on active duty in the US Army. My father, also a veteran, told me the day before I left for boot camp that I may not want the Army as a career, that it may simply be a stepping stone, and that one day, if I could find a career that I truly enjoyed every day, that I would never really have a “job” or have to “work.” Hand surgery has been that career, and although I love my job, it has changed dramatically over the past five years.  

As the first hand surgeon in my orthopaedic group as well as the first employed hand surgeon hired by my institution, I was quite busy from the start. My very first clinic had 32 patients in it – mostly referrals from my own ortho partners. The cream of the crop was a 33 year-old woman with a five-month-old firework-related blast injury to her dominant hand that the ortho trauma team had pieced back together. She had an ulnar nerve palsy, a distal radius malunion, and severe burn contractures – the referring partner for the patient casually smiled and said, “Welcome to the group – I was saving her for you,” when I ran into him in the hallway later that day. This is how the first four years of my practice went – long hours in the clinic and even longer hours in the OR with some months seeing 10-12 days of level one hand call…and I loved every minute of it. I operated, saw patients in clinic, and operated some more. It was all about the patients.  

For the past five years, I found that my interaction with patients has lessened. This decrease in patient interaction isn’t the typical “physical” interaction that all of us are experiencing secondary to the Covid-19 pandemic. Gone are the days when I could shake a patient’s hand or pat an anxious family member on the shoulder in the waiting room after a successful surgery. The decrease in patient interaction that I am talking about is different and is unfortunately self-inflicted as it is the result of a metamorphosis of my patient-centered practice into an academic, administrative practice.  

Since completing my hand fellowship and returning to my home institution where I did my residency, the majority of my decisions and actions have been to assist with the education of our orthopaedic residents and to establish a successful hand program at our institution. The last half of my relatively short career has seen this contribution to mentoring, teaching, and administrating increase exponentially. In the past 5 years I have hired four hand and upper extremity partners, established an ACGME-accredited hand fellowship (we have hired our first hand fellow just this past week), and I am currently assisting with establishing a regional replant center for the Southeastern U.S. Whereas in my first 5 years of practice, I was focusing my attention on finger replants and shoulder arthroplasty, I now find my time shared between editing research articles, writing letters of recs, and attending to an endless stream of on-line and in-person administrative meetings, phone calls, and emails. Again, I recognize that these choices in tailoring and shaping my practice were the result of my own decisions and responsibilities, and I have accepted the consequences without any regrets.

While I may not find the same happiness in my current administrative practice as a successful revascularization or nerve transfer surgery, I do recognize the importance and contribution that many of the actions that I and other “hand administrators” have taken in order to assist with the education and mentoring of medical students, fellows, residents, and our colleagues. I can honestly say that the changes and the evolution of my practice into an academic and administrative practice has been one that has challenged my time, my patience, and, at times, my sanity. However, I have welcomed these challenges and have found enjoyment in overcoming these obstacles. While this enjoyment is slightly less than the satisfaction of say, dialing in a dusted distal radius fracture and plating it, I’m still happy to say that I feel like I haven’t “worked” a day since becoming a hand surgeon.