Where Do Graduating Pediatric Residents Seek Practice Positions?

Objective.—To profile the characteristics of areas that graduating pediatric residents target in their job searches and to explore whether residents applying to primary care markets with higher pediatrician supplies experience job-search difficulty.

Study Design.—A national random sample of 500 graduating categorical pediatric residents was surveyed. The communities that the pediatric residents targeted for jobs were linked to local-area characteristics by using Dartmouth Primary Care Service Areas (PCSAs), which are discrete markets that represent patient travel patterns for primary care services. PCSA population and providers were characterized by using data from the 2000 US Census and American Medical Association/American Osteopathic Association Physician Masterfiles.

Results.—A total of 308 graduating residents (62%) completed the survey. Of the respondents, 136 (44%) applied for general-practice positions. The characteristics of the PCSAs that residents applied to differed from the PCSAs without an application. Residents' first-choice areas had higher ratios of general pediatricians, had higher median household incomes, and were more likely to be urban areas. Residents applying to higher-supply areas were significantly more likely to report moderate or considerable difficulty in their job searches than were residents applying to lower-supply areas. Residents applying to medium- and higher-supply areas sent out more total applications for positions and received lower starting salaries than did residents applying to lower-supply areas.

Conclusions.—Residents continue to prefer high-supply areas in their job searches, despite experiencing greater search difficulty in these areas. Current targeted incentives and market forces are unlikely to redress geographic variation in pediatrician supply.

KEY WORDS:  general pediatrics , maldistribution , pediatric workforce , resident education