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May 6, 1998

Physicians Enter the Job Market

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JAMA. 1998;279(17):1399. doi:10.1001/jama.279.17.1399-JMS0506-3-0

The model of the past, when medicine was a reliable field in which hard work was rewarded by a stable and comfortable lifestyle, no longer holds true. There is more opportunity, however, away from the bedside than ever before. Physicians are among the most capable individuals in the workforce, and their particular training in the biomedical and clinical sciences makes them a valuable asset to law firms, businesses, consulting firms, and other corporations.

The worsening job market and changes in the practice of medicine motivated physicians to leave patient care and seek alternative careers.1 The experience of physicians in California, where the health care market is already deeply penetrated by managed care, illustrates the frustrations with which many physicians are dealing.2 In a 1995 survey of office-based MDs and DOs, 21% of physicians over age 50 said they wanted to retire or sell their practices within a year.3 A San Francisco survey of 173 practitioners of mental health found that 43% were considering leaving the field.4 There are also indications that specialists in certain fields have found it necessary to relocate to other states just to maintain a sufficient patient population.5

In 1997, physician focus groups conducted by the American Medical Association met to discuss physician career management in an era of increased demand for efficiency, productivity, and cost-cutting.6 As a group, they identified work pressures and job insecurity as leading causes of dissatisfaction in clinical careers. In addition to these compelling dissuasions from patient care, MDs may soon find that clinical practice may not be an option, as the job market for clinical positions is already more than saturated and will soon be forced to absorb a surplus of trained physicians.7

This problem was forecasted early in this decade, by the Council on Graduate Medical Education.8 Preventive measures such as limiting the number of graduate medical residency positions to 110% of the national graduating class size and eliminating up to 25% of US medical school programs in the next 5 to 10 years have been widely iterated suggestions but have yet to be fully implemented.

While reasons to leave the field of patient care may become more pressing, fortunately, inducements for MDs to enter other fields are rapidly growing. No longer does the acquisition of medical training imply a lifetime of work limited to the clinical setting. Today, physicians are finding that a medical degree opens the door to an increasing number of opportunities in a variety of settings.

There has long been a sizable portion of physicians involved in occupations outside patient care. In 1980, of 373503 MDs in the United States, at least 59000 (15.8%) were not involved in patient care. In 1994, the number was nearly unchanged (57000), although the proportion of these MDs sank to 10%, likely as a result of the lucrative return for providing patient care in the 1980s.9 With an anticipated physician surplus as high as 200000, this absolute number can be expected to increase dramatically over the next decade.

The question of exactly how 200000 surplus MDs will be employed remains to be determined. A look at past practices and current trends may prove useful. In 1990, Rucker and Keller10 assessed the breadth of involvement in alternative careers of the then 11.8% of physicians outside clinical practice. They identified more than 900 employment opportunities in 12 broad categories. While physicians have entered professions as varied as politics and entertainment, the careers that will hold the most opportunity for them are those for which a medical education is particularly suited. Three fields that are full of opportunities for MDs are bioinformatics, patent law,11 and governmental legislation and policy.

The newest surge of employment for MDs may come from the young field of bioengineering. Several chemical giants have recently shown a keen interest in developing genetically engineered food sources. These massive undertakings will undoubtedly require medical doctors to carefully evaluate the safety of these products, as well as to address skeptical consumer groups.

The key to taking advantage of these options is the realization that a medical career needs to be developed and managed for an entire career life cycle. The idea of actively managing a career is a new and unwelcome concept for most physicians, but is a reality that must be addressed to ensure employment in today's complex marketplace. Numerous resources are available commercially to guide the physician in the process of self-assessment.12-1316 New niches abound, and the creativity and resourcefulness of physicians will help them find a variety of alternate ways to employ their skills.

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Hymowitz  CPollack  EJ Psychobattle. Wall Street Journal. July13 1995;A1
Ginzberg  E The future supply of physicians. Acad Med. 1996;711147- 1153Article
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Timpane  J Six hot careers: biotechnology, pharmaceuticals, and beyond. Science. 1996;273 ((suppl)) 1898- 1913
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American Medical Association, Managing the Job Interview.  Chicago, Ill American Medical Association1997;
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