The Job Hunt II - Geographic Variations

Even within the United States, medicine is highly geographic. In medical school, we all learn about and lament geographic disparities in health care delivery and outcomes. However, when we start looking for a job, we're just as reluctant to go to rural America. It's unfortunate, and yet a harsh reality. It seems that the best way to get physicians into places that need them is to recruit medical students from those areas and backgrounds.

Nevertheless, geography is perhaps the most important factor for a graduating resident in search of a community position. Even a year before I finished, I started getting postcards from places that were desperate for an anesthesiologist. If you're interested in the Midwest or South, a job awaits. These really aren't bad options; given the salary increase moving from resident to attending and the low cost of living in many of these places, it is a great way to work down debt. Furthermore, many of these areas are in need of well-trained physicians, and it can certainly fulfill that desire many of us have when we first enter medicine to really help a community.

Nevertheless, because of family, friends, our social network, our fear of inclement weather, our personal desires and goals, or any dozen other reasons, we tend to stay in the place we did our training, and often, that means in places that are replete with physicians. The Bay Area, for example, is a tight market. When I first started sending out letters of inquiry, half of my emails got no response, and a quarter got a "Thank you for your interest, but we're not looking to hire." Only a few groups were actively and publicly recruiting; most were only looking around through contacts or not necessarily in need of another doctor. Thus, all my colleagues in the Bay Area felt intense pressure if they wanted to stay. In fact, more than half my residency and nearly 90% of my fellowship class ended up leaving this area because there simply weren't acceptable jobs. This can be really scary, and it's why even for a well-trained highly qualified physician, finding a job isn't a walk in the park.