Context.— Studies analyzing the physician workforce have concluded that the United
States is verging on a physician oversupply, yet we lack persuasive evidence
that this is resulting in physician underemployment and/or unemployment.
Objective.— To determine the degree to which graduating residents have difficulty
finding or are unable to find employment in their primary career choices.
Design.— Two 1-page surveys sent separately to residents and to program directors
to collect information on the employment status of residents who were completing
a graduate medical education program at the end of the 1995-1996 academic
Setting.— A total of 25067 resident physicians scheduled in the spring of 1996
to complete a residency program accredited by the Accreditation Council on
Graduate Medical Education, and 4569 program directors in 31 specialties and
Main Outcome Measure.— Both the graduates' employment status and the degree of difficulty they
experienced securing a practice position, as reported by resident physicians
and program directors.
Results.— After 6 months of data collection, 12135 (48.4%) of 25067 resident physicians
responded to the survey. Of the respondents, 11200 had completed their training,
and 7628 (68.1%) were attempting to enter the workforce, 28.4% were seeking
additional training, and 3.5% were fulfilling their military obligations.
Of the 7628 resident physicians who sought employment, 67.3% obtained clinical
practice positions in their specialties, 15.5% took academic positions, 5.0%
found clinical positions in other specialties, 5.1% had other plans, and 7.1%
did not yet have positions but were actively looking. In addition, 22.4% of
resident physicians who found clinical positions reported significant difficulty
finding them. The subgroup reporting greater difficulty finding clinical positions
included international medical graduates (more than 40%), those completing
programs in the Pacific or East North Central region, and those in several
specialties. The 1996 graduating residents reported significantly higher rates
of difficulty finding suitable employment than program directors reported
for their graduates (22.4% vs 6.0%); however, the percentage of graduates
reported by both groups as entering the workforce was the same (68.1%). Program
directors reported an unemployment rate of only 1.2%, for their 1996 graduates,
which was less than the rate reported by the resident physicians (7.1%).
Conclusions.— Resident physicians' direct reports of their employment-seeking experiences
differ from what program directors report. Program directors accurately determined
the number of residents pursuing further training; however, they did not have
complete information about the employment difficulties experienced by their
graduates. Based on graduates' reports, we conclude that employment difficulties
are greatest among international medical graduates and vary by specialty and