The Other Side of July

The fourth of July weekend for many Americans means fireworks, family, picnics and barbecues, corn-on-the-cob, and apple pie as we celebrate the anniversary of our country's independence. While many are packing up their bags to head off for a long weekend vacation, former medical students are being filled with anticipation as they begin the craft they've so carefully prepared for: treating real live patients in a real live hospital. How exciting! How terrifying! Like a great action film full of tons of plot shifts and chase scenes - it's an exciting ride. So much so that those of us "older" doctors love to reflect on this time of our careers, even offering tips to the new folks on how to succeed.

But for all the pomp and circumstance of the moment, first year residents are still sheltered and spoon-fed within our academic medical model thanks to work-hour restrictions, training requirements for surgical or medical specialization, and reguirements for licensure and certification of training programs. Slowly and gradually, we see the careful guidance of our newly-minted doctors through training as they are sculpted into tomorrow's American Doctors. Each step is carefully choreographed. Each step funded either by the student themselves or from government subsidies.

But there is another side to July.

While one group of doctors are going into training, another is going out. Doctors stop paying into the education system and start taking: it's the side where doctors' years of delayed gratification suddenly turn into months or years of delayed realization about the job market.

Most used to think it post-training employment was pretty simple: continue as a teacher or researcher of medicine in a familiar academic role or enter a risker (but potentially more lucrative) world of private practice medicine.

But the private practice model is much less certain now.

For young specialty doctors who find a job, they are thrilled. But hospital positions for specialists are less plentiful now as former independent practices are increasingly consolidated by large hospital systems that place their newly-joined specialists on productivity quotas. Who wants to hire when the current market specialists are at larger and larger risk of making less money? Hospitals are the new employers now, not private groups. The market forces have suddenly shifted so hospitalist positions are plentiful and specialty positions less so.

And large education debts for these new doctors are coming due. Those not so lucky to find a local job are realizing they will have to find a job and find it fast. They ask themselves "How will I pay my bills?," "Will I have to move?", "If so, where?"

So their job search net is cast further than they ever imagined. They meet new doctors in new places over dinners promising the world. As a result, decisions are made and contracts signed without a clue about the local patient referral and practice politics in play. You see that information can't be found in a contract. Still, our new doctors are happy to have landed a job even though it's nowhere near the location they had imagined. They try to get situated. Try to make a home. It'll be perfect, really.

For these happy doctors I have one more piece of advice. Please, trust me on this:

Rent, don't buy.

Because it's not that you're a bad guy or gal, it's just that there's a good chance you'll soon be moving again.

-Wes