Announcement

Collapse
No announcement yet.

Texas for EM residency is the way to go, right? Academics vs Community?

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Texas for EM residency is the way to go, right? Academics vs Community?

    I'm in the middle of residency interview season and could use a sanity check:

    From a financial standpoint, it sounds like working in Texas is a no-brainer, with tort reform (excellent malpractice environment), low cost of living, no state income tax, and high-paying jobs. Moving there for residency gives me the chance to try it out for 3 years, get stellar training, make connections, and decide whether staying long-term makes as much sense in real life as it appears to on paper. I should go for it, right?

    Another option is to go for an academic career and jump-start it at Big Name Prestigious EM Residency (think 3-year programs like Indiana, Carolinas, Emory, Christiana). I enjoy teaching, some forms of scholarly work, and think I might have better career longevity in the academic environment. But... playing around with PhysicianOnFIRE's calculators, it looks like the corresponding $50-100k pay cut means hitting financial independence is going to take ~5-10 years longer, especially if try to increase my academic employability with a fellowship. That seems like a big sacrifice. People seem to get really excited about these Big Name programs, but they sound overrated! On the other hand, sometimes I hear doom-and-gloom scenarios of CMGs taking over the universe and rates plummeting, and I wonder if an academic career insulates me somewhat.

    The final alternative is to stay at my home program, which I like. LCOL area, grads go into community or academics, husband gets to keep his $40k/yr job (which he likes), moving would be a non-issue, transitioning to residency would be much much easier, have friends in the area. The idea of having my life stay as much the same as possible while transitioning to residency has a lot of appeal from a quality of life standpoint, but if I can eventually make $50k/year more in TX, I feel like it's worth it.

    About me: I grew up dirt poor but discovered personal finance early enough that it's shaped a lot of my decisions and really had a positive impact on my financial situation. Consequently graduating medical school with no debt of any kind! Another big win is that I'm married to an awesome frugal guy who also has no debt. Admittedly, he doesn't have a ton of earning potential, but his job is a great fit for him even if he's likely underpaid at around $40k/year. I would be very surprised if his next job was more than $60k/year. Our families are doing well and won't need us to support them financially in old age. We don't plan on having children. We have inexpensive taste in housing, cars, hobbies, dining, and we always want to stick to low cost of living areas. Feel like we could be happy anywhere with minimal cold weather.

    We'll be 33 when I finish residency, and we have about ~$100k between us in retirement accounts and inheritances from my husband's family, inclusive of our emergency fund. Plan on living as inexpensively as possible until graduating residency, then inflating our lifestyle to about $80k per year or less and stashing the rest away so we can hit FI 10-15 years out of residency.

    So, obviously, there's more to life than money, but I subscribe to the idea that you have a lot more flexibility in life if you get the Big Ticket Items right. Residency selection feels like a Big Ticket Item, but I don't have financially-minded mentors and advisors.

    Anyway, what do you think? Am I overestimating the benefit of being in Texas? Underestimating the value of going to a Big Name residency? Anything else I haven't considered?

  • #2
    go where you will be well trained and competent. the rest will follow.

    Comment


    • #3
      From your description, I would stay at the home program. The transition will be effortless, and your husband can keep his job that he likes. The latter is huge.

      If there is more money to be made in Texas, you can take a job there after residency with no loss. (Resident salaries are all similar.)

      You're very focused on your financial position, so I doubt you would remain in academics for the long-term.
      Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

      Comment


      • #4
        Texas is great.  I do not live or work there but my oldest brother does.  He lives outside of Austin and it is booming.  Texas has a unique culture of its own different from other Southern states in my observation.  Texas is hot but less humid than where I live...Alabama.  My brother lived all over but went back to Texas to retire from IBM.  Good tort reform situation is sweet.  No income tax. (Higher property tax than here.)  If you are liberal go to Austin.  If you are conservative go any where else.  If I was just finishing residency I would consider it.  As for residencies I went to a Big Name (Vanderbilt) and it does not help you except maybe getting your first job.  If you want academics then go to a Name.

        Comment


        • #5
          The best way to try a location is by doing locums work after residency.  You won't need three years to figure that out.  Although when you're married that can be more of a challenge.

          The good and bad thing about Texas is that it's huge... almost like its own country.  You're not going to get a good feel for South Padre Island if you're doing a residency in Lubbock or El Paso.

          I agree with the previous poster that if you have a good situation, good mentorship, good training, and are in a good, affordable location, it's hard to see the drawbacks of staying put.

          Comment


          • #6
            Agree w/ peds. Here's the long winded version:

            The financial pros and cons of one residency prog vs another is a pretty small rock, for most people and certainly for you.  So I place very little importance on that.

            Also, you can always get job in TX later, so don't worry about that.

            I think the most important thing for you is to go where you will get good training.  I don't know anything about EM training or programs, but my general philosophy is that residency education is what you make of it.  If you are motivated and are put in the effort, you will come out well-trained at most programs.  The key is that you actually need to go to a program where you will see a variety of pathology.  So I don't think it matters if you go to the number 1 academic center or the number 20, as long as you are in a setting where you will see a wide variety of patients and diseases.  Once you have that environment, then how well-trained you end up is 95% based on how much you put in.

            So, the bottom line is go to any program where you will get exposure to everything.  That will allow you to be well trained.  Once you're done with training (or close), then start thinking about what exactly you're going to do, where you are going to live, etc.  Don't put the cart before the horse.  Being the best doc you can be is priority #1.  Everything else pales in comparison.

