Best areas to move for job post-residency?

[letmeinwillya]

Currently in NY, IM resident, have young kids and can move after residency to better climate and brighter future prospects. What're the resources (online websites, books etc) that I can use to educate myself on the topic to make an informed decision down the road. Thank you for reading this far and hoping to get some helpful perspectives from you.

Is there a consensus on some places to best more physician friendly than others? Are there places that pay well but also not too far from the human civilization

It looks like major metro areas are not going to pay well.. NYC, Boston, etc or if they do..cost of living will eat up that up..If this question belongs to another forum section, please advise and I will post there.

---

Members don't see this ad.

 

[Obnoxious Dad]

I'm sure that you will scoff at this answer but I will offer it anyway. The best places to practice medicine in the U.S. are Wisconsin and Minnesota. These two states pay the best and malpractice premiums are a trifle. Juries in Minnesota tend to be very pro physician and malpractice caps in Wisconsin have turned WI medical malpractice law into a dead letter. Furthermore, these two states have the best public schools in America as indicated by average ACT scores. Average commute times in Milwaukee are about 15 minutes and in the Twin Cities they average about 25 minutes. It is true that income taxes in Minnesota are high but property taxes there are nothing. If you live in the Milwaukee area and want great music, you just hop on I 94 and you are in Chicago. There is terrific theater in the Twin Cities. Both states have great public golf, professional sports, great state supported university systems and low crime. The price of housing is low.

Don't be a fool. Get out of New York and come to God's country.

 

[VA Hopeful Dr]

Basically anywhere outside of major metro area to start. The farther you are from the coast the better as well - flyover states pay very well and are very inexpensive.

I'm partial to the Piedmont areas of southern coastal states (Virginia, NC, SC) - good COL, close enough to the coast for long weekend trips, enough mountains for anyone outside hard core skiers, and just generally nice places to live.

 

[deleted859535]

Depends on what you want.

If Midwest: Wisconsin as above; Indiana; if Michigan, stay towards the west side of the state.

Elsewhere: Texas; Colorado.

Expect to pay in opportunity cost the more idyllic a climate/setting you get and, in some cases, for living towards more "happening" places (for example, Austin versus suburbs of Dallas).

Medicolegal: can't beat Texas, Colorado, and Indiana. Minnesota is sort of a unique situation as is alluded to above. Wisconsin tends to be very friendly.

Stay away from Illinois and DC along with most of New England for the same reason.

For the medicolegal part, look at the report card from ACEP and the series done a few years ago by AAEM. Focuses on emergency medicine, obviously, but still useful reading.

 

[VA Hopeful Dr]

Depends on what you want.

If Midwest: Wisconsin as above; Indiana; if Michigan, stay towards the west side of the state.

Elsewhere: Texas; Colorado.

Expect to pay in opportunity cost the more idyllic a climate/setting you get and, in some cases, for living towards more "happening" places (for example, Austin versus suburbs of Dallas).

Medicolegal: can't beat Texas, Colorado, and Indiana. Minnesota is sort of a unique situation as is alluded to above. Wisconsin tends to be very friendly.

Stay away from Illinois and DC along with most of New England for the same reason.

For the medicolegal part, look at the report card from ACEP and the series done a few years ago by AAEM. Focuses on emergency medicine, obviously, but still useful reading.

Something else to consider is how strict your medical boards are.

SC FTW!

The Best And Worst States For Doctors In 2015

 

[Rads312]

Wisconsin or Indiana near the illinois border...can reverse commute to a nice chicago suburb and not get killed on malpractice, etc.

 

[ThoracicGuy]

Wisconsin or Indiana near the illinois border...can reverse commute to a nice chicago suburb and not get killed on malpractice, etc.

Why would you want to live in Illinois if you work in Indiana or Wisconsin. You'll get killed on taxes that way. Just go visit Chicago on the weekend if you wish.

 

[Light at end of tunnel]

Why would you want to live in Illinois if you work in Indiana or Wisconsin. You'll get killed on taxes that way. Just go visit Chicago on the weekend if you wish.

Chicago vs Madison vs Indianapolis. That's why.

Easy choice.

Visiting Chicago 4 times per month gets more expensive than the theoretical taxes you'd be saving. Ain't nobody got time for that.

 

[RadOncDoc21]

Chicago vs Madison vs Indianapolis. That's why.

Easy choice.

Visiting Chicago 4 times per month gets more expensive than the theoretical taxes you'd be saving. Ain't nobody got time for that.

I'm cold reading this!

 

[ThoracicGuy]

Chicago vs Madison vs Indianapolis. That's why.

