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Practicing where the money is...

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  • Practicing where the money is...

    With the average med student graduating with >200,000 in debt and finishing residency/fellowship with roughly the same amount does it make sense to head to a rural location for a year or two where salaries for specialists are peaking (>500,000) and cost of living is low. After two years one could easily pay off all debt and start saving a large cash reserve. How realistic is it to practice somewhere for a year or two then move back closer to family? I've personally considered this and so have some of my residency buddies.

  • #2
    Married: What does the wife say?

    Single: What does your social life say?

    Check those off and you can move.

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    • #3
      Many people are obviously doing it, myself included.

      I'm in a high income specialty and make twice what I would make in an average city and about 3x what I would make in a congested big city.

      Docs in these areas are mostly either chasing money or so bad that they couldn't get a job anywhere else, so collegiality can vary. Small hospitals typically mean lack of infrastructure and support, poor emr, and most importantly more call and workload. Plus the obvious lack of some fancy tools/procedures. That was a conscious decision of something that I knew would impact my skill set but I don't really love what I do so I didn't care. But have to be careful.

      You might make more money but you'll have to work for it, just typically less competition.

      I can ski, golf, waterski here so it's fine by me as I don't need any of the fancy city life stuff anyways. So to each their own. We will probably stay as my wife prefers to lay roots anywhere than be nomads after 7 year residency/ fellowship

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      • #4




        After two years one could easily pay off all debt and start saving a large cash reserve. How realistic is it to practice somewhere for a year or two then move back closer to family?
        Click to expand...


        .
        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.

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        • #5
          Fiance (Wife next year), has a list of places she would be call with for a year, she has family in Toledo, and South Florida which seem like nice places to practice.... Alaska did not make the cut.

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          • #6
            How does one then handle sign a contract if you know your plans may only be temporary?

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            • #7
              .
              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.

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              • #8
                Contracts aren't necessarily any different than elsewhere. In general you should have more flexibility to keep yourself free to move.

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                • #9
                  Its a smart move if you don't mind a couple of years in a rural place.  I personally think it would be pretty nice to practice somewhere like Montana and have access to places like Glacier National Park and Yellowstone so close.  I love hiking and backpacking so my days off could be pretty sweet.  My wife likes being close to her family though, so it would be a hard sell.

                  I do think more young physicians should take advantage of those rural opportunities.  It's kind of crazy that not only are they graduating with record setting debt, but they are also choosing to live in areas with record setting rent and cost of living.

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                  • #10




                    Fiance (Wife next year), has a list of places she would be call with for a year, she has family in Toledo, and South Florida which seem like nice places to practice…. Alaska did not make the cut.
                    Click to expand...


                    I doubt you'll find a large salary differential in Toledo or South Florida.

                    Look in the rural south or Midwest.
                    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.

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                    • #11
                      Here is another perspective. If you are in a specialty where jobs are competitive and are training in an institution that is highly acclaimed, you will never be more desirable than the day you finish your training. I would recommend trying to get to the first choice location first. Chances are, this is where your spouse can find work and will be happy and where you will want to raise your children.

                      Then, at the tail end of your career, if you are still light in the wallet and the kids have moved along, you can always hit the rural job as your last job. They seem to always be available.

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                      • #12
                        I live in Boston so that's what I'm comparing it to, I don't want to practice in the Harvard Hub, 1 hour outside of the city though, perhaps.

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                        • #13




                          I live in Boston so that’s what I’m comparing it to, I don’t want to practice in the Harvard Hub, 1 hour outside of the city though, perhaps.
                          Click to expand...


                          Salaries are reportedly low throughout the northeast. If your aim is to maximize your salary, you will probably do much better in the middle of the country far from metropolitan areas.
                          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.

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                          • #14
                            Sounds words everyone, thanks

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                            • #15
                              I would also put into consideration whether the place you ideally would want to work at has a partnership track. If there is one then it may not be that big of a financial advantage to start working in the rural areas for the first couple years out of residency then move to the ideal job. You might be better off working on that partnership track from Day 1 after residency and become a partner sooner in order to get the profit sharing, voting rights, etc.

                               

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