How concerned should we be of job prospects when deciding our residency?

[justwannabeadoc 28]

Everything seems to have no jobs  

- U of T MD Class of 2021

[LittleDaisy 289]

I think that there are jobs, but not WHERE you want to be! A few years of locum is expected for surgical or some IM specialties (resource-heavy), or any resource-intensive specialties (radiology, anesthesiology, radiation oncology, etc)

A few of orthopedics resident or surgical residents that I have worked with actually did find jobs, but in remote rural areas. Academic positions are pretty competitive nowadays, a masters, even phD has become a norm; 1-2 years of fellowship are expected. Let alone the stress of hoping landing a job in urban area, and stand out among your peers for 1 position throughout your training.

Let's face it, it's so much life-friendly to work in an academic center, when you have R1-R5s taking evening-night calls for you, and you come in the morning to review those overnight consults and still get paid. Or coming during the weekend for a few hours, while the senior residents run the show aha! In surgery, having residents and medical students do roundings for you at 6 am, and you come in to operate and go home after saves you a lot of sleep

As a medical resident after 5 years or residency, or 1-2 years of fellowship, I guess that many of us are very geographically limited due to familial or significant others, let alone children. I think that if you are heart-set in one specialty, go for it! You don't want to regret 10-15 years down the road, doing something you don't like, and ask: what if?

[ralk 1,068]

Few doctors in Canada are truly unemployed, that is, without any job at all. Rather, we're seeing big problems with underemployment in some (but not all) specialties, where new grads are taking on lower-paying fellowships, locums, or part time work, instead of landing their desired steady, full-time job. The bills get paid, but life and career goals can get stalled.

 

For medical students looking at the job market, I think the question to consider for each specialty is not whether you'll land a job, but what you're likely to have to do to get one. On one extreme, in something like Neurosurgery or Ortho, it can mean multiple fellowships, perhaps a PhD as well, just to land a community job or in many cases, a job in the US. For more middle-tier job markets, like Rads or some IM subspecialties, it can mean a required fellowship or two for a community position with maybe a shot at an academic job in a larger centre. For specialties with good job markets, like FM or Psych, it means set up shop almost wherever you want, with additional training only being necessary for those looking at specific jobs in academic centres.

 

These requirements do change over the years, so it's important to be concious of where the job markets are trending. Still, it's all about what you're willing to put up with to go into a given specialty. For those who can't see themselves in anything but Ortho, the sacrifices to find a job in that field are worth it. For those who are more flexible about what specialties they can see themselves in and want more guarantees about when and where they can get a job, something like FM might be a better fit.

[LittleDaisy 289]

Ralk: you sum it up pretty well!!!

At the end of day, you will be doing your specialty of choice for at least 30-40 years (if you are terrible with retirement finances aha), choose something you love is the most important thing. It is important though to know what is expected to land a job where you want, i.e, fellowship and extra educational degrees (masters, phD).

We will be spending most of our time working anyway, so what's the point of being in your desired location, but doing something you dislike for over 50+ hours per week? I do understand that some people are more geographically limited due to familial and significant others.

I would say that getting an academic position, the most important thing is to make sure that your staff physicians would want to work with you in the long road, and there is a job position available! Medicine is the art of science and social interactions

[MarsRover 99]

I used to think about just do the thing that you love, and maybe I will still think that if something really jumps out - or if I just hate everything else. The one downside though is the job market. I just saw myself jump through hoops for years to get in school, then interested in a surgical subspecialty that is competitive. So I just sort of think do I want to jump through hoops again for another 4 years putting aside personal life to some degree to be competitive and match, then 5 years of scut work in residency and jumping through hoops to get a good fellowship (which you are doing something you love).. just to then be told yea you are in your mid-30's - but you need to do another 3-4 years of training to do a fellowship or two at a low pay rate still treated like a resident until you are almost 40. Then it's basically like now that you have very narrowed your field, there are only a couple jobs and you need to work on the other side of the country. 

