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Leaving a HCOL for a LCOL

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  • #31




    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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    Dodgers are in the Series this year. Took the fam this summer, was a lot of fun.

    I really enjoy NYC, its a fun place, but dont think I could live there. I get claustrophobic after a while when there. If you're from the west there arent many places that even come close to approaching the density of the east coast, just a different animal.

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    • #32
      I grew up in lcol midwest.  My goal was always to move out of there  to experience greater culture.  I've moved around to northeast, southeast, upper midwest through school + training.  Settled in HCOL and love it.  It will take me a decade longer for FI.  But, I love being surrounded by different cultures, food, entertainment and beautiful surroundings.  It is really touching to me that my kids never worry whether the teacher will pronounce their name correctly.  Kids don't ridicule their food and background.

       

      so, yes, working harder and longer is worth living in HCOL.

       

      Lastly, I'm not convinced LCOL gives a better paycheck.  none of the doctor salary surveys are accurate.  The flyers and emails from physician recruiters do not tout incomes that cannot be had in HCOL.

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      • #33







        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.

         
        Click to expand…


        Dodgers are in the Series this year. Took the fam this summer, was a lot of fun.

        I really enjoy NYC, its a fun place, but dont think I could live there. I get claustrophobic after a while when there. If you’re from the west there arent many places that even come close to approaching the density of the east coast, just a different animal.
        Click to expand...


        Yes, I stand corrected, Dodgers are in the World Series this year.

        Comment


        • #34
          This is one benefit of Primary care -- portability and job opportunities.   I can do about anything I want with it -- the world is my oyster.

          We chose a HCOL - San Diego -- and probably won't leave paradise.  Even choices of vacation is hard to make beyond nice staycations -- it's usually for cultural jaunts than anything now.

          I do think the rec of retirment for 6.01 months to FL/AZ/TX is good for taxes

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          • #35
            I don't think the OP needed to live "paycheck to paycheck" in his HCOLA even with 250K of med school debt. Still it seems like the right choice for many people to move to a LCOLA and benefit from geographic arbitrage.

            I've always been puzzled how LCOLAs are able to afford higher salaries for physicians. I understand it's partially a function of supply and demand but how do practices in less affluent LCOLAs have a strong enough payor mix to pay high salaries.

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            • #36





              I don’t think the OP needed to live “paycheck to paycheck” in his HCOLA even with 250K of med school debt. Still it seems like the right choice for many people to move to a LCOLA and benefit from geographic arbitrage.

              I’ve always been puzzled how LCOLAs are able to afford higher salaries for physicians. I understand it’s partially a function of supply and demand but how do practices in less affluent LCOLAs have a strong enough payor mix to pay high salaries.
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              More likely the anomaly is the lower pay in HCOL areas. The money is certainly there, they just dont have to pay it to you. One of the biggest downsides in academic medicine is you have no idea how much money you're making the system, and they certainly dont tell you. They like to discuss the stuff you can see, the overhead you can appreciate etc...while leaving out facility fees, kick backs and the multiplying factors you may allow other specialties, etc...


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              • #37




                I’ve always been puzzled how LCOLAs are able to afford higher salaries for physicians. I understand it’s partially a function of supply and demand but how do practices in less affluent LCOLAs have a strong enough payor mix to pay high salaries.
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                As Zaphod says, the HCOL areas know that you want to live there at any cost and hence they only offer you lower wages. Just like you get fixated with buying only "that car, that color, that accessory" and get screwed with paying MSRP.

                I went to SF in 1996 and they were offering less than half the pay they were offering in the South East. And they expected us to jump at the opportunity and thank them for the low wages :x . Yet at the same time the IT geeks were getting astronomical income.

                Thank God I saw that there were better opportunities in rest of USA.

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                • #38
                  If you think of yourself as a wage earner, you will be treated as such. If you think of yourself as a revenue creator, you will thrive whether you are in a LCOL or HCOL area.

                  The truth is that there is more potential to make money in HCOL areas because of payer mix/patient density etc. It's just a matter of who is making the money and who is being taken advantage of.


