The second most important question to answer before residency - insider's perspective

Hey friends.  As we all know, the match is soon.  I wonder how many medical students know what they're getting themselves into, though.

The second most important question to ask before applying to residency (the first being what to apply for, of course) is what the job market is going to be like in the future, and what to expect as far as what kind of practice will be available (private practice on your own, joining a group, working in an academic setting, working at a government hospital, etc).

Sure, a lot of people just matched ophthalology and urology, fields which are really competitive and prestigious, but what kind of future are we looking at?  What's going to happen to reimbursements for eye injections, TURPs, and so on?  Money might not be everything, but it certainly can be for people with almost half a million dollars of student loans.

You can search online specifically for speculation on the future of different specialties regarding income, but here is some general information I gathered from program directors, doctors in private practice, and surgeons in academic practice:

1.  Big cities are saturated with specialists.  It will be hard to carve out your own niche in NYC, LA, or other big cities.  Also, everyone prefers the doc who has more experience than a new guy to do their procedure, etc.
2.  If you do find an opening in a big city, it might be with a group.  Being the junior member of a group means taking more call, covering more, and a smaller salary
3.  A lot of fellowships take internal candidates who have really gotten to know and impress their senior faculty
4.  Similarly, a lot of groups employ residents (to serve as an attending when they graduate) who have impressed their senior members and are well-known to them (it's a safe business practice)
5.  Non-competes become an issue.  Find out the rules specific to your state
6.  You might find yourself competing with practices filled with PAs and NPs if you're looking at going into primary care

So, a lot of finding a job is based on who you know and your reputation.  Just because you got that really competitive residency doesn't mean you can choose where your job as a doctor will be.  That's the reality of practicing medicine in the US, it becomes all about connections when it comes to finding a job.

I tell it like it is and I don't give people false hope or empty encouragement.  My job is to help guide you and keep from becoming a person who says "well, I wish I had known that before."

Cheers, and stay upbeat and hard-working.