I get the appeal of a specialty. However, when you look at it like that just doing family and tailoring it to how and where you like has its benefits. Though there are aspects of day-to-day family medicine I could see not everyone (including myself) liking. ie. script refilling, chronic disease management, dealing with the brunt of the annoyance from patients that can't have their symptoms solved. 

[Turk 14]

I was wondering where you are able to find information on the job market? Thanks!!!

10 hours ago, ralk said:

Few doctors in Canada are truly unemployed, that is, without any job at all. Rather, we're seeing big problems with underemployment in some (but not all) specialties, where new grads are taking on lower-paying fellowships, locums, or part time work, instead of landing their desired steady, full-time job. The bills get paid, but life and career goals can get stalled.

 

For medical students looking at the job market, I think the question to consider for each specialty is not whether you'll land a job, but what you're likely to have to do to get one. On one extreme, in something like Neurosurgery or Ortho, it can mean multiple fellowships, perhaps a PhD as well, just to land a community job or in many cases, a job in the US. For more middle-tier job markets, like Rads or some IM subspecialties, it can mean a required fellowship or two for a community position with maybe a shot at an academic job in a larger centre. For specialties with good job markets, like FM or Psych, it means set up shop almost wherever you want, with additional training only being necessary for those looking at specific jobs in academic centres.

 

These requirements do change over the years, so it's important to be concious of where the job markets are trending. Still, it's all about what you're willing to put up with to go into a given specialty. For those who can't see themselves in anything but Ortho, the sacrifices to find a job in that field are worth it. For those who are more flexible about what specialties they can see themselves in and want more guarantees about when and where they can get a job, something like FM might be a better fit.

 

[ralk 1,068]

2 hours ago, Turk said:

I was wondering where you are able to find information on the job market? Thanks!!!

 

Hearsay and conjecture mostly! 

Unfortunately great information on the job market for physicians isn't readily available. Some physician groups and government entities are starting to take a closer look at these sorts of human resource issues, but little has come out of that yet. An old report on physician unemployment by the Royal College has some useful data.

Otherwise, I got a sense of the market for various specialties the old fashioned way - talking to people, especially graduating residents. No one knows the job market like people searching for jobs. Keeping a eye on job postings gives a sense as well, albeit an imperfect one. Most jobs in medicine are never posted or don't stay up for long, so job postings can appear more negative than reality. Still, if there are tons of calls for physicians in a given field, it probably has a decent job market. If there are absolutely zero postings, especially in a somewhat larger field or for a long period of time, then that could signify a weak market.

[bearded frog 726]

It's difficult to predict these things. FM will always be a safe bet if that's what you're interested in, however with royal college specialties you are trying to predict a job market 4+5 years, almost a decade, in advance. In Canada the health care system is strongly influenced by politics as well so hard to predict any major shakeups in the future. In Canada the procedural specialties are limited by OR/facility time which is limited by budget which varies a lot by year and political climate. And what if the provinces stop billing for knee scopes due to the lack of evidence of effectiveness? Changes the profession overnight. The non-procedural ones are less strongly influenced, but are influenced nonetheless. Anecdotally, ortho and some of the other surgical subspecies are becoming slightly less competitive to reflect job prospects.

But, you need to also consider the age of current practitioners, and population demographics. I think the CMA has data on average age and demographics of each specialty, so if there is a ton of 55+ year olds than there might be a shortage in 10 years as they retire. Also, psychiatry and anything geriatric is a growth industry. Children are getting healthier in general so pediatrics is shifting to more of a mental health (think autism and ADHD) and chronic disease management specialty, also neonatology is growing as the survivable premature gestational age lowers. Less family doctors are doing obstetrics but midwifery seems to be expanding to take up the slack (province dependant) so the obstetrics side of obgyn is neutral, but the demand for gynecology is increasing with population age, again limited by OR time.

