High Unemployment, Long Hours

The current job market for physicians is a bit weird right now. There are several specialties with a combination of high unemployment/underemployment (by physician standards), but long work hours for those employed and generally high pay. Many surgical specialties fall into this category. I've expressed that this is a rather absurd situation, as physicians who likely need shorter hours and have the per-hour income to afford an associated decrease in take-home pay from working less have plenty of people to pick up additional work yet who aren't being utilized.

I haven't had a good reason for why this isn't happening, so I've assumed that physician stubbornness (or perhaps greed) in these specialties is to blame.

I stumbled across a random comment that may provide a better explanation, essentially boiling the situation down to bargaining power. Hospitals and universities in Canada would generally prefer to hire the minimum number of specialists necessary to get the work they have done. In specialties with more physicians than positions, the hospital (or physician group) has additional leverage to insist on longer hours - after all, if one physician doesn't want to handle a standard load, there are plenty of other physicians who would gladly do the work.

Similarly, in specialties where the number of positions vastly exceeds the number of available physicians, it's the doctors who have the bargaining power. The is a major need for more psychiatrists, yet they tend to work relatively short hours. Same for Emergency Medicine, which has reformed itself to have comparatively light schedules, albeit with shifts at all times of the day, and has a very favourable job market.

Granted this doesn't explain everything - Radiation Oncology has low average work hours, decent compensation and a terrible job market. Patient population, culture within the specialty, and funding models obviously have an impact on the work hour and employment situations. Nevertheless, it's an interesting theory that I thought I'd share, one I intend to keep in mind as the job market in certain medical specialties evolves.