Two years ago, I (Kevin) watched as our program's graduating class departed our community hospital in southern New Jersey to start new careers in fabulous destinations. Several were headed for sunshine, the coast, prestigious cities and programs, and underserved communities in difficult-to-reach places.
These graduates talked of their job-hunting experience with an ease and comfort that reassured me after a difficult PGY-1 year. We were told to prepare our CVs because we would enjoy the same experience in one short year. I was excited by the idea of swatting away recruiters who were anxious to pique my interest with fabulous job opportunities and lucrative bonuses. I listened as attending physicians and the faculty in our program echoed these same sentiments as truths that had been consistently demonstrated since their own residency graduation in the BC (before COVID) times.
They reiterated the advice they provided year after year: Our fates were finally in our own hands. We, a group of students and then doctors who historically had left so much up to chance and algorithms on match day, were in control. Post-residency employment is the first time that I would be able to make affirmative decisions about my career that were not dictated by the training system.
Not Enough Hours
Fast forward to the new year, 2020, and a new virus was emerging far from home. The news showed health care workers abroad in full hazmat suits combating a virus with staggering mortality rates, and we in U.S. health care started to get apprehensive. Late winter became spring, and as April, May, and June arrived, we watched our new graduating residency class give the same speech and advice we heard the year before. A handful had been affected by the pandemic; they had had to surrender bonus money, but remained employed.
One graduate actually lost a position, but it was in a competitive location and no one seemed fazed or worried. The overarching tone was one of celebration, and we were again told to prepare our CVs in anticipation of the coming job feast.
Meanwhile, our attending coverage narrowed. They removed shifts and completely restructured our ED pods due to falling patient volumes and to cohort COVID patients. Colleagues in other programs across the country echoed these experiences as volumes plummeted and patients stayed home. Mentors advised, though, that the job market never changed: “Get your CVs ready,” they said.
These current employment waters feel uncharted as we watch our graduating classes attempt to stay afloat. Gone are the days of cold-calling an ED in your region and expressing interest to be offered an interview. Recruiters are bewildered in a situation in which they would have previously been salivating. We observed a soon-to-be graduate lose an offer for a spot in a private group despite close family ties because there “weren't enough hours.”
Sympathy, No Advice
Across the employment board, hours were cut, belts were tightened, and the job market once promised as glorious and fruitful was no more. Even our home program didn't hire a graduating resident for the first time since its infancy. I (Kevin) had a job offer revoked at the request to negotiate the terms and rate, an indicator of how the supply of providers was so much higher than the demand. These stories were not the exceptions but rather expressions of a new rule in our field. Soon-to-be graduates in other programs were panicking and settling for jobs they never would have previously considered. Yet, the feedback from leadership was sympathy, not advice.
That sympathy was appreciated, but minimal concrete guidance was provided to graduating residents when they needed it most. Certainly, when asked to review CVs and contracts, faculty stepped up as they had in years past, but no one had advice on how to navigate this new, difficult job market. Was pursuing a fellowship to improve marketability and waiting out the current trends the best path? No one knew. How can graduates, as candidates who have fulfilled the necessary ACGME and RRC requirements for residency graduation, distinguish themselves from other fresh graduates and physicians with decades of experience? No answer. By mid-October, graduates were scrambling, flying to faraway interviews on a promise for decent pay and a more lenient commitment structure. This experience was not the exception but the norm.
Many graduates chose to pursue fellowship out of academic interest, love of teaching, and the hope that they were strengthening their CVs. Will this help them stand out among next year's graduating class of high-caliber emergency physicians? None of the faculty could counsel if this was a sound strategy. Our community ED faculty viewed this as a year of lost wages in comparison with potential earnings. It was never contextualized among the global pandemic and present job market.
Now, more than a year into this new job market, mentors are still at a loss for how to provide the best advice. Frankly, upon reflection of the experience, we think faculty mentors were never really good employment advisers because they didn't need to be. The market didn't necessitate it. Mentors and advisers could provide a contact's information or direction toward a local group that had an opening, but they never focused on standing out among a nation of our peers because jobs abounded, and our field was churning out residents to fill them.
We can't keep feeding our graduating residents the same advice. It's insufficient to tell them to polish their CVs, subscribe to job application websites, and wait for offers to roll in. This is a situation graduating residents have likely never been in before. It is a place that our specialty has never been before. It is our hope that our mentors will take a more active role in career advising, use the recent class's struggles as a case study to educate themselves, and find new ways to support, empower, and guide graduating residents. We worry the current market trends will be slow to recover, and we will end up with a lost generation of emergency medicine residents.
Dr. Kucharskiis currently an emergency ultrasound fellow at Georgetown/Washington Hospital Center in Washington, DC, after having completed a three-year emergency medicine residency at Inspira Health Network in Vineland, NJ. Follow him on Twitter@kev_kuch. Dr. Blazaris the emergency medicine clerkship director and the assistant research director at Inspira Regional Medical Center in Vineland, NJ, and an associate professor of emergency medicine at Rowan University in Glassboro, NJ. Follow him on Twitter@eblazar.