At a crossroads early in my career - and significant financial implications

[hsmooth]

Hi all you fellow WCI members. Hoping to get your thoughts and opinions and maybe an idea of what you would do in my situation.

I'm at a crossroads early on in my career in family medicine. 3 years out of residency with my first contract ending soon.

Living in a small town, I'm considering two options:

1) Remain here and take a rural job with a 35 minute commute each direction, for a 2 year guarantee salary of $247,000 and probable signing bonus of $75,000-$100,000. Will likely require me to work at this location for 4-5 years minimum.

2) Move to a metropolitan city: 2 year guarantee of $230,000 but sign on bonus likely only $15,000 or so.

My wife and I are strongly considering Option #2 because of how unhappy we are living in a small town. We're urban city folk at our core. We're bored, have few friends in the area, and don't fit in culturally or socially in this town. I've seen a bit too much racism and intolerance here, being a visible minority.

However the financial incentives of going rural are huge:

- We've paid off about $150k in student loans over the past 3 years and have about $100k remaining. Taking the rural job would basically eliminate our remaining student loan debt immediately and really fast track us towards a pathway of FI/RE.

What's your price on happiness? Would you suck it up for another few years to eliminate a large portion of your debt almost immediately?

[StarTrekDoc]

Happiness is just that.  Without it, what's the point?

You've had 3 years to test our rural life and looking at 1 hour windshield time and another 4-5 year commitment.   "how unhappy we are living in a small town. We’re urban city folk at our core." sounds pretty solid.  Only the two of you can reconcile the $100K-$150k opportunity cost.   (1/2 year in your career).

[SValleyMD]

I'm all for sucking it up and making extra money by living in rural America. I'm doing it now.

But that income difference is negligible in my opinion and would be no where near enough to justify living somewhere u don't like..

230k vs 400k annually? I would think twice. But 230 vs 247 plus a one time bonus?? Not a chance.

I would go to the city and buy some season tix.

[PhysicianOnFIRE]

At a Crossroads, eh?

The urban job sounds like a no-brainer. Money isn't everything. If it was, you wouldn't have chosen family medicine. You chose to be a family doc for a reason -- it makes you happy. Get yourself to the city for the same reason.

Best,

-PoF

 

[DMFA]

Above all else, be happy.  Several tens of thousands more a year to be in a place I didn't love but tolerated OK would be fine, since money does indeed please me...but only a few thousand more for a place I thoroughly dislike and even fear for my own safety?  Nope.  I'm out.

Make sure your student loans are appropriately structured so that not paying them off ASAP like you could otherwise do will not penalize you too much.  5 year variables are in the low 2% range at the moment.

[CM]

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[Anesthesia84]

Go where you are happy! It sounds like you are doing well financially and as others have said, what is the point of the extra money if you don't like living in that small town?

[Miss Bonnie MD]

The price differential is more with the increased COL in a city. But if you keep costs low, live in a modest apt until you're out of debt I think you should def go where you are happy. Kudos for sucking it up for a few years to get you ahead.

Just because you move to a HCOL does not mean your expenses will go up dramatically. It really depends on you. I live in Brooklyn and able to live vey modestly while paying down debt and maxing all available retirement accounts. It can be done. Just keep your eye on the goal.

[Kamban]

My counterarguments against the sentiment of the thread

Make sure you really hate the place and that all the antagonism and racism is real and that it will not exist in the urban area where the other job is. I am a minority and when I got my first job in the Bible Belt there were very few minority, foreign doctors and our referral base was low. Being of a different religion made that even lower. One lady wanted to switch to me for further care but after hearing that I was a Hindu stated " I would not even bring a dog to such practice".

I could very well have packed and left but then realized that such people will exist in any part of the country and for every one such person there will be two or more who would love the care I give. I persisted and the barriers of the old boys ( and girls) club slowly came down. The town started to grow exponentially and more non fundamental physicians and people moved into town. The town is completely different now than what it was 20+ years ago.

