Deciding on location for first attending job

[da8s0859q]

I'm an about-to-be PGY3 in a three-year program which is far from where I'm from. Some of my year have already signed attending / community doc contracts.

The way I see it, here's where I am.

1. State #1 (Texas): doc friendly / medicolegally great. Good compensation as a rule. Open job market, mostly. No state income tax. I lived there for years.

Cons: no seasons / don't like the weather / too damn hot. No mountains.

2. State #2: Pays fairly well. Probably in the top third or close as far as states protective of their physicians, going by ACEP/AAEM. Four seasons.

Cons: heavy winters. No connection to the state whatsoever.

3. State #3: love the geography. Personal bias, up there with Texas. Loved being there when I was there last.

Cons: doesn't pay quite as well. Job market harder. Middle of the pack or worse as regards medicolegal issues going by ACEP and AAEM.

4. State #4 (Colorado): seasons, proximity to cold weather activities / mountains for some of the state, geography. Somewhat favorable legal climate.

Cons: job market tough, and tougher as you get closer to popular areas. Pays less / opportunity cost for the scenery.

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Would love others' thoughts on this.

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[deleted109597]

1. Texas has mountains. It also has cold weather. It's rather large, you know.
2. You don't need a connection to the state. The great thing about EM is you can work where it's in your best interest, be that financial or familial. Shoveling snow sucks. Driving in deep snow sucks worse.
3. Bad legal environments suck. You don't see me in North Carolina anymore.
4. Great place, but it basically has the "pot" tax (think pineapple tax for Hawaii).
Great pay, great location, great legal environment. Pick 2

They are hiring in Wyoming and Montana, as I've noticed in my mail recently. Similar to Colorado geography but significantly cheaper. Whatever you do, rent first, don't buy. Unless you're moving next door to your parents. It's woth buying there just to avoid the "why are you renting, don't you like us" questions.

 

[RustedFox]

Wyoming gets an "F" on the ACEP report card for several things. In addition, it sucks altogether. Been there a bit.

 

[goodoldalky]

Nobody can really make this decision for you on an internet forum. It may be more useful if you have particular contractual or job details you want input on, we may be able to help you with that. Where you should live is largely a personal opinion based decision. Some people like working locums in a dump for a lot of money and some people like working in Maui for a dollar a week. And if you are married like I am, you should consider doing what I did, which is whatever my wife wanted. (half joking.)

 

[shoal]

Nobody can really make this decision for you on an internet forum. It may be more useful if you have particular contractual or job details you want input on, we may be able to help you with that. Where you should live is largely a personal opinion based decision. Some people like working locums in a dump for a lot of money and some people like working in Maui for a dollar a week. And if you are married like I am, you should consider doing what I did, which is whatever my wife wanted. (half joking.)

No joke there. Let the wife pick which is a total shame, byt dragging her around the last 7 years takes a toll. Gl

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[DocRGR]

1. Texas has mountains. It also has cold weather. It's rather large, you know.
2. You don't need a connection to the state. The great thing about EM is you can work where it's in your best interest, be that financial or familial. Shoveling snow sucks. Driving in deep snow sucks worse.
3. Bad legal environments suck. You don't see me in North Carolina anymore.
4. Great place, but it basically has the "pot" tax (think pineapple tax for Hawaii).
Great pay, great location, great legal environment. Pick 2

They are hiring in Wyoming and Montana, as I've noticed in my mail recently. Similar to Colorado geography but significantly cheaper. Whatever you do, rent first, don't buy. Unless you're moving next door to your parents. It's woth buying there just to avoid the "why are you renting, don't you like us" questions.

Can you comment a little more on NC? I'm from the state, likely going back next year. My understanding was the medico legal climate had improved some in recent years? Thanks.

 

[ShanFan]

The pay in Colorado depends on where you are. I interviewed in 4 different cities in Colorado last year. One of them had low pay, one had average pay, and the other two actually paid quite well. If you want to be in Colorado, call around to hospitals in areas that you are interested in. If you can get an interview (which I've heard is the hardest part), then you might be pleasantly surprised at how much you can make there.

