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Leaving a HCOL for a LCOL

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  • #16




    This is a SDG, but no opportunity for partnership, there is a small pay raise after being full time for 3 years.
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    How is that a small democratic group? Democratic implies one doc, one vote. If you can never make partner, you're never going to have a vote. I think you mean it is "physician-owned."
    Helping those who wear the white coat get a fair shake on Wall Street since 2011

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    • #17
      top 3 financial decisions in our life:

      going to the cheapest good med school I got into (graduated with 4 figures of debt)

      moving to a moderate cost of living, no income tax state

      living like a resident for about six years (until reaching seven figure net worth).

      these are the big ones. get these right and you can buy a latte whenever you want.

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      • #18




        I ran across this gem of a post buried in a thread on the Student Doctor Network EM forum and thought it deserved a lot more publicity.

        https://forums.studentdoctor.net/threads/how-bad-am-i-being-taken-advantage-of.1283186/#post-19354652
        2011, my first job out of residency paid me about $140/h. long commute (65 miles each way, though done intentionally because this job paid quite a bit more than jobs in town) decent benefits, in a fairly high cost of living area. high state taxes, not as high a CA but too high to ignore. 250k loans. 2 kids. We chose to live in “our town”, extended family, lots of life long friends, great social scene, but we were just barely scraping by. putting 18k away for retirement, big monthly loan payment, left with a few hundred or a thousand dollars every mo which always seemed to be eaten up by some sort of “adult life” snafu. My wife and I sat down and started to run the numbers, at my current pay we would be well paid poor for decades. Then the third kid showed up and the $1000 buck a mo we were squirreling away was eaten up by diapers/daycare etc and we were rolling paycheck to paycheck which led to me supplementing with more work, which in turn, led to some spousal resentment because I was never around to help with 3 little kids because I was always at work or in the car coming/going to work. my 9h shifts were basically 12h with clean up time and commute and I was starting to resent her for moving us here and thus making me work so ************************ much just to break above even. A bit about me, I don’t super love our job. I like it, and I wouldn’t want to live in any other house in medicine but I’m not part of the “This is my calling” clan and fully intend to retire out of medicine as soon as I am able. Obviously after 3 years of this hamster wheel of this work I started to burn out…hard.

        At this point I was as crispy and fun as a deep fried tarantula, so my wife and I had an Algonquin roundtable discussion about what we wanted and where we were headed. We decided that our current situation was untenable. I was working effectively 18 12h shifts, spending 36h/mo in my car commuting. missing my children’s childhoods. pissing off my wife. not being able to enjoy any of the fruits of my labor, when the whole delayed gratification bug was already biting me hard hearing about my friends from residency who chose more profitable, lower cost places to live, buying sweet houses, new cars and I was renting and driving my Camry with 240k miles on it and not really seeing any growth in my savings. We were going to be living like fellows (slightly better than residents) for life at our current pace. And as an added bonus, I was spending plenty of time seething and silently blaming my wife and squabbling over spending. A bit more backstory, I love my wife dearly, she is the greatest person I have ever met and she’s a very rational person so we discussed all our options and we decided…we had to move.

        We looked at the south (where I did residency) and Texas. The rumors about Texas salaries alone were enough to pique our interest. add in no state income tax, tort reform, cheap housing, etc. I contacted a friend from residency who was there and confirmed the rumors. He was making about $250/h in a metro area, lived in a nice area about 20 minutes from the hospital and liked the work. So we went out, checked it out, and liked it enough. We struggled mightily with what we would miss by leaving but in the end we recognized, as previously stated, that even if we only did this for 3 years we would gross at a minimum 650k more than if we had stayed and it would alleviate the only real stressor in our lives. So in the summer of 2014 we packed up the family truckster and moved to Houston. Entering year 4 of the Texas experiment, truthfully we haven’t regretted it. Doubling your salary changes your financial life which has absolutely improved our regular lives. Loans gone. 15y mortgage on a reasonable (by Texas standards) house is been shrinking. Solo401k maxed out every year. Roth converted IRA every year. 529s for the kids are growing. Taxable account growing. At the end of every mo, we still have plenty left over to do with as we please. we still have enough to fly home (we still call it home even though we live in Texas) whenever we want, or fly wherever we want. We go home for a week or so every couple of months and stay for a few weeks every summer. We speak frequently about moving back, but my wife and I firmly believe that right now is the golden age of emergency medicine and that it won’t last forever. Physician salaries and reimbursement are clearly in the crosshairs of the populous as an idiotic “cost containment measure” and a hair cut is coming, but please spare the Hospital’s Junior Vice President of Pencil Sharpening….don’t get me started. So we want to make hay while the sun is shining and sock it away for a hopeful financial independence from medicine back on our front porch at “home”.