Easy choice.

Visiting Chicago 4 times per month gets more expensive than the theoretical taxes you'd be saving. Ain't nobody got time for that.

The poster I was responding to talked about a job just over the border from Chicago. If you lived in Chicago, you'd pay state income taxes in both states. Plus you'd have higher property taxes and horrible traffic for a daily commute. If you lived close enough to commute like that, you aren't living in Madison or Indianapolis. You're working in Kenosha or Merrillville or someplace worse.

So, in all your MD/PhD wisdom, how are you better off living in Chicago instead of visiting frequently?

 

[raiderette]

Wisconsin or Indiana near the illinois border...can reverse commute to a nice chicago suburb and not get killed on malpractice, etc.

Live in Munster, Chesterton, Valparaiso and visit Chicago. Cheaper taxes and closer to Michigan for other good restaurants. Live on Lake Michigan in Miller, Burns Harbor or Beverly Shores.

 

[letmeinwillya]

Thank you for your replies, really thoughtful insights. Have lived in New England for the better part of the decade and would love to move to more moderate climate. Don't mind that seasonal cold but no blizzards!! yup seen them in Boston and they are no fun!

General criteria include reasonable house prices (newer construction and open spaces), little to no income/sales tax, safe and accepting for someone who looks "different" (in terms of skin color and country of birth) and great public schools.. Had not thought of Minnesota or Wisconsin but will look into them.

TX, SC, NC generally keep coming up as good places to practice medicine and raise a family..

 

[letmeinwillya]

Something else to consider is how strict your medical boards are.

SC FTW!

The Best And Worst States For Doctors In 2015

Thanks for the link, would you kindly elaborate on what you mean by medical boards being strict? Sorry if this is a newbie question.

 

[VA Hopeful Dr]

Thanks for the link, would you kindly elaborate on what you mean by medical boards being strict? Sorry if this is a newbie question.

It's the likelihood of being sanctioned by the board. SC has the lowest rate of board action per thousand practicing physician.

 

[loeffy]

Fortunately as a doctor you can pretty much live wherever you want, just depends on what your priorities are. Professionally, states like TX and MN often come up as good for doctors, and pretty much the whole Northeast being bad, yet lots of doctors move there for other reasons. A quick online search can point out which States are better for doctors. The basic rules still generally apply, desirable areas (which are often HCOL) pay less, as does academics. However, I still know of people in these desirable cities (including Boston) that still pull in over $200k as a hospitalist at University-affiliated hospitals, while others in less desirable areas pull in closer to $300k. Based on your criteria, a huge list of areas could be made, so you should really do your own research (city-data.com is a good place to start).

 

[letmeinwillya]

@loeffy,
Thank you for chiming in. Another factor is my significant other (SO) is in the IT field and could possibly work remotely. it would be nice to have local IT opportunities since most IT places may not do a remote work arrangement from the get-go. I hear ya .. Some folks I know live in, far (Sharon, Dedham etc) from Boston but work in University affiliated hospitals that are not in the city (Boston) so that must work for them in terms of COL and overall cost-benefit ratio..

The hospitalist salaries are all over the place..no idea what to expect right after completing residency ... Thanks on the city-data suggestion..I've been to their forums and their individual State forums are good..I didn't find their main website to be easy to research places ..but I will take another look.

 

[letmeinwillya]

I'm sure that you will scoff at this answer but I will offer it anyway. The best places to practice medicine in the U.S. are Wisconsin and Minnesota. These two states pay the best and malpractice premiums are a trifle. Juries in Minnesota tend to be very pro physician and malpractice caps in Wisconsin have turned WI medical malpractice law into a dead letter. Furthermore, these two states have the best public schools in America as indicated by average ACT scores. Average commute times in Milwaukee are about 15 minutes and in the Twin Cities they average about 25 minutes. It is true that income taxes in Minnesota are high but property taxes there are nothing. If you live in the Milwaukee area and want great music, you just hop on I 94 and you are in Chicago. There is terrific theater in the Twin Cities. Both states have great public golf, professional sports, great state supported university systems and low crime. The price of housing is low.

Don't be a fool. Get out of New York and come to God's country.

No scoffing here Thank you for your reply, have not been to either state so will look into them. I hear ya on NY… Good to know that MN and WI have great public schools .. with young kids, it’s a must..

 

[Follow the Cairns]

No scoffing here Thank you for your reply, have not been to either state so will look into them. I hear ya on NY… Good to know that MN and WI have great public schools .. with young kids, it’s a must..

