A recent article in Emergency Medicine News caught my eye. Emergency physician Dr. Tom Belanger conducted a small study (n=573) in which he crafted a nine-question Likert scale survey and then attempted to predict emergency physicians’ employment structures based on respondents’ answers. He used statements like “I am paid fairly,” “I am secure in my career,” and “Emergency medicine is a good career” in his survey.

In medical school and residency, I thought little about employment structure, which can include democratic, hospital employee, contract management, independent or locums, academic, resident, or government systems. As a student, I was so focused on what specialty I would choose and was so influenced by the academicians I worked with that I didn’t even consider that I could choose a field in which I might be happy in one employment structure and discontent in another. 

Belanger found that employees of contract management groups (CMGs) tended to be the most negative respondents, and owners of CMGs were not far behind. On the other hand, owners of democratic groups were the most positive in almost every aspect. 

In this study, all respondents were in the same specialty and yet, employment structure divided respondents with regard to their career satisfaction. Belanger’s graphs are worth viewing in his piece, but the take-home point for medical students and residents is the importance of the employment structure in which you ultimately work, a topic that may not have even crossed your mind until now.