        I recognize that we made the extreme plunge and not all are willing to risk it. Happy wife/happy life is a good motto to live by but smoldering long term low level misery can really erode your martial bliss. As for a less extreme recommendation, you mentioned locums and if I might offer a suggestion look at travel locums in Texas. I have numerous friends that live all over the country in crappy paying areas, California, Arizona, Boston, Chicago, all of whom fly in and work 10 days in Texas and fly home. They make more in 10 days than they would have working full months in their respective home states and then they are off the rest of the month.

        I love some of the lines like these:
        I was as crispy and fun as a deep fried tarantula….

        We were going to be living like fellows (slightly better than residents) for life at our current pace. And as an added bonus, I was spending plenty of time seething and silently blaming my wife and squabbling over spending….

        Doubling your salary changes your financial life which has absolutely improved our regular lives….

        What do you think? What would it take for you to move to another state?
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        Great story

        The other thing my husband and I noticed is that desirable areas / HCOL areas typically (though obviously not always) have some very predatory practices. I interviewed at a program that chewed up 5 doctors in 5 years because there's always going to be a new sucker who graduates and wants to practice in NYC.

        While we obviously miss home (SF for me, NYC for my husband), we've managed to land jobs that pay us >3x as much in a LCOL area to boot. There's certainly a lot of variety to LCOL areas. We've interviewed at a couple of places where despite how attractive the job is and how nice the people were, we just knew it would be too much of an adjustment coming from a bustling city life.

        Where we are currently is a coastal area where people are flocking for retirement. Any time we feel "bad" for ourselves and wish to return home, my husband and I always make it a point to remind ourselves how lucky we are to be living and working (for ridiculous pay) in an area where people literally save their entire lives to be able to retire to.

        But those New Yorkers, nothing compares to their home city I guess

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        • #19
          Out of curiosity, how is everyone definintely HCOL area? It seems to me there are truly very few of these.  I was looking at some online lists and here were the ones that jumped out at me:

          NY, Bay Area, DC, Boston, LA, SD, Seattle and Hawaii.  Eliminating Hawaii, since almost no one is actually talking about that when they make these posts, it just gives us 7 Metro areas.  It seems weird to me that there are people who just have to live in one of them no matter what.  I live in one, but I would never even consider it if I were the position of the guy who made that post.

           

          I guess people could be referring to a bigger group of places.  Cities in the next tier down included Chicago, Denver, Portland, Philadelphia.  Those certainly seem a step down to me in terms of cost than the first group though and from what I know of them, there are pockets where a good standard of living can be had way more cheaply than the first group.

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          • #20


            But those New Yorkers, nothing compares to their home city I guess
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            That's probably true for most. People feel most comfortable where they grew up.

            I'd like to have the ABT and the NYC Ballet nearby, but still, I'd need to earn three times as much to even consider NYC.
            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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            • #21




              Cities in the next tier down included Chicago, Denver, Portland, Philadelphia.  Those certainly seem a step down to me in terms of cost
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              .
              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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              • #22
                We should be careful to assume compensation is always higher in LCOL areas. I went from a LCOL to HCOL area and saw a 33% increase in comp. better payer mix, higher patient density and referral pool, benefit from competition between different health systems instead of being stuck with "the only game in town". The fallacy that pay was always higher in LCOL areas is what motivated me to take the first gig, but I learned that it's much more complex and that there are microeconomies even within a big metropolitan area.


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                • #23




                  We should be careful to assume compensation is always higher in LCOL areas. I went from a LCOL to HCOL area and saw a 33% increase in comp. better payer mix, higher patient density and referral pool, benefit from competition between different health systems instead of being stuck with “the only game in town”. The fallacy that pay was always higher in LCOL areas is what motivated me to take the first gig, but I learned that it’s much more complex and that there are microeconomies even within a big metropolitan area.
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                  Agree, its all very specific. Also agree with AR that outside of a very few select regions, HCOL is very relative.

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                  • #24





                    Cities in the next tier down included Chicago, Denver, Portland, Philadelphia.  Those certainly seem a step down to me in terms of cost 
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                    Definitely a step down, but much more expensive than most of the country. I paid $2500/month rent for a 2 bedroom, 2 bath condo with stacked washer/dryer in Chicago. My landlord paid about $650,000 for the place during the bubble and similar places in the same building were offered in bankruptcy for about $425,000 during the bust. The selling prices are much higher now.

