The Road through Residency:

The Classifieds

As graduation approaches you can see the apprehension in many of the third-year resident’s eyes. After three years of caring for patients in the hospital and clinic, having placed tubes into the throat, and catheters into every conceivable vein in the body, there comes a more daunting task. It isn’t the looming board examination in Internal medicine or the application process to obtain a license, although those are both frightening endeavors. Instead, the graduates, months clicking down until they finish their residency, face their most difficult challenge yet: finding a job.

“A lot of fellows nowadays have a B.A., M.D., or Ph.D. Unfortunately, they don’t have a J.O.B.
— “Fats” Domino

I page through the back of one of the many medical journals littering my desk, perusing the classifieds section. I see “hospitalist needed in Poughkeepsie, New York; nocturnist wanted in Little Rock, Arkansas; general internist position available in Rock Springs, Wyoming.”  The internal medicine and hospitalist sections of the classifieds are the most extensive sections in the entire journal. Unfortunately, few of them look interesting to me, so I put down the journal and jump online. I find similar want ads about positions and job openings throughout the search engines. There are rural positions and academic hospital openings, permanent position offerings and locum tenens (a temp position), and generalist or more specialized hospitalist jobs. Feeling like I am drowning in this flood of choice and opportunity, I turn to my most trusted resource, my fellow colleagues and ask them a complex, yet pointed, question, “So whadda ya up to next year?”

We’re not really trained to assess the business aspect of applying for a job in internal medicine, and although there is some consolation in the amount of options, you still feel overwhelmed by the extensive research that comes with looking into business contracts. A few clauses here, addendums there, and you feel more lost. So you hit up the closest consultant to you, an attending you trust. I start to pursue this research by finding some of the younger internists I know and asking them what to do about this and that while looking for a job. The responses are, shall we say, mixed. I remember sitting down with a more senior attending physician who would carefully lay out what questions I would want to ask about vacation, call schedule, ancillary support, health benefits, and incentive packages. Another younger attending gave me very clear advice, “Get a lawyer to look at it.”

The experience underscores the maze of the ‘hidden curriculum’ that exists in the training to become a physician. There are no lectures, textbooks, or journal articles that cover this aspect of the practicing physician, and yet we still must learn it. As I page through another medical newspaper for further classifieds, a fellow senior resident sits down next to me in the lounge. “Looking for a job?” he asks.

“Just looking for now,” I reply. The statement strikes me as the same as someone whose clunker is about to give out paging through the car ads.

“I just finished my third interview,” he says.

I sit up and listen intently, “So what was it like, did they talk about salary, incentives, vacation and stuff?”

“Well, let’s put it this way…I liked it better when I was a resident.”