Figuring out location after residency

[FiveTwoFifty]

Hi everyone!

I am a PGY3 currently and am beginning to think about life post-residency. I'm considering working in academics but am not set on this yet. I will likely be doing a fellowship here in California after residency. I have been thinking quite a bit about where I'd like to end up after training. My partner works from home (even pre-COVID) so is very flexible and is amenable to a change in scenery. I've been in California my whole life but have always had the dream of spending time in Manhattan/NYC for either training and/or work. I've been to NYC over 20 times and have a general sense of how life will be different so hoping not to get too into the weeds of CA vs. NY, but read to hear that discussion too.

Before fellowship, I'm looking into moonlighting and am starting to get a grasp more of non-academic psychiatry work. Things like per diem work as an attending or companies where you "fill in" for inpatient jobs but only work a set number of days per month and this is considered "full time."

What I'd like to know is if anyone has had success in sort of "experimental" careers in this way to get a sense of a new geographic area?

My partner and I are financially stable enough that it wouldn't disrupt things too much to defer settling down and establishing ourselves in "our city" moving forward, so there is some flexibility. One thought I had was picking up this full-time job that amounts to 9-10 days per month in California and seeing if I could do something similar in NYC (obviously needing the NY medical license, etc. etc.). But given my lack of knowledge of what's out there, I'd be curious to hear what others had to say! I think tacking on another fellowship may be the easier answer, but at the cost of reduced salary. I am committed to my current fellowship selection which is in a different part of California (planned to get a sense of other parts of my current state).

Appreciate all thoughts on this!

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[dl2dp2]

You have a very prosaic post, so I'll provide a prosaic response.

Manhattan is nice if you can have a total HHI ~ 300k if you are DINK, 400-500k+ if you have children. This is "upper middle class" in Manhattan, which means a relatively cookie cutter unimpressive "luxury" 2-3 bed rental apartment in the 5-8k range but you should be able to afford trips, restaurants, plays and shows (post-COVID) and good public schools and slowly save for retirement and enjoy quirky cultural stuff in NY. There is a very large portfolio of different types of jobs in the NY area, and you can probably pick and choose if you want which would provide this level of income.

The "best" (i.e. most well paid) psychiatrists in NY don't have jobs--they either have practices or work in non-clinical roles, admin, finance, health tech, etc. or have family money and work in academia/research/other prestige public sector jobs--but you knew this already. Ideally you want a prestige job but still live "Manhattan affluence", which means HHI in the 700-1M range or net worth > 10M, which would allow for private school, the occasional first class ski trip in Vail, St. Barts, some charity gala later, things of that sort, nice large apartment (or a big house in Tier 1 suburb)--but definitely not extravagant (not park side, not more than 4000 sq ft house with multiple pools or view, no driver/other servants, still can't afford a large summer rental in the Hamptons, very rare if at all private jets, not in the finance crowd, etc--if that's the sort of stuff you are into). If you work hard it's not difficult to make 500k in the tristate area by doing multiple "jobs", but a more common and palatable strategy is to marry a rich spouse who will work harder on your behalf either in or outside of medicine.

For those among us commoners who make less than 300k HHI, IMO your options in the tristate area are better than your options in Northern California. The housing stock in 9+ public zones is *much* cheaper in the tristate area than NorCal. Southern California isn't much better. Traffic is by far better in tristate suburbs, public transit is better, air is better. The only positive in California is weather and its associated activities (i.e. wine region, water sports, etc). But qualitatively this life either in tristate or California is not that different (except a few small things like more "ethnic" experiences or host people for a weekend Broadway show) from living anywhere generically affluent (i.e. some good suburb of Scottsdale, AZ or Charlotte, NC), so you might as well move to one of those places and pay 30-50% less.

 

[psychacad]

they either have practices or work in non-clinical roles, admin, finance, health tech, etc.

Mind elaborating on that?


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One of the underrated things about a large metropolitan area is that you have a lot of options in a small area because of the population density. So while the pay for salaried jobs could be less than rural areas, you can hop between different types of jobs. It's definitely doable to do some per diem/moonlighting stuff in the NYC area while you look for something more stable. And yes, you can find places where you can work 9/10 days per month. There are tons of opportunity. I'd start my search early though; you're looking for 4-6 months just for credentialing. It definitely gives you a big edge if you have some inside info on places that are more pleasurable to work at.

