Moving to a big city after fellowship

[run91]

Hey, I am originally from one of the top 3 big cities in the US, but have been outside of the region for both medical school and residency. I would ideally like to go back to by home state, but am applying to a competitive fellowship and am expecting to match somewhere else, since my home city is very desirable.

My question is, is it hard to get a job back in your home city, if you have been outside of the region for basically all of your medical training? Can you basically get a job anywhere you want after fellowship? Any information or insight is appreciated!

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[NewYorkDoctors]

I work in New York City and there are indeed many opportunities. However, these opportunities are usually not handed to you on a silver platter.
Jobs for all specialties are plenty in NYC. However, physician supply tends to outpace demand (unless you are a rather in demand subspecialist) and most hospital offered jobs will have lower starting salaries than what you could get in a suburban or rural area. With a higher cost of living in NYC (and greater NY) compared to other states, you will have to consider strongly the cost/benefit and pros/cons of taking a lower paying starting job for another employer versus wanting to be in a big urban area.

On the other hand, if you are able to open your own private practice in NYC and leverage your business, then you can easily be a multimillionaire in a big urban area. I am serious even PCPs can make over 1M (gross revenue) in NYC in private practice and even taking managed medicare/ medicaid insurances due to sheer volume of patients in underserved areas.

Take this advice how you will. But most individuals who do not plan for being entrepreneurial will find greener pastures outside of the big urban areas. Though many individuals who are non-Caucasian and immigrants or children of immigrants prefer to be in an urban area near individuals of their culture to raise their kids. That is also something to consider.

 

[HemeOncHopeful19]

It’s easy to get a job in a big city, just be willing to give half of your income to someone else for the privilege of working for them.

 

[MD46]

Plenty of jobs which come with lower salaries than avg, likely more volume and longer hours.
Places like NYC will also have their own tax on top of state and income tax. I am originally from a suburb outside of New York and that area has absurd property tax now. Won't be going back anytime soon.

 

[rokshana]

Top 3 cities for what? Population? Desirability for living( though this is quite subjective)
Big cities like nyc pay less in general and academics in these big cities pay even less. Generally there are positions available and the less money you are willing to take, the more options available.
Working just outside of these big cities can give you better options and pay… making living in these big cities with vhcol doable.

 

[cards67]

Sure you can pretty much work anywhere you want, but that doesn't necessarily mean it'll be a good job and/or good pay. The more desirable the area, the tougher it is.

 

[run91]

I work in New York City and there are indeed many opportunities. However, these opportunities are usually not handed to you on a silver platter.
Jobs for all specialties are plenty in NYC. However, physician supply tends to outpace demand (unless you are a rather in demand subspecialist) and most hospital offered jobs will have lower starting salaries than what you could get in a suburban or rural area. With a higher cost of living in NYC (and greater NY) compared to other states, you will have to consider strongly the cost/benefit and pros/cons of taking a lower paying starting job for another employer versus wanting to be in a big urban area.

On the other hand, if you are able to open your own private practice in NYC and leverage your business, then you can easily be a multimillionaire in a big urban area. I am serious even PCPs can make over 1M (gross revenue) in NYC in private practice and even taking managed medicare/ medicaid insurances due to sheer volume of patients in underserved areas.

Take this advice how you will. But most individuals who do not plan for being entrepreneurial will find greener pastures outside of the big urban areas. Though many individuals who are non-Caucasian and immigrants or children of immigrants prefer to be in an urban area near individuals of their culture to raise their kids. That is also something to consider.

Thanks for the reply! Have you found that people who did their medical training in the city had a easier time finding a job in the city than people who did not? Will practices basically choose an individual who did training close by over an individual who did their training in another state/region of the US?

 

[NewYorkDoctors]

Thanks for the reply! Have you found that people who did their medical training in the city had a easier time finding a job in the city than people who did not? Will practices basically choose an individual who did training close by over an individual who did their training in another state/region of the US?

there is no hard or set rule with that. I think the "connections" of recommending a certain "desirable" job is easier if you were local, but that is by no means the only way to get a job in an urban area.

 

[DrMetal]

Hey, I am originally from one of the top 3 big cities in the US, but have been outside of the region for both medical school and residency. I would ideally like to go back to by home state, but am applying to a competitive fellowship and am expecting to match somewhere else, since my home city is very desirable.

