Some new doctors are discovering that a medical degree is no guarantee of a job, especially in popular parts of the country.
A study in Wednesday's Journal of the American Medical Association found that more than 7 percent of resident physicians surveyed by the AMA in 1996 did not have positions within six months of completing residency.It's not like it's horrible out there. Many doctors still make a living that most Americans would deem very comfortable - $199,000 on average in 1996, though that figure is somewhat inflated because of specialists like neurosurgeons who make more than $300,000.
"You won't see physicians standing on a corner holding the proverbial `Will do bypass surgery' signs," said Dr. Kevin Grumbach of the Center for California Health Work force Studies at the University of California at San Francisco.
But there are areas where it's more difficult to find a job - namely along the West Coast and around the Great Lakes, according to a survey of 25,067 doctors who completed their accredited U.S. residency programs in the spring of 1996.
There also are too many doctors chasing too few jobs in specialties such as anesthesiology, cardiology and gastroenterology.
The ever-shrinking health-care dollar has left some doctors scrambling to join well-established private practices or HMOs, often for less money - particularly if they're set on living in a popular state.
At the same time, an increasing number of non-physicians - nurse practitioners, midwives and nurse anesthetists, to name a few - are performing tasks that doctors used to do.
Some new doctors see "super-specialization" as the way to secure a good job.
Dr. Jonathan Shifren, a Harvard-trained plastic surgeon, is now doing a fellowship in "aesthetic surgery" in Beverly Hills to make himself more marketable. "A diploma is simply a wall decoration," he said.
Other doctors are going in the opposite direction, opting for the broad skills of family practice or internal medicine.
Doctors are "still able to maintain an income level above what the free market would otherwise provide. But are salaries increasing the way they used to? Not at all," says Dr. Itzhak Jacoby, director of the Center for Health Quality Assessment at the Uniform Services University of the Health Sciences, a training center for military doctors in Bethesda, Md.
Another study, also published in Wednesday's JAMA, found that the number of non-physician clinicians graduating from training programs more than doubled between 1992 and 1997 - from 8,850 to 18,496.
Grumbach said he thinks that that, once again, universities are headed for an oversupply of doctors and clinicians. He and others have called for a public-private collaboration to make hard decisions about quotas.