Will I Have A Job When I Finish My Residency?

This is an article that I wrote for the ASCP, featured in Pathology Today. I am republishing it on this blog space in hope of getting your input with the permission of the American Society of Clinical Pathology. It can also be found at http://www.ascp.org/AboutUs/Newsroom/pathologytodaynews.aspx


Will I Have A Job When I Finish My Residency?
What pathology resident doesn’t have that question on their mind? I’ll bet not many. It’s only natural to look forward to the start of your professional career. Many of our non-physician friends – even those with post-graduate education – have been in the workplace for years now. (I’ll also bet that they keep asking you the same question they ask me:"So when are you going to finish?" During the holidays, I ran into a high school friend who informed me that he had been practicing law for seven years. I nearly dropped my eggnog.) So, yes, I am a little anxious about the Pathology job market. In an attempt to ease this anxiety, I turned to the ASCP Resident Job Market Survey to give me some insight. Here is what I learned. [You’ll find the complete report in the News section at this link: http://www.ascp.org/MyAscp/ForResidents.aspx]

Significance of the 2006 ASCP Resident Job Market Survey
For 10 years the ASCP Resident Job Market Survey has been providing graduating residents with data about job availability by geographic location, practice type, salary, and lately, the expanding fellowship market. This year’s survey was different from the others for two reasons: 1. There were two graduating classes of residents entering the job/fellowship market – a result of the American Board of Pathology’s decision to shorten residency training. 2. For the first time, the Job Market Survey was attached to the ASCP Resident In-Service Exam (RISE).That meant that the survey statistics are based on virtually 100 percent participation of the graduating residents.

Residents, Fellows, and Jobs
According to the 2006 Job Survey, 278 (37%) of the 742 respondents finishing their residency had applied for a job.Of those, 71% had interviewed for 1-3 jobs, 9% had interviewed for 4-6 jobs, and 3% had interviewed for greater than 6 jobs.The remainder (17%) had not yet interviewed. Eighty-five percent of those who had interviewed were offered at least one job; 50% of those were offered more than one job. These percentages are very similar to those from previous years. Surprised? I was, considering that last year was exceptional in terms of the number of graduating residents.Then I realized why the numbers had probably not dropped.Again, there were two reasons: 1. There has been a rapid increase in the number of non-ACGME-accredited fellowships. 2. Almost half of the accredited fellowship positions were not being filled prior to 2005.This provided significant room in the fellowship market to absorb the extra "graduating" class of residents.

Fellowships
According to the ASCP Survey, 638 of the respondents were finishing their residency training (PGY-4 or PGY-5); 702 respondents (PGY-3 and higher) indicated that they had applied for a fellowship within that year. Of the graduating residents, 174 (excluding fellows) had applied for a job. Assuming that those who applied for a fellowship did not apply for a job, approximately 464 (73%) of the graduating residents chose to apply for a fellowship position.

What Effect Will This Have on the Workforce?
Using these numbers, I speculate that there are approximately 450 fellows in Anatomical and Clinical Pathology this academic year in both ACGME accredited and non-accredited fellowship programs. It is difficult to compare this number to previous years because no one is keeping track of the non-ACGME-accredited programs, but I think that we are safe in making the assumption that there are more fellows now than ever before and thus, more fellows applying for jobs next year than in any year previously. Suffice it to say, getting a job without a fellowship will be much harder in the future. That was confirmed during the Resident Luncheon at the ASCP Annual Meeting in Las Vegas last October by pathologists from the private and public sector who participated in the "How To Get a Job" panel for residents.The underlying message was, as I’ve said, that fellowships are becoming more important in securing a job in pathology. In essence, the fellowship year is taking the place of the 5th "credentialing year" that was recently dropped from residency training. Determining how these changing dynamics in the profession will affect the overall workforce is tricky. In general, you might think that it would not disrupt the number of jobs available as long as you complete a fellowship but there is one caveat.To my knowledge, most programs have not decreased their total resident number in response to the change in the length of residency training. On the contrary, they have increased the
number of residents per year to compensate. For example, if your program has 20 ACGMEfunded residency spots, it probably switched from having 4 residents per year (4 residents × 5 years = 20) to having 5 residents per year (5 residents × 4years = 20). Therefore, your program is graduating one extra resident per year, which ultimately increases the total graduating rate by 20%.The ASCP Resident Job Market Survey actually confirms this increase. If you compare the total number of PGY3s who took the Survey to the combined total number of PGY4s and PGY5s, the numbers are almost equivalent. How this increase will affect the job market is difficult to predict.To my knowledge, a comprehensive workforce analysis has not been performed in recent years. Gathering demographic information from current practicing pathologists would give us more insight.

Conclusion
It appears that shortening residency training has resulted in:
1. More residents entering a fellowship which, in turn, has greatly increased the competition for fellowships and the demand for fellowship training by future employers.
2. Residency programs increasing their number of residents per year, raising the number of graduating residents by 20%.
Both of these conditions will impact the job market. Getting a job without a fellowship will be much harder in the future, and the increase in graduating residents will likely make the job market more competitive.To what degree the market will be affected will remain largely unknown until a comprehensive workforce analysis is performed.