             

             

             

            Comment


            • #7
              Im not sure what the draw is in Texas compared to your current place. You said its LCOL as well. Given that the attending salaries would have to be outrageously higher to make any sort of difference (remember with taxes any raise is only ~50% face value). You wont make enough as a resident for taxes of any sort to matter, and moving, etc...will eat into that anyway. If you end up in Texas for a real job thats different, but they get you with egregious property taxes. Texas is huge and strange, you have Austin which is pretty awesome for certain kinds of people and then the other cities with their own different culture that fits totally other kinds of people. Then of course there is the more rural areas that are totally different. You may or may not fit in depending, but theres a big enough spectrum it would be easy to find the place that fits you.

              Sounds like youre at a good place, I'd stay there all things considered. Maybe consider it with your permanent job.

              Hot, humid, windy as heck, and can get cold too. Somewhat prone to natural disasters that vary by location. They dont like to pay for infrastructure so traffic is a nightmare and theres loads of toll roads (something something private market libertarian blah).

              Comment


              • #8
                I'm from Texas and went to medical school there but I'm not in EM. There are some good programs there with good training. It is also pretty cheap to live there for the reasons you described. It is big, so I feel like you can find a place you fit in. Personally, I love the areas surrounding Austin and San Antonio. I left for residency and don't see myself going back for 2 reasons, or maybe 3: I like having 4 real seasons, with snow!, The bugs!, And I like living farther away from my family. So if you can handle the weather and the politics it's a good place to live and I don't think you could go wrong trying it out. But given the situation you've described, you are going to be fine financially wherever you go, so you should go wherever you want to be.

                Comment


                • #9


                  The bugs!,
                  Click to expand...


                  Really? Bugs are worse in Texas than elsewhere?
                  Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

                  Comment


                  • #10







                    The bugs!,
                    Click to expand…


                    Really? Bugs are worse in Texas than elsewhere?
                    Click to expand...


                    Yeah, largest daddy long legs ever seen and a "spider" that is basically a giant tarantula, fire ants, scorpions, etc...bigger and badder. I remember mowing the lawn, and hundreds of these tarantula like spiders would run up the side of the house. Horrifying. Caught one in the house bigger than my hand. One of my coresidents had scorpions fall from the ceiling into her bed and sting her and her husband, that was pretty funny, but ugh.

                    Not that Cali is much better, I mean there are like thousands of black widows around my house rn, theyre everywhere. At least they try to hide.

                    Comment


                    • #11




                       

                      Another option is to go for an academic career and jump-start it at Big Name Prestigious EM Residency (think 3-year programs like Indiana, Carolinas, Emory, Christiana). I enjoy teaching, some forms of scholarly work, and think I might have better career longevity in the academic environment.

                      The final alternative is to stay at my home program, which I like. LCOL area, grads go into community or academics, husband gets to keep his $40k/yr job (which he likes), moving would be a non-issue, transitioning to residency would be much much easier, have friends in the area. The idea of having my life stay as much the same as possible while transitioning to residency has a lot of appeal from a quality of life standpoint, but if I can eventually make $50k/year more in TX, I feel like it’s worth it.

                       
                      Click to expand...


                      Do one of those things. If there's a chance you might want an academic job at a more recognizable name place train at a more recognizable name place. Not making value judgements about anything about the reality of the academic EM job market.

                      Plenty of great EM training in TX and great places to live if the TX scene is for you, but no compelling reason to move there for residency unless you want the adventure. Generally not the hardest place in the world to get a job either although I'd imagine Dallas, Austin, and SA might be a bit tight for great gigs.

                       

                      Comment


                      • #12
                        The reason the pay is high in rural Texas is that demand is high. You don't have to go to residency in Texas to get those high paying jobs in undesirable locations. Your big time decision is when you finish residency. I know I could make double traveling to rural areas in my state. But I don't. Instead I choose to have a happy family. Plus I could still retire after a 15 year career. Have this open discussion with your spouse.

                        Comment


                        • #13





                          The bugs!, 
                          Click to expand…


                          Really? Bugs are worse in Texas than elsewhere?
                          Click to expand...


                          In Galveston we had cockroaches that were enormous and guess what? THEY FLEW! Nothing like having a cockroach fly at your face as you're trying to crush it with a cookie sheet (because a shoe just didn't seem big enough).

                          Mosquitos were also terrible. One time I was trying to unlock my bike (this was in med school) and I was getting bitten by so many mosquitos I actually started crying. I left the bike and ran home.

                          I'm pretty sure every kid that has ever lived in Texas has a story about the time they got swarmed by fire ants. And has PTSD from the experience.

                          Comment


                          • #14
                            As long as the free standing ERs stay open in Texas, they'll be plenty of demand for ER docs here no matter where you train. I am an older doc and am Family Med board certified not even ER board certified and can still get all the well paying ER shifts I can handle.

                            Do your residency at the place you prefer and you can always moonlight here in Texas to try it out.  We have docs that fly in from California a week a month and make enough to justify the flights, hotels and rental cars.

                            Comment


                            • #15
                              doesn't matter if you're in texas for residency in terms of saving money: its negligible. I would pick my residency on quality of training and how it would affect my future career goals. you can always move to texas as an attending if interested.

                              Comment

                              Working...
                              X