 

[deleted109597]

Can you comment a little more on NC? I'm from the state, likely going back next year. My understanding was the medico legal climate had improved some in recent years? Thanks.

Couldn't say. In 2011, when I left, it was a ****storm. John Edwards still had enough political clout to make lawsuits a nearly yearly occurance. It might be better now, but I don't care. I'm not moving back.

 

[Birdstrike]

I can't tell you how important it is to avoid states that are toxic to doctors, particularly by allowing a predatory tort environment. If you can, go to A and B rated states. Avoid poorly rated states if at all possible.

 

[Old_Mil]

Bird strike is absolutely right.

Montana has taken significant steps backwards by expanding medicaid this year. Wyoming, in addition to being a medicolegal nightmare is also joining the medicaid expansion ranks. That is probably why they are hiring. People vote with their feet.

Texas pay is good, but not everywhere.

 

[docdragon]

Wyoming also has few residents, no med school, no residency and therefore has difficulty recruiting. There have been ads out for the last 3 or so years, often in the same places. Oh, and I hear it's cold sometimes.

 

[RustedFox]

Wyoming also has few residents, no med school, no residency and therefore has difficulty recruiting. There have been ads out for the last 3 or so years, often in the same places. Oh, and I hear it's cold sometimes.

I've been to Wyoming three times, for 5 to 7 days each.
Let me just throw some words out there.

Cold. Desolate. Impoverished. Methamphetamines. Depression.

The next town is often over 2 hours away. Inaccessible in winters.

There were many billboards advertising suicide help lines.

 

[Birdstrike]

I've been to Wyoming three times, for 5 to 7 days each.
Let me just throw some words out there.

Cold. Desolate. Impoverished. Methamphetamines. Depression.

The next town is often over 2 hours away. Inaccessible in winters.

There were many billboards advertising suicide help lines.

That post gave me the warm & fuzzies

 

[WilcoWorld]

I've been to Wyoming three times, for 5 to 7 days each.
Let me just throw some words out there.

Cold. Desolate. Impoverished. Methamphetamines. Depression.

The next town is often over 2 hours away. Inaccessible in winters.

There were many billboards advertising suicide help lines.

But there's this one pretty decent bar in Jackson Hole...

 

[deleted109597]

But there's this one pretty decent bar in Jackson Hole...

There's more than one.

 

[gutonc]

There's more than one.

Two is in fact more than one.

 

[Cinclus]

Many parts of Wyoming are gorgeous, and I love visiting for outdoor activity. But I do not desire to actually live/work there for several of the reasons mentioned previously.

 

[da8s0859q]

Bumping my own thread. Appreciate everyone's thoughts. Have been mulling.

Any strong feelings or observations on Wisconsin jobs compared to my initial post? If Texas, thinking north Texas. If CO, maybe Colorado Springs or somewhere away from Denver.

Am definitely more than okay with a smaller city so long as it's economically okay. Four seasons, decent legal climate, decent location -- some blend of that, just depends on where I find that suits me.

 

[docdragon]

There are several democratic groups in Wisconsin, some harder than others to get in. Obviously taxes are higher in Wisconsin. The state has been high on the reimbursement ladder for a while. You'll get four seasons. Heavy winters. Worth having a connection, or at least loving green summers with lots of deer. And beer, cheese, sports, snowmobiling, lakes and water sports... What do you want in life? Realistically, as long as you're near a half-decent airport you can live somewhere for dollars and fly out for fun.

 

[EM_Rebuilder]

Texas, its the best option by far.

You can probably come to Texas, work 8 shifts a month, and travel the rest of the time. Go visit the mountains, oceans, seasons (which, as pointed out, Texas does have these). Still make more money than those other places and not have to stay awake at night worrying about your next suit.

 

[Docinthetrenches]

Well in my opinion it depends what kind of person you are. Are you an urbanite? Are you more politically progressive or conservative? Do you like big city energy or outdoor sports? Do you need a big house with a yard? Or don't you care? Are you planning on having a bunch of kids? These are more important factors than pay since over time, these things will bother you more no matter what you make. I personally could never live outside a big city regardless of what you paid me.