Specialists Finding Prognosis for Good Jobs Is Grimmer : Medicine: Domination of HMOs plays a key role. Universities plan to redirect students.


In years past, the California Radiological Society has hosted an annual get-together for radiology residents to learn about job opportunities across the country.

But “we didn’t even do it” this year, said Bob Achermann, the society’s executive director. “We didn’t think we had much to tell them.”

Job prospects for newly minted radiologists and other specialists are dwindling nationally, but perhaps most drastically in HMO-dominated California. And that is making for anxious moments as young doctors jostle for jobs after years of training.

Although many still land sought-after employment at top-notch medical centers, more have to settle for medicine’s version of driving a cab.


That can mean taking temporary jobs because full-time work is unavailable or accepting positions in cities they would not have even considered when they began their training. It means employers who are less willing to offer long-term commitments, such as group partnerships. Finally, it means generally lower salaries--no small matter for doctors who may have run up medical school debts of $100,000 or more.

At UC San Francisco, anesthesiology department Chairman Ronald D. Miller was concerned that so few of his third-year residents had jobs lined up that he sent out 700 letters of recommendation to alumni last Christmas. Nearly all the 23 residents found jobs or fellowships.

But, he notes, “it’s very common for them to start out at 50% less pay than they would have three or four years ago.”

John Hauschildt, a fifth-year radiology resident at UC San Diego, hardly gave a thought to job prospects when he chose his specialty in 1990.


“That was before everything came down about the push for primary care reform,” he said. “In places with high levels of managed care like San Diego, it is very tough for radiologists to find jobs now.”

Hauschildt tells of residents in fields such as gastroenterology and cardiology who have quit after a year or two of training to focus on internal medicine--a primary care field with more available jobs.

He plans to postpone his job search for a year and take a fellowship at UC San Diego, which he hopes will give him an edge in the job market. Hauschildt does not expect the overall job picture to brighten anytime soon, and says he is leaning toward a career in academic medicine.

Despite widespread agreement that there is an oversupply of specialists, medical schools continue to churn them out, though they have begun tightening the spigot.

At the University of California, 55% of residency positions were in specialties in 1993-94, versus 45% in primary care. The UC system’s five medical schools plan to reverse those figures as early as 1999.

Students at the UCLA School of Medicine are told “this is a terrific place if they want to get trained as a generalist or go into academic medicine or research,” said Department of Medicine Chairman Alan Fogelman. “But if they want to get trained in a sub-specialty, they’re better off going somewhere else, because we’re not interested in adding to the oversupply of specialists in medicine.”

UCLA’s departments of cardiology, gastroenterology and nephrology no longer accept students--unless they intend to pursue careers in academia or research.

“Our young doctors in cardiology have had to go to Texas or the Midwest,” Fogelman said. “There are no jobs in California for young cardiologists anymore.”


In the future, he said, cardiologists will be less likely to pursue careers as highly paid surgeons. Instead, they are more likely to go to work for biotechnology or pharmaceutical companies, helping to discover new treatments for heart disease.