Yes I'm staying here. I rotated on the Hand service as a resident & enjoyed it. It's a very strange situation for Plastics & Orthopedics here. The norm @ most places is alternating hand call b/w those service. Here KK&A have ~ 24 hand fellows a year & do all the hand call in the downtown medical complex (5 hospitals). I spend 3-4 months as a hand fellow of my 2 years & don't do any hand the rest of the time unless I choose to do some of my elective time on that service. Ironically, this is prob. NOT a good place to get good hand training during your PRS training because you do it so infrequently. However, if you don't want to do a lot of hand in your practice (an increasing sentiment among plastic surgeons in practice) it works out incredible. I will have NO hand call for the majority of my fellowship which is the traditional bane of plastic surgery call nights & only be taking face call 2-3 nights a month. It works out beautiful & lets the fellows here do obscence #'s of aesthetic cases with our clinical faculty (aesthetic training is by far and away the weakest part of training at almost program)
As far as the match.... the # of positions has been pretty static for the traditional fellowships for the last several years. The match rate falling has to do with a steady surge of application #'s.
There should actually be more spots via this route as I believe Duke, NYU, Emory,& UCLA are abandoning the combined programs they've experimented with. It's become clear to a number of people that the 3/3 model will not work at some places for a variety of reasons.I personally think 4 years of surgery prior would be the best compromise prior to starting plastics, and this may be the future "integrated" model to fall in line with the other specialties with the coming changes in the general surgery specialties. It would suprise me if some of the current combined & integrated programs didn't evolve that way.
When you say "1+4" jump I'm not sure what you mean. I haven't heard any movement for that model discussed in the Plastics forums. Like I pointed out, there have been a lot of hiccups with the attempts by some programs to go integrated. A model like urology (1+4) would be a disaster I think & marginalize the field from its core disciplines.
BTW, congrats on your match. Where are you going?