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Workforce Issues - Where the Jobs Are

by Patrick C. Alguire, MD, FACP
Director, Education and Career Development, ACP

To adequately determine your value to a general internal medicine or subspecialty practice, you need to assess the job market. This assessment should take into account the relative number of working physicians in your area as compared to the demand for them. This information will help predict your probable worth on the job market, although sometimes it is not directly available and surrogate measures must be used. One such measure is provided in an annual report by the Division of Medical Education at the American Medical Association. This year's annual report is unique in that it directly asks graduating residents about their job-seeking experiences, where before this information was obtained from program directors (Miller RS, Dunn MR, Richter TH, Whitcomb ME. Employment-seeking experiences of resident physicians completing training during 1996. JAMA 1998;280:777-783).

In this study, a one-page survey was mailed in May to 1,996 graduating residents and fellows. They were asked a series of questions, including whether they accepted a part-time position, how many job offers they received, if the job they accepted was their first choice, if the salary met their expectations, if job location was their first choice, and if they experienced significant difficulty in finding a practice situation compatible with their career goals. Some of the major findings are summarized below.

Specialty

Residents reporting significant difficulty in finding a practice position, %


Residents receiving only 1 job offer, %


Residents reporting position was not their 1st choice, %


Residents reporting location was not their 1st choice, %


Residents reporting salary lower than expected, %


General Internal Medicine

22.7


12.4


11.4


21.7


20.9


Cardiology

29.9


7.6


10.0


29.2


21.8


Critical Care

45.5


8.3


8.3


33.3


25.0


Endocrine

45.5


8.3


8.3


33.3


25.0


GI

43.9


16.7


16.3


37.5


33.0


Geriatrics

25.0


0.0


44.4


14.3


44.0


Hematology

25.0


25.0


12.5


37.5


25.0


ID

52.9


28.6


17.8


45.7


35.3


Nephrology

30.2


6.7


28.6


33.3


26.7


Oncology

40.7


19.0


22.2


42.1


19.0


Pulmonary

40.7


14.8


21.2


29.6


33.3


Rheumatology

34.8


17.4


17.4


26.1


34.8


Totals for all specialties, including those outside of internal medicine

22.4


12.5


12.0


24.2


22.2


The response rate to this survey was only 48%, furthermore, males, international medical graduates, and under-represented minorities were less likely to respond to the survey, suggesting the possibility of bias.

With this caveat in mind, female physicians reported working part time more often than male physicians, but it could not be determined if this was by choice or by necessity. Male physicians reported more difficulty in finding a position than did female physicians, despite female physicians reporting a greater rate of unemployment.

More than 40% of IMGs reported having difficulty in finding a suitable position, but underrepresented minorities did not report any more difficulty in finding a position than did non-minorities.

Male and female physicians did not differ in the number of offers received, but IMGS were much more likely to receive only a single offer.

A logistic regression analysis revealed that a resident was most likely to experience difficulty in finding a position if he or she was an IMG, completing a program in the Pacific (California, Alaska, Hawaii, Oregon, Washington), or East North Central (Illinois, Michigan, Ohio, Indiana, Wisconsin) regions of the country, or had graduated from a Gastroenterology, Infectious Disease, or Pulmonary and Critical Care training program. On the other hand, graduates from general internal medicine were not as likely to experience employment difficulty, especially in the West South Central (Texas, Arkansas, Louisiana, Oklahoma) regions of the country (see map).

This information, although potentially biased, remains an important source of planning information. For those graduates who fall into a high-risk group for experiencing difficulties in finding a job, beginning a search 12 months or more before graduation and expanding the job search to cover a larger geographic area is highly recommended. Additionally, consulting a recruiting firm or utilizing one of the many online employment Web sites for physicians may be important strategies to consider in order to increase your exposure to potential job opportunities.

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