In summary there's lots to consider for every specialty and there are significant pros and cons beyond the practice itself. Your best bet is to find specialists you trust and ask them frankly about life in that specialty. Consider what the senior residents are thinking as they are in the thick of transition, but also talk to recent attendings as well as senior doctors who have seen their professions change.

[Turk 14]

Great, thanks for the advice!!

48 minutes ago, ralk said:

Hearsay and conjecture mostly! 

Unfortunately great information on the job market for physicians isn't readily available. Some physician groups and government entities are starting to take a closer look at these sorts of human resource issues, but little has come out of that yet. An old report on physician unemployment by the Royal College has some useful data.

Otherwise, I got a sense of the market for various specialties the old fashioned way - talking to people, especially graduating residents. No one knows the job market like people searching for jobs. Keeping a eye on job postings gives a sense as well, albeit an imperfect one. Most jobs in medicine are never posted or don't stay up for long, so job postings can appear more negative than reality. Still, if there are tons of calls for physicians in a given field, it probably has a decent job market. If there are absolutely zero postings, especially in a somewhat larger field or for a long period of time, then that could signify a weak market.

 

17 minutes ago, bearded frog said:

It's difficult to predict these things. FM will always be a safe bet if that's what you're interested in, however with royal college specialties you are trying to predict a job market 4+5 years, almost a decade, in advance. In Canada the health care system is strongly influenced by politics as well so hard to predict any major shakeups in the future. In Canada the procedural specialties are limited by OR/facility time which is limited by budget which varies a lot by year and political climate. And what if the provinces stop billing for knee scopes due to the lack of evidence of effectiveness? Changes the profession overnight. The non-procedural ones are less strongly influenced, but are influenced nonetheless. Anecdotally, ortho and some of the other surgical subspecies are becoming slightly less competitive to reflect job prospects.

But, you need to also consider the age of current practitioners, and population demographics. I think the CMA has data on average age and demographics of each specialty, so if there is a ton of 55+ year olds than there might be a shortage in 10 years as they retire. Also, psychiatry and anything geriatric is a growth industry. Children are getting healthier in general so pediatrics is shifting to more of a mental health (think autism and ADHD) and chronic disease management specialty, also neonatology is growing as the survivable premature gestational age lowers. Less family doctors are doing obstetrics but midwifery seems to be expanding to take up the slack (province dependant) so the obstetrics side of obgyn is neutral, but the demand for gynecology is increasing with population age, again limited by OR time.

In summary there's lots to consider for every specialty and there are significant pros and cons beyond the practice itself. Your best bet is to find specialists you trust and ask them frankly about life in that specialty. Consider what the senior residents are thinking as they are in the thick of transition, but also talk to recent attendings as well as senior doctors who have seen their professions change.

 

[rogerroger 156]

If I was looking to apply to med school today, I would not apply. This is based on the job prospects. I predict they will be miserable in 6-10 years from now. I am speaking with the hindsight provided by someone who just finished residency. 

As a premed you might think it's all great doing FM. Maybe you might finish med school and like it. But a significant portion of people would hate to do it and only figure this out during med school. You can't figure this out definitively until well into med school, contrary to what some may tell you or you might think today.

Now imagine you plopped down 100k and 4 years of your life and hate FM and are being forced into it. That is not a happy prospect. 

The future will involve forcing a ton of newly minted residents into FM. A dismal prospect, but one that I can understand from a resource allocation standpoint. It is not a med student-friendly system. That is the reality. 

 

Edited June 1, 2017 by rogerroger

[Arztin 611]

3 hours ago, rogerroger said:

If I was looking to apply to med school today, I would not apply. This is based on the job prospects. I predict they will be miserable in 6-10 years from now. I am speaking with the hindsight provided by someone who just finished residency. 

As a premed you might think it's all great doing FM. Maybe you might finish med school and like it. But a significant portion of people would hate to do it and only figure this out during med school. You can't figure this out definitively until well into med school, contrary to what some may tell you or you might think today.

Now imagine you plopped down 100k and 4 years of your life and hate FM and are being forced into it. That is not a happy prospect. 

