Despite a continued need for specialist physicians in Canada, securing a job is not always straightforward, especially in resource-intensive fields that depend on hospital infrastructure rather than private office or clinic practice. These include critical care and some surgical specialties, where employment may depend on funding, operating room access, institutional priorities, and available full-time positions. New research published in CMAJ highlights how difficult and uncertain the hiring process can be for physicians seeking these roles.

“This study sheds light on the complex and often opaque nature of the hiring process for physicians applying to resource-intensive jobs in Canada,” write Dr Nada Gawad, a general surgeon at The Ottawa Hospital and assistant professor at the University of Ottawa, and her coauthors. Specialists at the University of Ottawa and the University of Alberta conducted the study.

Researchers interviewed trainees, recent graduates, programme directors, and division chiefs across Canada between 2021 and 2022. Their goal was to understand better how hiring decisions are made in resource-intensive specialties and to identify ways to help physicians navigate the employment process. Participants described several barriers, including limited full-time job availability, poor access to job listings, family and spousal employment considerations, and shortages of resources such as funding and operating room time.

The study identified five major themes: the hiring process is difficult to navigate and poorly defined; decisions often emphasise a candidate’s perceived “fit” and lack transparency; bias and inequity can occur; active mentorship and networking influence success; and perspectives differ among trainees, recent graduates, programme directors, and division chiefs.

The authors noted that proactive, well-networked candidates were more likely to succeed, but warned that the emphasis on “fit” may create problems. Because fit is vague and subjective, it can undermine equity, diversity, and inclusion efforts by disadvantaging candidates from underrepresented backgrounds, reinforcing homogeneity, and limiting access to different perspectives and skills. Some participants also said job postings were sometimes treated as formalities, with preferred candidates already identified.

The authors say improvements are needed at the individual, programme, institutional, and national levels. They recommend that trainees clarify career goals early, build networks, contact potential employers, and seek mentors. Training programmes should guide hiring and applications, while institutions should post opportunities earlier and clearly describe the candidates they are seeking. National resident associations and specialty societies could also support transparency by hosting hiring information sessions, creating best-practice guidelines, and developing centralised job repositories.

More information: Kameela Miriam Alibhai et al, The path to securing a resource-intensive physician job in Canada: lived experiences of decision-makers and trainees, Canadian Medical Association Journal. DOI: 10.1503/cmaj.251882