This is an aspect of this discussion I would like to elaborate on based on personal experience. My husband and I are in our mid 40's and have two elementary aged children. When he initially finished his surgical training, we moved to a small city in Texas where he was in practice for 5 years. We did very well there financially because he was a big fish in a small pond, had income from ancillaries, and the area had a very low COL. However, we left to move to another state for a variety of reasons, chief among them was that the community was just to small to support not only good schools, but also a variety of other aspects as well. I think a lot of people perceive that small communities are ideal places to raise a family, but don't always consider that these communities are often not large enough to support lifestyle considerations important to young, high income professionals, such as access to arts, culture, museums etc, and even logistical things seemingly as unexciting as access a large airport.

You also need to consider job prospects for your spouse. This was an issue for us because where we lived pretty much eliminated my ability to work a job comparable to my education and background as a Master's prepared professional in Health Administration.

Now, the above can be mitigated if you are close enough to a large metro, but I just thought I would throw my $02 out there.

 

[Raryn]

No scoffing here Thank you for your reply, have not been to either state so will look into them. I hear ya on NY… Good to know that MN and WI have great public schools .. with young kids, it’s a must..

It's pretty variable within the states though. For example, urban Milwaukee has horrendous public schools, but move 15 minutes into the suburbs and they're great.

 

[WingedOx]

Live in Munster, Chesterton, Valparaiso and visit Chicago. Cheaper taxes and closer to Michigan for other good restaurants. Live on Lake Michigan in Miller, Burns Harbor or Beverly Shores.

Lake County, IN is a hole.

If you're going to live in the Chicagoland region, do it right. This'll be my view on my run this evening (also my drive home in a few minutes)

 

[raiderette]

Lake County, IN is a hole.

If you're going to live in the Chicagoland region, do it right. This'll be my view on my run this evening (also my drive home in a few minutes)

I will take Indiana taxes and malpractice rates any day. Also, half the places I listed were in Porter county with cheaper taxes. I would never raise kids under CPS, and most charters are worse.
I am just glad I got out of the Midwest and hope I never have to return.

 

[WingedOx]

I will take Indiana taxes and malpractice rates any day. Also, half the places I listed were in Porter county with cheaper taxes. I would never raise kids under CPS, and most charters are worse.
I am just glad I got out of the Midwest and hope I never have to return.

You get what you pay for out there though. You can make bank out in northwest Indiana, or some other location to squeeze every penny out of your doctor life, but at the end of the day, you're still living in Northwest Indiana.

Even with the budget cuts, our local CPS school gets some of the best test scores in the entire state too.

 

[WingedOx]

It's the likelihood of being sanctioned by the board. SC has the lowest rate of board action per thousand practicing physician.

sounds like a great place to be an opiate addict.

 

[meerkat111]

Interesting discussion. Lived in MN for 15 yrs, have family there. I will never move back there. Nice city, terrible, awful weather. And why would anyone want to live in WI? What about quality of life? Of course, both of those states are better than NE w/o doubt.

 

[VA Hopeful Dr]

sounds like a great place to be an opiate addict.

If you're a physician, yes actually. If your license is ever revoked then you never get it back so we do lots of suspensions.

If you mean as a patient, we're not even in the top 10 for opioid prescriptions.

 

[*brobro*]

Great topic!

I'm curious about the southwest. I was born and raised in Arizona and my wife is from Minneapolis. We are both in residency still but are thinking we would like to end up in AZ. From a cost of living and quality of life stand point, Phoenix is amazing - sure it gets hot for a few months, but it's always sunny and 8mo of the year are beautiful. I know very little about the climate for practicing medicine though. Anyone have an opinion or info on that?

 

[Rads312]

Why would you want to live in Illinois if you work in Indiana or Wisconsin. You'll get killed on taxes that way. Just go visit Chicago on the weekend if you wish.

Because you aren't going to visit. You're going to stay in crappy indiana or wisconsin. I grew up in indiana, 40 minutes from chicago. trust me.

 

[Rads312]

Lake County, IN is a hole.

If you're going to live in the Chicagoland region, do it right. This'll be my view on my run this evening (also my drive home in a few minutes)

Absolutely agreed. Make the extra dough in indiana or wisconsin, suffer a bit on the taxes and living costs and live around chicago, that's the way to go....Life is short and living in a craphole isn't on my agenda. I'll work in a craphole and get paid though. $.

 

[Rads312]

Live in Munster, Chesterton, Valparaiso and visit Chicago. Cheaper taxes and closer to Michigan for other good restaurants. Live on Lake Michigan in Miller, Burns Harbor or Beverly Shores.

I grew up around chesterton and valpo - NO THANKS.