The future will involve forcing a ton of newly minted residents into FM. A dismal prospect, but one that I can understand from a resource allocation standpoint. It is not a med student-friendly system. That is the reality. 

 

I agree. I used to think family medicine was cool, until I rotated in family medicine as a third year and now I absolutely hate it. Many students, including myself, do realize that we might have no choice but to do family medicine in the end and that thought is hard to describe...

[indefatigable 726]

.

[MacMed2018 24]

19 hours ago, justwannabeadoc said:

Everything seems to have no jobs  

- U of T MD Class of 2021

except for family and derm where you can go set up shop anywhere.

[rmorelan 2,581]

1 minute ago, MacMed2018 said:

except for family and derm where you can go set up shop anywhere.

quite true - but that doesn't mean you can open shop in all places and actually get a full roster etc. One of the weird things in medicine is the pay/lifestyle differences between specialties and within the same specialty. You won't in many fields be unemployed but you can be under employed. 

[MacMed2018 24]

Just now, rmorelan said:

quite true - but that doesn't mean you can open shop in all places and actually get a full roster etc. One of the weird things in medicine is the pay/lifestyle differences between specialties and within the same specialty. You won't in many fields be unemployed but you can be under employed. 

definitely.  There's a difference between being able to practice and having a thriving practice ... although for Family, it doesn't seem to matter where you go ... patients will find and flock to you!

[indefatigable 726]

15 minutes ago, MacMed2018 said:

definitely.  There's a difference between being able to practice and having a thriving practice ... although for Family, it doesn't seem to matter where you go ... patients will find and flock to you!

I don't think that's really the case in FM anymore.  Example - Windsor Ontario, historically deprived of physicians, but now starting doctors are actually giving incentives to patients apparently.  Windsor isn't a very large city.  Of course it would be even more saturated in a lot of specialties.  

Edit: There is even talk within Quebec of possibly reducing med student enrolment due to the situation.  There's always the paradox of underemployed physicians coupled with medical need, just don't think it will be resolved anytime soon.  

Edited June 2, 2017 by calcan

[Arztin 611]

Montreal is already starting to be full when it comes to PREMs for FM. 

[indefatigable 726]

.

[justwannabeadoc 28]

This entire conversation makes me sad. Thank you for all your replies though!

[rmorelan 2,581]

27 minutes ago, justwannabeadoc said:

This entire conversation makes me sad. Thank you for all your replies though!

There is a balance between the hopefully optimism of people trying to get into medical school and medical students, and perhaps the more in the trenches cynicism of those later on that I think is a health place to end up in the end. If you are in this long enough you see people making a lot of sacrifices that don't always work out, and not everyone is happy with their choices in the end. You see people struggle at each step of the way. You see a lot of external forces at play that will likely get worse as time goes on - politics is everywhere. 

Just because things aren't perfect doesn't mean it isn't worth doing

[PeterPatting 53]

4 hours ago, Arztin said:

I agree. I used to think family medicine was cool, until I rotated in family medicine as a third year and now I absolutely hate it. Many students, including myself, do realize that we might have no choice but to do family medicine in the end and that thought is hard to describe...

If you don't mind sharing, what about FM did you/your peers not like?

[ralk 1,068]

2 hours ago, justwannabeadoc said:

This entire conversation makes me sad. Thank you for all your replies though!

I think it's worth keeping things in perspective with relation to job markets in similar professions. I disagree with rogerroger's opinion that the job market makes going into medicine not worthwhile. Right now, aside from a few select specialties, pretty much all graduates eventually get a job. It may not be in their desired location or entail doing exactly the work they'd like to do, and probably requires at least an extra year of training than anticipated, but jobs do come eventually. Additionally, physicians benefit from being paid while doing training in most circumstances, with a rather good salary.