 

[PsyDr]

Mind elaborating on that?


--

One of the underrated things about a large metropolitan area is that you have a lot of options in a small area because of the population density. So while the pay for salaried jobs could be less than rural areas, you can hop between different types of jobs. It's definitely doable to do some per diem/moonlighting stuff in the NYC area while you look for something more stable. And yes, you can find places where you can work 9/10 days per month. There are tons of opportunity. I'd start my search early though; you're looking for 4-6 months just for credentialing. It definitely gives you a big edge if you have some inside info on places that are more pleasurable to work at.

One of America’s ~400 billionaires is a psychiatrist that made his fortune selling silver futures. Which funded his son’s film, The Jinx.

The Mets psychiatrist is married to Mia Farrows attorney.


The ideal situation is an interaction between COL, culture, social mobility, malpractice tort reform, income potential, non clinical opportunity, and airplane routes. That all depends on your preferences of class vs. wealth.

 

[jbomba]

You have a very prosaic post, so I'll provide a prosaic response.

Manhattan is nice if you can have a total HHI ~ 300k if you are DINK, 400-500k+ if you have children. This is "upper middle class" in Manhattan, which means a relatively cookie cutter unimpressive "luxury" 2-3 bed rental apartment in the 5-8k range but you should be able to afford trips, restaurants, plays and shows (post-COVID) and good public schools and slowly save for retirement and enjoy quirky cultural stuff in NY. There is a very large portfolio of different types of jobs in the NY area, and you can probably pick and choose if you want which would provide this level of income.

The "best" (i.e. most well paid) psychiatrists in NY don't have jobs--they either have practices or work in non-clinical roles, admin, finance, health tech, etc. or have family money and work in academia/research/other prestige public sector jobs--but you knew this already. Ideally you want a prestige job but still live "Manhattan affluence", which means HHI in the 700-1M range or net worth > 10M, which would allow for private school, the occasional first class ski trip in Vail, St. Barts, some charity gala later, things of that sort, nice large apartment (or a big house in Tier 1 suburb)--but definitely not extravagant (not park side, not more than 4000 sq ft house with multiple pools or view, no driver/other servants, still can't afford a large summer rental in the Hamptons, very rare if at all private jets, not in the finance crowd, etc--if that's the sort of stuff you are into). If you work hard it's not difficult to make 500k in the tristate area by doing multiple "jobs", but a more common and palatable strategy is to marry a rich spouse who will work harder on your behalf either in or outside of medicine.

For those among us commoners who make less than 300k HHI, IMO your options in the tristate area are better than your options in Northern California. The housing stock in 9+ public zones is *much* cheaper in the tristate area than NorCal. Southern California isn't much better. Traffic is by far better in tristate suburbs, public transit is better, air is better. The only positive in California is weather and its associated activities (i.e. wine region, water sports, etc). But qualitatively this life either in tristate or California is not that different (except a few small things like more "ethnic" experiences or host people for a weekend Broadway show) from living anywhere generically affluent (i.e. some good suburb of Scottsdale, AZ or Charlotte, NC), so you might as well move to one of those places and pay 30-50% less.

In fairness, if a psychiatrist was working finance hours I'd imagine he'd easily make finance money/1MM a year in NYC.

 

[comp1]

I could never imagine leaving CA for any extended period of time, but I've seen some people do this intermittent kind of travel work. It hasn't necessarily been cross country, but it works for them. It sounds stressful, but if you're really into NYC, it might work for you.

 

[tr]

It kind of doesn't seem like there is as much of a locums market in NYC as in CA, or at least since switching coasts I am no longer receiving a constant barrage of locums recruitment spam. Maybe that's just because the recruiters here didn't get their hands on my info, or maybe my spam filters are better now. Not sure.

In general the psychiatry job market seems much tighter and generally worse in NYC vs northern CA at least. Salaries are significantly lower and even in the private practice market it seems like there is a lot more competition.

It might be easier to start out with a telepsych job in CA that you could do from NY while you test out the city, vs committing to a likely crappier NYC area salaried position and then having to job hunt cross-country when you come to your senses 😶