Why Are Universities Moving Away From Hand Surgery?
By Moroe Beppu, MD, PhD
I have worked in academic departments for 40 years until my retirement in 2015. My career began when I joined the Department of Orthopedic Surgery at the Jikei University, School of Medicine in 1975. I then worked as a research fellow and later a clinical fellow with Louisville Hand Surgery Associates from 1981-1983, after which I moved to St. Marianna Medical School until retirement. My record also includes: AOA International Travelling Fellow (May-July, 1990), Research Fellow at Mayo Clinic (1995-1996), Kleinert & Kutz Visiting Professor in Hand and Microsurery (2007), and University California Irvine Visiting Professor (2008).
During this time, we worked on emphasizing the importance of three factors: education, research, and clinical practice at the university. Several university professors who were hand specialists were among the executive members of the Japanese Orthopedic Society during this period with many ambitious young doctors entering the field of hand surgery as well.
However, in developed countries, hand trauma and amputations have decreased with both advances in medical technology and mechanical technology for prevention of hand injury. Advances in Orthopedics including spinal instrumentation, total joint arthroplasty, and sports medicine have come with a real economic cost. Health Systems have placed an increased emphasis on efficiency and technological advances rather than on meticulous dissection and microsurgery.
The unfortunate side effect is that in Japan today, university hospitals are focusing on the most profitable procedures. Younger surgeons are following the economics accordingly. In Japan, several university hospitals have moved away from hand surgery and today’s graduates have focused on artificial joint replacement and spinal surgical reconstructions (in response to Japan’s aging society). Those graduates that do train in Hand Surgery are drawn towards more lucrative hand & microsurgical centers that focus on the most profitable procedures.
I would like to hear your opinion on the current and future direction of hand surgery in the United States, Japan, and elsewhere.
Moroe Beppu MD, Ph.D.
Emeritus Professor
St. Marianna University, School of Medicine
Comments (6)
David Ring
April 10, 2020 12:37 amHello Moroe,
I admire you very much. This is a very important topic of discussion. One of the many things that I learned in my travels to Japan. I was supposed to be with you this month. Hope I can meet you in Japan or her in the US soon.
Moroe Beppu
April 12, 2020 2:03 pmDear David
Thank you for your comment. I was looking forward to attend your invited guest lecture in April, 2020 during Annual Meeting of JSSH.
Your title of talk was[ Nobel Prize Winning Research Applied to Hand Surgery: Cognitive Error, Cognitive Bias, and Choice Science]
It was a very interesting. Unfortunately The JSSH Annual meeting was cancelled but the meeting will be set up on line system.
i hope I will have a chance to discuss about my perspective and see you soon in the 7th Combined Meeting of Japanese and American Societies for Surgery of the hand in May 27-29th, 2021, Sheraton Waikiki in Hawaii.
Moroe Beppu
Robert L Bassett, MD, FACS PINES ORTHOPEDICS AND SPORTS MEDICINE
April 10, 2020 3:06 pmWe met when you were visitng Bob Carroll many years ago. Glad you are well.
Replantations are now being done primarily in larger centers
in USA they not lucrative
Moroe Beppu
April 14, 2020 10:48 amDear Bob
I’m very glad to hear from you. I began working on hand replantation following my fellowship in 1983. At the time, there were many cases but gradually became less and less as technology advanced and the need for surgery decline. By the time I retired in 2015, there were almost no replantation and fewer factory injuries. Of course, my university, St. Marianna, is located in the suburb of Kawasaki rather than in Tokyo.
It’s unfortunate that it’s necessary to postpone the 2020 Olympic and Paralympic games until next year. My hobby is tennis and I have worked as a medical committee chairperson for the Japan Tennis Association, so I’ve experienced more sports-related wrist and elbow disorders. Since you’re also a sports doctor, I’m curious to know your experience of how hand surgeons relate to wrist problems. In my opinion, it’s important for hand surgeons to do more work on sports-related disorders. Unfortunately, in Japan, not so many hand surgeons are currently interested in sports medicine and I’m interested to know your experience with the situation in the United States.
Best regards,
Moroe
orhan Kaymakcalan
April 10, 2020 6:23 pmMy dear old friend M. Beppu.
You are correct, but unfortunately inner cities like Chicago, we are seeing increased number of primary hand infection .complications of IV
drug abuse and violent hand trauma, including GSW.
Best wishes
Moroe Beppu
April 14, 2020 4:55 amDear Orhan
Thank you for your mail – I appreciate your comment. Though we both work in big cities – you in Chicago and me in Tokyo – the injuries that we treat are quite different. I understand that in Chicago hand surgery is frequently related to hand infections from drug abuse, gunshot wounds, and other violent injuries. In Tokyo, I’ve actually never had to treat a gunshot wound or anything related to drug use – most cases are related to degenerative changes like thumb CM joint arthritis, carpal tunnel syndrome, tenosynovitis, and other problems related to Japan’s aging society. Perhaps we are lucky here, though we are all faced with different challenges.
Best regards,
Moroe