Careerealism: It’s Not Your Imagination: No Jobs Anywhere

Thomas L. Belanger, MD FAAEM

Table 3. Total EM Docs Jobs Posts by Type

When I last applied for jobs before my family’s move to Texas at the end of 2014, all an emergency physician had to do was wait for the free steak dinner. I often joked to my family that you could be offered a job before a recruiter even knew your name. Flash forward to the present, and suddenly it seems as if there are no jobs anywhere. Two often-cited factors are the use of advanced practice providers as cheaper labor and private equity encouraging an overproduction of residents. The COVID-19 pandemic may have exacerbated the problem. The reasons for this shift are important, but there is some debate over whether a problematic shift exists. The question then is: How has the market for emergency physicians changed?

Classifying Posts

I used an unconventional data source for these data: the EM Docs Jobs Facebook group. This group started in mid-2018, and has about 7200 members who use it to post job listings and requests for employment. This appealed to me as a data source because it is an organic, honest dataset; the page contains information on both sides of the employment market, employers and employees; and there is a time-stamped electronic log of posts. I read each post and classified it as a job listing or a request for employment; other types were not included. Some posts were difficult to classify; as a general rule, I classified it as a request if it seemed the poster was trying to recruit employers. A post was classified as a job listing if somebody posted contact info for a paid job, even if the poster was not the employer. This also meant that I counted job listings for EDs, urgent care centers, medical spas, sports events, speaking engagements, and other similar listings (even though they may not all be considered equal by prospective applicants). I read every post from June 6, 2018, the group’s inception, to Dec. 14, 2020. It was a horribly depressing read, as you will see.

Table 1. Job Listings over Time

Table 2. Employment Requests over Time

Results

Examining the posts over the life of the group, both job listings and requests show a numerical increase over time, likely due to increasing membership in the Facebook group and some seasonality. (Tables 1 and 2.) Transposing the two histograms paints a much clearer picture, however. (Table 3.)

Table 4. Proportional Posting Types over Time

The job listings and requests seem to match up fairly nicely in mid-2018 through the first part of 2019, at which point a major change seemed to have occurred. After this point, growth in job requests far outpaced growth in job listings. Let’s view this another way, by the percentage of all posts by type for each month. (Table 4.)

Table 5. Ratio of Requests to Listings over Time

Earlier posts to this group were a mix of job listings and requests, but the page was about 90 percent requests for employment at the end of 2020. It is valid to ask if this trend could simply be statistical noise. To answer this, let’s first rephrase the post counts as ratios of requests-to-listings and fit a linear regression line that correlates this ratio to time. (Table 5.) Not only does our t-test show statistical significance (indicating an exceedingly low chance of finding the observed data in the case that there is no correlation between time and the given ratio, p=3.89e-07), but our 95% CI shows that we expect the ratio of requests to listings to increase anywhere from 1.06 to 2.04 year over year (with a ratio of 1.54 as the expected value from the regression). Finally, let’s compare the observed data from the group’s first year (September through November 2018) to the same monthly interval in 2020. Using resampling, we can see how likely it would be to observe the data in 2020 if there were no difference between the two periods. (Table 6.) The vertical line representing the percentage of requests in late 2020 does not even touch the resampling distribution. The chance of seeing the current distribution if, in fact, the trend is simply statistical noise is 4.209457410^{-9}.

Table 6. Resampling Distribution of Early Posts

No Surprise

Membership in this group is not constant. As the number of members increases (as it has done over the years), one would expect that the number of posts for job listings and requests to increase. This is why the relative composition of the two is more important. The most likely explanation for the trends demonstrated clearly in the data is that there are now fewer available jobs per emergency physician. There are, of course, other possible scenarios. These data may simply represent a change in the use of the page; more people are using the page to seek jobs than candidates. The data may also reflect a change in recruiting methods away from social media, though this seems unlikely. It also seems unlikely that the data may be a reflection of job scarcity due to the COVID-19 pandemic because the shift toward more requests begins before the months of the pandemic. Further analysis could certainly be done on the quality of job listings. From an unscientific appraisal, the quality of job listings seemed to have deteriorated over time, with employers being more difficult to contact, prices being lower, and true career-focused emergency medicine jobs being fewer and farther between. Considering which requests for employment appeared to be successful and their characteristics that made them so would be another potential area for future exploration. Unfortunately, I think these data will not surprise anybody. It is my hope, however, that they may give numbers and pictures to the disenfranchisement that many emergency physicians are feeling and begin to inspire solutions.

All code was written in R and can be found, along with the data, at

https://github.com/splatton/EMDOCSJobs.

Tom Belanger, MD, Emergency Medicine News: March 2021 - Volume 43 - Issue 3 - p 6-7, 2021 Wolters Kluwer Health, Inc. ©2021 This article first appeared in Emergency Medicine News, and is reprinted with permission. www.em-news.com