The path to securing a resource-intensive physician job in Canada: lived experiences of decision-makers and trainees

Securing meaningful employment as a physician is anxiety provoking, particularly in resource-intensive specialties, and newly certified specialists continue to report difficulty obtaining employment despite proposed solutions. In this study, we aimed to explore the lived experiences of decision-makers and trainees navigating job-seeking and placement in resource-intensive specialties in Canada and identify suggestions for improvement.

In this qualitative interview study, guided by phenomenology, we recruited trainees, recent graduates, program directors, and division chiefs from resource-intensive specialties across Canada, using purposive sampling. Participants completed semi-structured interviews, which we transcribed and inductively coded in duplicate using NVivo 12. We iteratively discussed the preliminary codes and grouped them into categories to identify overarching themes.

We interviewed 20 physicians across 15 specialties. Most described the hiring process as nebulous and difficult to navigate, citing challenges related to transparency, equity, and access. We identified 4 key themes: the hiring process is difficult to navigate and poorly defined, hiring decisions rely heavily on perceived fit, bias and inequity persist, and perspectives differ across participant groups. Participants suggested multilevel changes, such as creating national hiring guidelines to promote transparency and implementing structured career-planning initiatives for trainees.

Our study highlights factors that affect the hiring process for resource-intensive specialties in Canada and demonstrates misaligned expectations among participants that may create additional employment challenges. Changes at the individual, institutional, and national levels should be considered to promote transparency and reconcile divergent perspectives.