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Leaving midwest for fellowship or staying put?

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  • Leaving midwest for fellowship or staying put?

    Would appreciate input from readers.

    Background: wife and I are finishing up residencies (psych & PM&R) this month for me and fall for wife. Have 3 small kids not yet in school.  Currently live in great community in Columbus, OH. Think of the best of midwest (good neighborhoods, affordable housing costs, good schools, short commute, basically can easily live within our means).

    Situation: interventional pain fellowship (unaccredited) for wife in Phoenix.

    1. We are having quite difficult time in making decision whether to stay in community we have grown to love or to take the leap and move to Phoenix (Scottsdale area).

    2. Potential pros are obvious
    --much higher salary for her post-fellowship (we assume 400k) or opportunity to get descent salary while working part-time (rather than working part-time without fellowship training and making slightly over 100k).
    --higher salary will help us pay off loans quick (we have combined of 500k)
    --warmer climate most of the year (important to wife)
    --salaries for me as higher as well

    3. Cons
    --we are getting tired of moving, wish to settle down
    --worry we wont find schools as good as in Columbus
    --worry that if we move we will continue to be unable to settle down (will be renting initially, don't necessarily see us staying in Phoenix for over 5 years)
    --higher cost of living (will be renting, which is about $3k/mo. And for a place not much bigger or even smaller than what we currently have for $1.3k/mo.
    --Phoenix may be great, or it may be a nightmare of an area.
    --family is far, only way to come with us is to fly in from East.
    --Getting sort of tired of the training/achievement mouse-wheel
    --Why can't we be comfortable with $380k combined income we will have here in Columbus?, why are we chasing this potential $600k combined income in Phoenix?

    4. I just worry my wife will kick herself for not doing this fellowship for much higher salary opportunity.
    At the same time we wish to stay put, live this comfortable mid-west lifestyle.
    5. What do you folks think about this decision?


  • #2
    Well, I'd do it in a heartbeat, but I prefer Arizona to Ohio. Comes with a $220K raise? All the better.

    I think you guys have so much debt that finances have to make decisions like this. If you were debt free, then taking jobs that pay $220K less would be an option. In your situation, I think you need to make hay while the sun shines.

    You might like Phoenix too and plan to stay there long-term, you never know. But if nothing else, you return to the Mid-West in a much better financial position.

    You won't have trouble finding good schools in Scottsdale, give me a break.
    Helping those who wear the white coat get a fair shake on Wall Street since 2011


    • #3
      This scenario is somewhat confusing to me based on the details provided. To make sure I understand:

      You are graduating residency (Psych) this month. Do you have a job lined up yet in either location?

      She is completing residency (PM&R) later this summer. She has a fellowship for interventional pain lined up in Arizona, but she does not have any job available in Columbus at this time.

      If that is the case, then the scenarios presented are more theoretical because you are really deciding between one person with any employment in one location (AZ) vs no one with employment in your current location.


      As for the deeper question, what is her motivation for doing the fellowship? Yes, there is a big pay differential between physiatrists doing interventional spine and general physiatrists, but there is a large difference in the job as well. What are her long term goals? If she wants to do interventional spine procedures, she will need the fellowship to get the variety and number of procedures necessary to complete these in her career. I'm assuming that she's at OSU based on the location, and I do not think that their residents get high volumes of these procedures during training (I'm really not sure what residency programs do now since it is expected that people do fellowship, accredited or not, before doing the procedures alone in clinical practice). It is only a year fellowship so the short term annoyance of moving yet again and continuing the training is far outweighed by the long-term benefits of doing the fellowship if she wants to do interventional spine procedures during her career.


      • #4
        Well what is unique is that we have job offers (both of us) for Columbus as well as offers for jobs in Phoenix.


        • #5
          As someone who lives in the Midwest and knows Columbus, climate aside, there are many advantages to living in a city like Columbus compared to Phoenix, and these are often intangible and not well understood by people living on the coasts, in the Rockies, and other more "glamorous" locations.

          I think that you have an opportunity to have the best of all worlds, but it is going to require you to suck it up and move (at least) one more time. The year in Phoenix will give you a chance to get to know the area, its pros and cons, and whether you want to establish your professional lives there with little to no commitment. Chances are, you can have the same job in Columbus a year later, waiting for you, and maybe your wife gets an even higher paying interventional job.

          I did something similar early in my career, though not exactly. Two years into my first job, I learned of an excellent opportunity in Seattle, an area that I always thought I would love to live. I took the job, hated it and did not like living in Seattle as much as I thought I would, either (heavy traffic all the time, lots of time behind windshield commuting, high cost of living, etc.). I returned back to my Midwestern city job and have stayed there ever since. I think it was smart to check out what I thought I wanted before settling into my long term situation.


          • #6
            The way I see it, it's a no brainer to do the fellowship.

