Disparities in employment opportunities for critical care physicians from non-pulmonary training backgrounds: a nationwide cross-sectional study.

BACKGROUND

Multiple physician training pathways exist for critical care medicine. Prior research has demonstrated an increased perception of barriers to employment for non-pulmonary trained intensivists, but none have examined the landscape of current job openings.

OBJECTIVE

This study sought to describe characteristics of publicly posted critical care job opportunities for physicians with different training backgrounds.

METHODS

We conducted a cross-sectional study of job postings for adult critical care physicians on four popular databases between April and July 2024. The primary outcome was the availability of each position to physicians trained in each critical care specialty. Secondary outcomes included characteristics of the job setting. When key data were not contained within the posting, recruiters were contacted to provide additional information.

RESULTS

A total of 223 job postings across 41 states were included. Most openings were at non-university-affiliated academic centers (51.2%) or non-academic hospitals (26.5%), with only 8.6% representing tertiary care centers. A higher percentage of positions were available to pulmonary-trained intensivists (84.8%) than those without pulmonary training (30.5%; OR 4.6 95% Confidence Interval [CI] 3.1 to 6.8; P < .001). The number of positions available to each non-pulmonary specialty was similar except neurocritical care, which had fewer opportunities. Significant differences in hospital size (P < .001) and academic designation (P = .002) were observed that appeared to be driven by higher percentages of positions open to non-pulmonary specialties being at medium to very large hospitals and at tertiary care centers, while pulmonary-only positions were more commonly at small and non-academic hospitals. Differences in metropolitan setting approached significance (P = .059), with non-pulmonary positions more common in large urban cities. No significant differences in regional distribution were noted.

CONCLUSION

In this cross-sectional study, publicly posted critical care positions were much less likely to be available to intensivists without pulmonary training. Positions open to non-pulmonary physicians were more commonly at larger, academic hospitals located in bigger cities.