Summer home in beverly shores - sure. Actually living there? are you serious. Also michigan - sure. you're close to new buffalo. Great times at the casino and average restaurants.

 

[ThoracicGuy]

Because you aren't going to visit. You're going to stay in crappy indiana or wisconsin. I grew up in indiana, 40 minutes from chicago. trust me.

If I lived in nw Indiana, I'd go into Chicago frequently...

 

[raiderette]

I grew up around chesterton and valpo - NO THANKS.

Summer home in beverly shores - sure. Actually living there? are you serious. Also michigan - sure. you're close to new buffalo. Great times at the casino and average restaurants.

I moved from the Bay Area to Indiana, so I appreciate both areas. I will never return to the Region willingly, but it is not a cultural wasteland.

 

[WingedOx]

I grew up around chesterton and valpo - NO THANKS.

Summer home in beverly shores - sure. Actually living there? are you serious. Also michigan - sure. you're close to new buffalo. Great times at the casino and average restaurants.

Also I got pulled over in Ogden Dunes like five years ago. Still bitter.

The fact that the South Shore line in Michigan City just runs right down the middle of the street is cool at least.

 

[letmeinwillya]

What're your thoughts on accepting job at the residency program where currently in training? Does it give you any advantage in terms of negotiating or getting better overall package vs negotiating out of the program? I know a lot would depend on location which drives the cost of living and salary ranges.

 

[gutonc]

What're your thoughts on accepting job at the residency program where currently in training? Does it give you any advantage in terms of negotiating or getting better overall package vs negotiating out of the program? I know a lot would depend on location which drives the cost of living and salary ranges.

You're actually much less likely to get a good deal from your current program than somewhere else.

Besides, don't you want to GTFO?

 

[WingedOx]

You're actually much less likely to get a good deal from your current program than somewhere else.

Besides, don't you want to GTFO?

I would have liked to stay at my residency program, but the salary they were offering was insulting.

 

[ThoracicGuy]

What're your thoughts on accepting job at the residency program where currently in training? Does it give you any advantage in terms of negotiating or getting better overall package vs negotiating out of the program? I know a lot would depend on location which drives the cost of living and salary ranges.

I'm not sure how it is in your field, but often times the residents/fellows that would become attendings at their training sites would be considered in many ways to still be trainees by more senior staff. Lots of dumping on you with that.

 

[letmeinwillya]

How about California? Are there places left in CA that don't cost million bucks to have a one bed room house (kind exaggerating but not much). Is the weather main attraction and if so are there areas within CA that are better than others? Like Sacramento I heard is more affordable than say Bay Area. Can one get a license fairly quickly in CA..

Texas is another big one..pun intended! Cost of living seems to be much better but humidity and heat may be too much for some. I'm personally ok with heat as long as it still gives you time to go out in the evening and not see dark like we do here on the Northeast in Winters!

Does Florida present a good option? I'm also looking at no income states so that could be another factor.

Arizona I heard is too much heat but how does it compare to TX then? TX has heat but comes up more often as a place to go than AZ.

North Carolina is coming up a lot in discussions..especially the Research Triangle area.

 

[doc05]

How about California? Are there places left in CA that don't cost million bucks to have a one bed room house (kind exaggerating but not much). Is the weather main attraction and if so are there areas within CA that are better than others? Like Sacramento I heard is more affordable than say Bay Area. Can one get a license fairly quickly in CA..

Texas is another big one..pun intended! Cost of living seems to be much better but humidity and heat may be too much for some. I'm personally ok with heat as long as it still gives you time to go out in the evening and not see dark like we do here on the Northeast in Winters!

Does Florida present a good option? I'm also looking at no income states so that could be another factor.

Arizona I heard is too much heat but how does it compare to TX then? TX has heat but comes up more often as a place to go than AZ.

North Carolina is coming up a lot in discussions..especially the Research Triangle area.

Liability climate in California is above average. COL is way too high.
Florida is bad in terms of QOL, the sunshine only goes so far. Liability climate not good.

 

[Raryn]

Liability climate in California is above average. COL is way too high.
Florida is bad in terms of QOL, the sunshine only goes so far. Liability climate not good.

Liability climate in CA is among the best in the country actually. They've had malpractice reform with caps on non-economic damages since the 1970s. The only states with lower malpractice premiums are a few in the midwest (NE, MN, WI, SD) and Texas. You're less likely to get sued in CA than you are in Arkansas.

COL isn't bad in central CA - but no one wants to live in the San Joaquin Valley.

 

[DrDreams]

What about Washington State?