My question is, is it hard to get a job back in your home city, if you have been outside of the region for basically all of your medical training? Can you basically get a job anywhere you want after fellowship? Any information or insight is appreciated!

If by chance you're talking about CA, it can be frustrating. Throw a rock out here an you hit a cardiologist. Start looking early, and taper your expectations (with respect to offers, income, etc). No one is starving, but its getting a little nasty.

 

[sanfran256]

Thanks for the reply! Have you found that people who did their medical training in the city had a easier time finding a job in the city than people who did not? Will practices basically choose an individual who did training close by over an individual who did their training in another state/region of the US?

Yes this is a given. That's why we recommend training in the place you eventually want to work if possible.
Doing your residency there will allow you to gain those connections too, doesn't have to all come from fellowship
However, sounds like this is not possible? So in that case go to the best program you can, and when it comes time to the job search start early, and leverage any connections you have. Also make it clear family is there and you want to stay long term. I think this helps since companies want to hire someone who will work for them their entire career (very expensive to hire)

 

[dozitgetchahi]

Take it from someone who has lived and worked in both big cities and in more rural areas in America - working as a physician in big urban areas isn’t worth it. Prepare to take a drastic pay cut and get treated much worse by employers who have the attitude that if you leave, there’s 10 other doctors lined up to take your job. Your pay cut always comes along with a huge increase in COL as well. Been there, done that and I won’t be going back.

 

[whoknows2012]

Tons of jobs in nyc area. If willing to work just outside of manhattan (sw ct Long Island NJ westchester outer boroughs) pay is much higher. I grew up on Long Island, did all my training in NYC and now work in Manhattan and live on Long Island. I’m very happy currently both with my job and my living situation

 

[NewYorkDoctors]

Take it from someone who has lived and worked in both big cities and in more rural areas in America - working as a physician in big urban areas isn’t worth it. Prepare to take a drastic pay cut and get treated much worse by employers who have the attitude that if you leave, there’s 10 other doctors lined up to take your job. Your pay cut always comes along with a huge increase in COL as well. Been there, done that and I won’t be going back.

Agreed. The NYC hospital systems are all so "corporate" and scared of liability. I mean I get it. NYC is full of lawyers and a**hole patients and family members. But the corporate climate of many of the larger hospital employees has doctors bending the knee on so many issues...

Let's say I am just glad I am autonomous and only use the hospital to do my procedures. I (and the hospital) am more than happy to have the in house group see my patients if they get admitted (which is not many at all...)

 

[90sportsfan]

Yes this is a given. That's why we recommend training in the place you eventually want to work if possible.
Doing your residency there will allow you to gain those connections too, doesn't have to all come from fellowship
However, sounds like this is not possible? So in that case go to the best program you can, and when it comes time to the job search start early, and leverage any connections you have. Also make it clear family is there and you want to stay long term. I think this helps since companies want to hire someone who will work for them their entire career (very expensive to hire)

Yup. This is what everyone has told me. Universally, if you want to land a job in a specific city, it’s “safest” to do residency there (fellowship is an option too, but they are shorter and it’s not always guaranteed you’ll get a spot if it’s one of the competitive ones). There are obviously plenty of people who have gotten jobs where they want to go, but it’s likely a lot more difficult.

 

[collegestud2013]

Hey, I am originally from one of the top 3 big cities in the US, but have been outside of the region for both medical school and residency. I would ideally like to go back to by home state, but am applying to a competitive fellowship and am expecting to match somewhere else, since my home city is very desirable.

My question is, is it hard to get a job back in your home city, if you have been outside of the region for basically all of your medical training? Can you basically get a job anywhere you want after fellowship? Any information or insight is appreciated!

Depends largely on job market of your specific specialty. Big cities are usually the most saturated, so unless you're in a high-demand specialty, chances are, as a new grad, you will get a low-ball offer with minimal room for negotiation (and they will go with someone else if you try to negotiate up) or you may not even find a opening at the time you're applying. Also, academic positions tend to be mostly in big cities which also tends to try down pay. The other options would be to find a job outside the city (maybe in the suburbs or farther) that may pay better, and live in the city with a longer commute, or go full-time telemedicine (which allows you to live almost anywhere).