AMERICAN Society for Surgery of the hand.

These questions, often asked during my year as President, inspired the following address. 1. What is the recommended time for hand surgery training? 2. What should this training include? 3. If hand surgery is established as a specialty, does this exclude the general, orthopaedic, or plastic surgeon not trained specifically in this type of surgery? 4. How many hand surgeons does this country need? 5. What hand surgical services should be provided by a community hospital? By a medical center hospital? 6. What would be the effect of national health insurance? The three major components of an effective, innovative medical program are (1) direct patient care, (2) teaching, and (3) research (Fig. 1). These may be envisioned as three overlapping circles, as in a Venn diagram. Direct patient care is the first priority, and when effectively administered, strong teaching and research capabilities follow (Fig. 2). Teaching stimulates research, for it is from the interchange between teacher and student that new ideas are created (Fig. 3). From the resolution of these ideas, new knowledge and service emerge (Fig. 4). Patient care is either elective or emergency. The statement, "The surgeon who first operates plays the greatest role in the eventual outcome and the final result achiev.ed, " especially applies to the emergency patient. The productive time lost by our nation from hand injuries sustained at work and home is so large that its value has not been estimated accurately. Patients are usually off of work or regular activity for 3 to 6 weeks following even minor hand injuries. If one combines