Job Market and Physician Career Choices

As I've said, one of the parts of clerkship I really enjoy is getting more opportunity to hear from residents and other clerks about what their future career goals are and how they're going about achieving them. Rather than just hearing from your friends, you suddenly get exposure to a lot of diverse opinions and priorities. As someone overly interested in the medical training pipeline, that broad on-the-ground perspective is invaluable.

It could be just the group I'm talking to, but the trend in long-term career interests definitely seems to be responding to the job market, with one big exception. That exception is those interested in surgery, who seem perpetually immune to job market changes, though I'll admit there seems to be a trend away from the truly awful job markets like Ortho and Neurosurg. For the non-surgeons, fields with good job markets certainly seem to be getting more attention: Family, Psych, Emerg, Derm. Likewise, talking to Internal Medicine residents, the in-demand subspecialties are getting more attention, particularly Geriatrics.

However, while trainees seem increasingly responsive to job market considerations, the supply of physicians isn't. For a variety of reasons, the number of trainees each year in each specialty is roughly constant. There's some slow movement based on job markets, but that's decided by governments, medical schools and residency programs, not by trainee interest. Specialties get more or less competitive in the sense that an interested applicant may have a higher or lower chance of securing a highly-desired spot, but in the end the vast majority of Canadian grads get matched somewhere and the vast majority of offered residency positions get filled, whether by Canadian grads or international students. There are market forces at work, but the physician training pipeline isn't a market system (whether it should is a whole other discussion), so it's not responding to those forces, or is doing so at glacier speed.

I'm eager to see what this year's match results show. In particular, I've got my eye on Psych and Emerg. Psych's traditionally been an easy specialty to match into, but mental health is seen as increasingly important and it's hard to beat its combination of job market and lifestyle. On the other end, Emerg has been ultra-competitive, looks to be even more competitive, yet still has one of the better job markets. How those fields change in terms of competitiveness - and how schools respond to that change - will tell us a lot about how physician human resources are going to look in the next couple decades.