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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?
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?
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