Graduates entering the job market during an economic downturn are compensated significantly less than graduates joining the workforce during economic prosperity. The reduction in pay may be close to 10 percent, and although this starts to improve a few years later, the negative effect can last up to a decade. (Stanford Institute of Economic Policy Research. April 2019; https://stanford.io/2TbktUX.)
It is also during that first decade of work that most employees experience the highest degree of professional advancement. The repercussions of entering the workforce at an unfortunate time like the COVID-19 pandemic have a potentially huge lifetime impact on personal wealth.
We are watching our robust economy deteriorate into utter desperation during this historic pandemic, with an unemployment rate approaching one in five working Americans at press time. (Time. May 7, 2020; https://bit.ly/2T9iArW.) But emergency medicine residents were concerned about their future job prospects even before the world descended into COVID-19 chaos.
For the past 30 years, it's been taken for granted that emergency medicine grads could choose from several highly compensated jobs in a wide variety of locations. As I have detailed in several columns, however, historic increases in the number of emergency medicine residents, coupled with the dramatic increase in advanced practice providers, create doubt that as many employment opportunities will be there for them. (“Is There an EM Residency Glut,” EMN. 2019;41:1; http://bit.ly/2or6kqm; “The Invasion of the Physician Assistants,” EMN. 2019;41:1; http://bit.ly/37ZBQOv.)
The media show us desperate health care workers overwhelmed by dying patients infected with COVID-19, but many areas of the country, mine included, have depressed patient volumes because local residents are reluctant to go to a hospital. Stories abound of people with surgical and medical emergencies suffering at home for days because they are afraid to seek help. Recently I cared for a woman who waited at home for six days with an intraperitoneal abscess until she could no longer stand the pain.
Current EM residents need to think carefully about their future employment, and it will likely be a significant departure from the past perception of being able to train anywhere and get a great job wherever you want. Even if the pandemic recedes quickly and our economy experiences the recovery we all hope for, it will not affect the market pressure to drive up the supply of emergency health care providers. “It's just business” is not just a cliché; it is the management strategy of most businesses.
EM graduates use three parameters to evaluate a job: compensation, geography, and what they do at work. In my experience, the most persuasive parameter is geography. Most graduates want to be close to family or in a familiar region of the country, while a few others want to live someplace new. But as the various pressures continue to shrink the pool of practice opportunities, good jobs may be in areas far from what is desirable. Another way of thinking about this is that the EM job market may become more and more like that of most other professions—you have to go where the work is.
Current EM residents should also consider what new graduates in other fields do when economic conditions are poor—they go back to school. Consider a fellowship if you are finishing residency between ages 28 and 30, have a manageable amount of debt ($200,000 or less), and don't have a large family. Many new EM fellowship programs have started over the past decade, and many do not fill up. Having a highly sought-after skill can make you more competitive. Besides, you can pass your boards, pay off a little debt, allow the economy to improve, and avoid becoming entrenched in a new job that you were not entirely enthusiastic about taking in the first place while you are in fellowship. Don't be the person who buys a big house and has a couple of kids after finishing residency when you really want to be someplace different doing something else. Remember, a 30-year career is 30 years long. What's the rush?
And think outside the box. The dramatic increase in business conducted via Zoom, Skype, and many other internet-based meeting platforms includes telemedicine. I recently talked with a cardiologist who said he was as busy as usual seeing patients online, and he hypothesized that many of the administrative staff working for his group before the pandemic might not be needed in the future because their duties can be fulfilled by online resources. “After all, the patients can sign in online, record their pulse, blood pressure, and weight,” he said. “They can even pay their bill. If I need lab studies, I can send over a car to do an ECG, collect blood, and do a quick echo to look at their ejection fraction.”
There are two telemedicine fellowships listed on the website of the American College of Telemedicine. How much do you want to bet their applicant pool is exploding?
This may not be the time to focus narrowly on your first job out of residency but to think more broadly about how to diversify your skillset. If ED patient volumes stay low or your new employer decides to decrease physician staffing in place of cheaper coverage by APPs, the last physician to join the group will likely be the first to leave (that would be you). Think carefully about when it's best to take your first real job and what other valuable skills you can acquire in the meantime to secure your position.
Dr. Cookis the program director of the emergency medicine residency at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter@3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.