Again, it's about trade-offs. Many specialties in medicine require you to move - often multiple times, often to less-preferred locations - and involve career paths that take longer than desired to land an acceptable position. Yet, that's true of almost every profession these days. Dentistry, law, finance, academia, consulting - the high-paying professions require mobility, patience, and persistence these days. That medicine has a fields like FM, Psych, Geriatrics, Rheumatology, EM, and Derm, comprising over half of all graduates, that still have good job markets and average incomes well above other non-medical professions means that medicine as a whole is still doing relatively alright job-wise. There are downsides to pursuing medicine that other professions avoid - longer and more random hours, often less independence, less flexibility to change career paths within the profession - but then we get back to trade-offs. At this stage, I don't think the job market alone should scare people away from medicine, though it should be considered as part of the pros and cons of pursuing it versus pursuing other careers.

[NLengr 787]

On June 1, 2017 at 2:08 AM, LittleDaisy said:

I think that there are jobs, but not WHERE you want to be! A few years of locum is expected for surgical or some IM specialties (resource-heavy), or any resource-intensive specialties (radiology, anesthesiology, radiation oncology, etc)

A few of orthopedics resident or surgical residents that I have worked with actually did find jobs, but in remote rural areas. Academic positions are pretty competitive nowadays, a masters, even phD has become a norm; 1-2 years of fellowship are expected. Let alone the stress of hoping landing a job in urban area, and stand out among your peers for 1 position throughout your training.

Let's face it, it's so much life-friendly to work in an academic center, when you have R1-R5s taking evening-night calls for you, and you come in the morning to review those overnight consults and still get paid. Or coming during the weekend for a few hours, while the senior residents run the show aha! In surgery, having residents and medical students do roundings for you at 6 am, and you come in to operate and go home after saves you a lot of sleep

As a medical resident after 5 years or residency, or 1-2 years of fellowship, I guess that many of us are very geographically limited due to familial or significant others, let alone children. I think that if you are heart-set in one specialty, go for it! You don't want to regret 10-15 years down the road, doing something you don't like, and ask: what if?

You've assumed that community surgery jobs are just basically academic jobs without residents, which isn't true at all. The style of practice in the community is much different which makes the lifestyle much better. For example, the ER only calls you overnight for actual emergencies that need OR right now. That's probably about 0-5% of the ER consults you get in an academic center, where they don't give a shit about waking you up cause you are a resident. That's just one example. There are many others. 

There are jobs around in my specialty but you need to be willing to move around and work community. Every person I know in my soecialty who  finished is working, just maybe not in thier dream job. Almost everyone seems happy though. 

[Arztin 611]

15 hours ago, PeterPatting said:

If you don't mind sharing, what about FM did you/your peers not like?

Some problems are related to the nature of FM:

- The main problem I realized is that you just don't have enough time per patient. For example, I saw many elderly patients with multiple comorbidities. A 10-15 minute yearly visit just isn't enough time to take care of the patient properly. I have seen some staff doing a mix of hospital and office and after a while, they decided to not do office anymore because of this problem. Edit: again, might be a bias due to my own clinical exposure.

Some are more purely personal:

- I prefer being able to order tests fast in the hospital instead of having them go to the hospital, then having them back in the office a few days later

- I prefer treating sick patients than dealing with ''healthy'' patients

- I don't want to have to follow patients

- Probably every specialty becomes repetitive after a while, but dealing with people who come to the office with a common cold and small rashes is not very exciting for me personally

Edited June 2, 2017 by Arztin

[justwannabeadoc 28]

4 hours ago, NLengr said:

You've assumed that community surgery jobs are just basically academic jobs without residents, which isn't true at all. The style of practice in the community is much different which makes the lifestyle much better. For example, the ER only calls you overnight for actual emergencies that need OR right now. That's probably about 0-5% of the ER consults you get in an academic center, where they don't give a shit about waking you up cause you are a resident. That's just one example. There are many others. 

There are jobs around in my specialty but you need to be willing to move around and work community. Every person I know in my soecialty who  finished is working, just maybe not in thier dream job. Almost everyone seems happy though. 

What is your specialty if you don't mind sharing?