If you don't have kids or they are small, then schools in rural area might not be an issue now. If you can clear the debt, live frugally and save then you might have a nice chunk of retirement money and savings to take with you when you leave the place in 5 years. But make sure your spouse is on board with this, as nothing can ruin your finances like a divorce.

[Ivy]

Move.  If you're not happy it doesn't make sense to stay.  If you were asking this question coming out of residency, I might recommend the rural job.  But, you've tried it and don't like the rural life and practice.  Get out.

I would rent for the first year or so in the city to make sure you like the practice and to figure out what area of town you want to live in.  Don't be in a big hurry to buy.

[pulmdoc]

I would ask for a big raise to stay in the rural area. The differential simply isn't big enough compared to the metro job. If they decline, then your decision is made for you.

Why does option #1 require a 4-5 year stay? That by itself is a big red flag for me.

To me it sounds like a straightforward decision. You aren't happy with rural life and the job offer isn't an offer you can't refuse.

[childay]

Happy wife happy life and all that

Also I would never take a 35min commute in a rural area, that makes no sense at all!  Even if the jobs were identical I would take the paycut not to have that commute.

[jfoxcpacfp]

All rural areas are not as you describe, please believe me, and most white Americans are not racist far-right homophobes. There are surely many small-town hospitals near cosmopolitan areas who would offer similar packages and welcome you with open arms. Are you sure there only 2 options?

[VagabondMD]

Not much to add. Make a "pros and cons" list? There is no right or wrong answer. I know what I would do (leave the rural area), but I am not you and have never had to make a similar decision, under similar circumstances.

[hsmooth]

Wow, thank you all so much for your replies. This is certainly helping me with our decision. I always felt leaving for the urban job was what's right for us, but just hearing your thoughts has been so helpful and reassuring.

StarTrekDoc wrote:

Happiness is just that.  Without it, what’s the point?

- Thanks for this. It really resonated with me.

SValleyMD wrote:

 

I would go to the city and buy some season tix.

- Great idea actually, can't believe I didn't think of it haha. City has all 4 major sports teams plus MLS soccer.

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PhysicianOnFIRE wrote:

At a Crossroads, eh?

The urban job sounds like a no-brainer. Money isn’t everything. If it was, you wouldn’t have chosen family medicine. You chose to be a family doc for a reason — it makes you happy. Get yourself to the city for the same reason.

- Even before clicking the link, I had a feeling it was going to be Bone Thugs. That was the very first music album I ever bought, when I was in high school. Thanks for your comment and also thanks for doing your blog, I enjoy reading it.

 

DMFA wrote:

Make sure your student loans are appropriately structured so that not paying them off ASAP like you could otherwise do will not penalize you too much.  5 year variables are in the low 2% range at the moment.

- Thanks for the tip. Majority of my loans are in a ~2% interest range. 

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Miss Bonnie MD wrote:

The price differential is more with the increased COL in a city. But if you keep costs low, live in a modest apt until you’re out of debt I think you should def go where you are happy. Kudos for sucking it up for a few years to get you ahead.

- Thanks! We would sell our house here and move into an apartment, to rent, for about the same price as our current mortgage + a few hundred.

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Ivy wrote:

I would rent for the first year or so in the city to make sure you like the practice and to figure out what area of town you want to live in.  Don’t be in a big hurry to buy.

- Thanks! We're definintely renting for at least the first year, probably more. We jumped into a house after residency and found that the day to day house tasks and chores just don't bring us happiness. We were spending all our weekends keeping the house clean and in shape and not doing anything fun.

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childay wrote:

Happy wife happy life and all that

Also I would never take a 35min commute in a rural area, that makes no sense at all!  Even if the jobs were identical I would take the paycut not to have that commute.

- Bless my wife - she's been doing the 35 minute commute herself the past 3 years and she's ready for a change. I worried so much about her drive esp in the winter with all the snow and poor road conditions.

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Thanks again to all your thoughts and comments. I think our decision is going to be much easier.