 

[NITRAS]

Texas main tax is property tax. AKA, you can avoid it if you don't buy a bazillion dollar property. I love Texas, just enjoy the heat. Personally, I think Houston is a big hole. San Antonio, Austin, Dallas have way too much traffic (can you tell I like smaller places). I'm here in a town where there are only a few hundred thousand in the county and yet I have a tertiary care center to work at.

My family lives in CO. The weather and out-door activities (hunting, hiking, fishing) is much more appealing, but COL is going to be higher without increase in income.

What're your thoughts on accepting job at the residency program where currently in training? Does it give you any advantage in terms of negotiating or getting better overall package vs negotiating out of the program? I know a lot would depend on location which drives the cost of living and salary ranges.

I personally think there are advantages to moving out of system.
1. The RN's don't remember you as an intern. Same with some of the other staff.
2. You realize some things you do isn't necessary the only way to do them.

The advantages you have is that you know the system, which takes a while to really get. You may already own a house, which encourages you to not expand your lifestyle and encourages you to pay your loans off faster.

 

[Obnoxious Dad]

What about Washington State?

From a tax perspective you can't beat Vancouver, Washington. There is no state income tax. For major non automobile purchases you can shop in Portland where there is no sales tax. Furthermore, as evidenced by insurance rates the malpractice environment is not bad.
How Much Does Medical Malpractice Insurance Cost?

 

[Mass Effect]

Someone once told me that if you accept a job at your residency program without having moved out of the system for a while, it's really difficult for people to get to know/treat you like an attending instead of a resident. There's something to be said for spreading your wings elsewhere for a few years, then returning if you want to work there.

 

[Winged Scapula]

How about California? Are there places left in CA that don't cost million bucks to have a one bed room house (kind exaggerating but not much). Is the weather main attraction and if so are there areas within CA that are better than others? Like Sacramento I heard is more affordable than say Bay Area. Can one get a license fairly quickly in CA..

There are cheaper places to live in California, but as my friend @Raryn notes, who wants to live in the central San Joaquin Valley? I grew up there and did not return for a reason.

Malpractice in California is one of the attractive things; rates are much much lower than they used to be due to malpractice reform.

Getting a license in California is notoriously slow.

Arizona I heard is too much heat but how does it compare to TX then? TX has heat but comes up more often as a place to go than AZ.

Malpractice climate here decent: no reform but more pro-doctor climate.

Speaking of climate: Arizona has it all. Flagstaff rarely gets above 85 in the summer and of course, gets lots of snow in the winter. Evergreen trees, etc. PHX is hot but triple digits only for 4 months a year and you can walk around without a coat in the winter. Besides, you're working inside an AC office/hospital, car etc. Very private practice friendly. Tucson is about 10 degrees cooler than PHX in the summer.

I like AZ; the only thing I miss is an ocean, although you can drive to Mexico in 4 hours from PHX to get to the beach.

 

[SXMMD]

What's wrong with Illinois? Asking for a friend...

 

[Raryn]

What's wrong with Illinois? Asking for a friend...

Among the worst malpractice environment in the country. Pay in Chicagoland is also usually on the low side.

 

[DrDreams]

From a tax perspective you can't beat Vancouver, Washington. There is no state income tax. For major non automobile purchases you can shop in Portland where there is no sales tax. Furthermore, as evidenced by insurance rates the malpractice environment is not bad.
How Much Does Medical Malpractice Insurance Cost?

Did not consider Portland! Excellent. Currently Washington is my #1 choice for match!

 

[mvenus929]

Speaking of climate: Arizona has it all. Flagstaff rarely gets above 85 in the summer and of course, gets lots of snow in the winter. Evergreen trees, etc. PHX is hot but triple digits only for 4 months a year and you can walk around without a coat in the winter. Besides, you're working inside an AC office/hospital, car etc. Very private practice friendly. Tucson is about 10 degrees cooler than PHX in the summer.

I like AZ; the only thing I miss is an ocean, although you can drive to Mexico in 4 hours from PHX to get to the beach.

But scorpions...

 

[Obnoxious Dad]

Did not consider Portland! Excellent. Currently Washington is my #1 choice for match!

If you live in Washington but work in Portland, you will pay the outrageous Oregon income tax. It is absolutely brutal.
Oregon Department of Revenue : Individuals : Do I need to file?
If you can get a gig in Vancouver, however, and live on the Washington side you will be free of Oregon tax. You can still hang out on the weekends with all of the screwballs in Portland.

 

[Winged Scapula]

But scorpions...

LOL...its not like you're wading through them to get to work.

In my first 10 years here, I never saw one. I've only seen a couple of others since I moved to a more "desert-y" area.