                    For $320,000 I have about 1.75 acres with wooded areas on 3 sides (for privacy) in the nicest neighborhood in town, and 4-5 thousand square feet, 5 bedrooms (with 2 masters), 5 bathrooms, a walk-out basement, and a 3-car garage. I drive less than 10 minutes to work with no traffic.

                    Similar places are available in the suburbs of Cincinnati, Columbus, Indianapolis, Kansas City, St. Louis, etc., albeit not in the ritziest neighborhoods in those towns.

                     
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                    Yeah, it's all relative, but I know there are affordable suburbs that you can pick around Chicago where you can get a pretty good job (at least in the specialties I'm familar with) and much more affordable housing than Chicago proper.  And you're still close enough to take advantage of Chicago on the weekends or a night out.  Yeah, it's not the baller house you've got, but most docs should be able to make this work without much difficulty if living in the Chicago area is that important to them.

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                    • #25
                      I don't know if it's just me, or medical training ( moving for medical school, then residency, then perhaps fellowship, then first job) but I'm feeling really ancy and restless right now. Everything in my life is great- perfect job, perfect house, husband loves his job, kid loves his school, good savings rate, etc. But I constantly find myself reading the job offers I'm sent daily and frequently think about what it would be like to move to a lower cost of living area. I think what stops me, is I don't want my son to have to make new friends and start a new school. But I'm itching to make a change. Maybe I just need to get a hobby . . .

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                      • #26
                        I grew up in a HCOL area and lived in a few others, and have lived in Texas, the decision of where to settle is difficult.  I have family up and down the west coast, and Hawaii is a consideration as well, but doing the math, looking at potential salary, cost of living and taxes, FI could be delayed by up to 10 years for me.  I'm not sure that cost is worth it for me, visiting these HCOL areas regularly may be sufficient enough.  I could very well compromise and work in the LCOL/high-salary area for a few years to pad my savings then move to the HCOL area.  However, I'm also not naive to the issues and downsides of living in these HCOL areas, irregardless of costs, they're not necessarily a utopia either.

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                        • #27
                          Doing my residency and fellowship in HCOL NYC cured me of any desire to live there. The high taxes, tolls and traffic were my top three irritants. As an attending I might have earned more but the tax hit would have been bigger. I would have more money post fellowship but less time to enjoy the restaurants and cultural events.

                          At the same time, I also interviewed in a one horse town which had a Piggly Wiggly as its only option to buy things and a sandwich shop was its fine dining place. It was literally a place where if you blinked you could pass through the town and the motel was a Double wide trailer parked next to a gas station. Talk about living in the deep South. I knew I would not last there a month since I was so different from the people living there.

                          Luckily I ended up in a Medium COL area. It has a small airport, but also easy access to large international airports 90-120 minutes away if needed. Broadway shows and concerts. Great downtown with easy parking. Goldilocks weather with 4 seasons. And decent taxes. And I have no intention of moving.

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                          • #28
                            All things relative of course; and general speak the entire state of Cali is at least MCOL with its highly progressive taxation.  We went from great suburb Detroit to Central Valley california which is arguably the most affordable place in Cali and still had a 20% step up in COL with the same pay.

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                            • #29
                              I think most people's attraction to NYC is all hype.  A lot of the folks I know that claim NYC is the best either haven't lived there long enough or have never lived there at all.  And to be fair, I have lived there for more than 10 years.  And when I mean NYC, I actually mean those 5 boroughs only.

                              Unless you are one of the few who earn outrageous amount of money (beyond 1%) and live within walking distance to all the amenities (and let's be honest, one can't really walk from Lincoln Center to SoHo even when the weather is perfect, which is like 1 week out of the entire year), everywhere else in NYC is dirty, crowded and difficult to tolerate after about 45 minutes.  Even less if you have kids.

                              Somewhat related pet peeve- I have a close friend who has recently sworn allegiances to NYC and its beloved Yankees.  This is even despite the fact that he has never actually lived within the defined NYC boundaries. Even more interesting is the fact this particular friend HAS lived in LA for 5 years and the Dodgers are actually in the playoffs this year.  I guess I just don't get it.  It is like watching herd mentality in action.  Okay, stepping off soap box now.

                               

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                              • #30
                                If I was in this guy's situation without question I would leave.  Two most important things in life are family and time.  He was sacrificing both.

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