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                  • #39




                    Lastly, I’m not convinced LCOL gives a better paycheck.  none of the doctor salary surveys are accurate.
                    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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                    • #40


                      look at houses that cost what you’re paying for your condo in your hometown
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                      What a terrible, terrible looking house.  I know the cost per square foot is favorable, but this looks like the sort of ham-fisted McMansion that would be featured on http://mcmansionhell.com .

                      Comment


                      • #41
                        I think another thing to keep in mind about where people decide to live despite the cost is where they fit in and feel comfortable.

                        Religious beliefs, race, political views, sexual orientation--these are issues that some people might not consider at all when they decide where they live because they might be able to "blend in" anywhere. But for others, their religion or race or sexual orientation or political views might not make them welcome in some LCOL places in this country. Some HCOL areas offer a diversity that is worth the cost for some.

                        I'm not arguing that there aren't tolerant, accepting places in this country that are LCOL. But I do think that some parts of the country feel like they wouldn't be as welcoming to certain families. I know that this has affected my own family as we've decided where we would be willing to live.

                        Comment


                        • #42





                          look at houses that cost what you’re paying for your condo in your hometown 
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                          What a terrible, terrible looking house.  I know the cost per square foot is favorable, but this looks like the sort of ham-fisted McMansion that would be featured on http://mcmansionhell.com .
                          Click to expand...


                          Ha, yeah, fair.

                          Was just making a point about housing prices.

                          Comment


                          • #43




                            I’m not arguing that there aren’t tolerant, accepting places in this country that are LCOL. But I do think that some parts of the country feel like they wouldn’t be as welcoming to certain families. I know that this has affected my own family as we’ve decided where we would be willing to live.
                            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.

                            Comment


                            • #44







                              I’m not arguing that there aren’t tolerant, accepting places in this country that are LCOL. But I do think that some parts of the country feel like they wouldn’t be as welcoming to certain families. I know that this has affected my own family as we’ve decided where we would be willing to live.
                              Click to expand…


                              It may be true that some people will feel unwelcome in some communities, but that assumption is made far too often.

                              In our community of < 20,000, our best friends are a caucasian and Indian couple (albeit American-born). At the hospital, I work with many immigrants from Asia and several from Africa. We have many Muslims in traditional garb as patients, and there is also a community of Mennonites. I have at least three local patients in black-white marriages.

                              There is also a small university well-known for its engineering program, and there is similar diversity among the professors and students there.

                              I’m white but my wife is Korean. The caucasian lady who lives next door organizes lunches (that last for three hours) for the six ladies on our street, including my wife and the young Chinese woman who moved in recently.

                              My wife met a Korean woman at the local Starbucks who is married to a professor. That woman invited her to lunch with six other Korean women affiliated with the university. So far, she hasn’t been able to make their monthly lunches because of conflicting social engagements!

                              ***

                              The assumptions about tolerance result from unfamiliarity. I won’t go to the Carnival in Rio because of news reports of rampant crime. Meanwhile, plenty of Europeans probably won’t come to the US because of all the mass shootings they read about.
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                              Im sure it depends on where you live north, midwest, or south. It doesnt have to be aggressive and in your face to be unwelcoming. I moved from LA to the sticks for training, and the hyper religious in your face attitude was oppressive (was particularly prominent among my residency faculty). It didnt ruin my life or anything, but I definitely was happier and more comfortable when I left. I live in a very conservative area in Cali, but dont even notice it, not like residency where they basically cornered you and tried to bring you in the fold, and judged you for not going to their church etc...

                              I can live almost anywhere, we're boring homebodies that dont need much and have found enjoyment everywhere we've been. However, there are noticeably better choices as well. Trick is to find the happy medium.

                              Comment


                              • #45


                                What a terrible, terrible looking house.  I know the cost per square foot is favorable, but this looks like the sort of ham-fisted McMansion that would be featured on http://mcmansionhell.com .
                                Click to expand...



                                I just died laughing. That's awesome. Thanks.

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