            It seems to me that if you want to go back to Columbus,  you should be able to find a job for yourself when you do.  After all, your wife has a job now for PM&R, not pain, so she really doesn't have a job in her desired field right now.  And the mantra on this website is to "live like a resident".  Well, take the fellowship  and live like a resident for another year.   It looks like a pretty good return on investment to me.

            I keep reading about all the psych moonlighting positions out there, with residents making 120k a year just moonlighting in residency.  If that's the case, you should have no trouble finding work in Phoenix and no trouble finding a job a year from now in Columbus if you still want to go back there.

            Also, while I'm sure that Columbus is a very nice place, t it's not exactly a destination city.  I don't hear it being mentioned along with NY and San Francisco.  So, unless you have family in Columbus, there are likely several dozen, if not hundreds , of communities that would be just as nice to live in.

            My only concern is that the fellowship is unaccredited.  I have read that some insurance won't reimburse for procedures from unaccredited docs, and some hospitals won't credential.  Have you looked into that aspect?  If that all checks out, I would go for the fellowship.


            • #7

              The "unaccredited" fellowship does give me pause, but my guess is that both parties can at the very least get the same jobs they would have had in Columbus, one year later, and have only lost one year...

              except for the kids, and that is the one thing that makes it not a no-brainer. It's a lot of work to do with three small kids (under 5), finding pre-schools or nannies, making new friends with both parents in busy FT jobs, in an area where you do not have any resources or support.


              • #8
                I did a year long fellowship in Columbus, and besides the weather, which is awful, most of the year (Im in california so adjust for your region accordingly), Columbus is a really nice place. Really nice. Great people, nice looking city, lots to do, educated, etc...we really liked it there and it was tough choosing to leave but ************************ the weather was awful if you're from cali and are used to basically amazing weather with surfing, national parks, skiing, and anything you want within 1-2 hours of you thats a tough compare.

                I could probably live in Columbus again though, it really is a great place. I dont think anywhere in the midwest can be considered a destination city though, but then again I dont think Phoenix is either, I do like Tucson (great cycling). Phx is like the polar opposite of Columbus, like walking on the sun.


                • #9
                  Unaccredited fellowship does have issues, I agree. That is the concern, that although there are jobs in Phoenix for unaccredited pain docs, finding them in Columbus is tough.  The move will be quite a big one (sell the house, ship 3 cars, move 3 kids, 1 cat and our AuPair).  The jobs in Phoenix require 2 year commitment to keep the entire relocation bonus (which is $10k, and I think my relocation costs will be greater than this). Once a family is a certain size doing all this adds quite a bit of stress. Columbus is a hidden gem, and so are many smaller cities in this country. It made to #5 on medscape survey of best places to practice (
                  We are midwesterners our selves, so we have no pull to be on the coasts and fine with the weather (its sunny quite often and nice change in seasons).


                  • #10
                    Can you enlighten me?  I take it that this is different from a pain management program that an anesthesiologist might do.  Is that why it is unaccredited? How easy will it be for her to find a job?


                    • #11
                      For an extra 300k per year, assuming she can get a job with whatever that fellowship is, you should obviously consider it.  It doesn't sound like you guys families are in Columbus?

                      Looking at your cons, they basically boil down to moving sucks.  Well yeah, but for $300k (per year) I would put up with a lot of moving annoyances..


                      • #12
                        #4 is a really important one.  If there is any thought that she might want to do fellowship I would encourage her to do it.  While it may be theoretically possible to go back and do it later if you regret it, once you get older and more dependent on your larger income it will be practically very difficult to allow yourself to do it.  Don't focus so much on the $ early on, focus on what you want to do with your careers - a 30-year career is a long time.

                        I used to live in Phoenix (residency), and found it to be a really enjoyable place.  It was a hard adjustment at first, but by the time we left we were really fond of it.  Cost of living is higher - food, restaurants, housing are all going to be more than OH.  Its the inverse of living in the north - you stay in during the summer and go out during the winter.  And there's so many people from the midwest that moved to Arizona you might not even get homesick.  We still go back to visit regularly, and I have friends who aren't from there that wound up staying after residency when I'm sure they never planned on doing that.  I would encourage you to seriously consider trying something new - even if you move back (as I did) you'll probably really appreciate the experience.


                        • #13
                          Do the fellowship, the earnings potential is too great.  Medicine is undergoing a lot of changes.  Doing the fellowship and the greater earnings now will provide you so much more financial independence later. We know we can at least keep current levels of compensation to 2023 minus 10%.  After that who knows.  to earn about 3 or 4 times as much means that by that time you have a lot more options including early retirement.  I work a ton now, late office hours, operating in the evenings and saturdays.  I'm FI and can RE, but I love what I do.  While my partner and I give each other 6 weeks off a year, I rarely take more than 2 or 3.  Find myself more stressed and getting bored on vacations.  That will change with time, but for now I love my work.


                          • #14
                            Thanks all. Decision has been made to move. The tough part was getting over the planning needed to make the move. Beyond that we are excited to be doing this.