Practicing in a different location from residency

[Psyxh1]

Hi everyone,

So I matched to a program much farther from the region/city I would ultimately like to live in. Will I really be at a disadvantage if after completing residency I try to find a job in the region I'm moving from? Is it that difficult to obtain positions in a different state/area from where you completed residency? Thanks in advance.

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[whopper]

Yes you will be at a temporary disadvantage.

Every city has the following.
The idiot psychiatrist that gives every patient what they want even if it's hurting the patient such as Xanax, the one that diagnoses everyone with bipolar disorder, the one that is into some type of bogus holistic treatment (e.g. ginseng for schizophrenia), one that only spends 5 minutes per patient and is rude to them.....

By the time you finish residency you have a decent idea of who the good doctors are the vs the bad ones, the good gigs vs the bad ones, what the going rate of pay is, what to expect in terms of how easy it will be to make a private practice.

These things are location specific. You will need to have a lot of good local knowledge to figure this stuff out.

By the time I left Cincinnati my patients showed me a list of which doctor they should take to replace me. I looked at the list and was able to check off 1-avoid, 2-avoid, 3-avoid, 4-decent, 5-okay that one's good, 6-avoid, know what I exactly wanted to do had I stayed (too bad I was leaving) and entered a new place where it took me about 6 months to realize I wasn't going to like my job, another 6 months to figure out what was the best exit strategy (and I really had to actively network on that one) and then eventually get out of it.

Been in the new location for 1.75 years now and I still don't know anywhere near of what I knew of Cincinnati in terms of psych opportunities. By the time I left Cincinnati almost every mental health provider knew who I was and I established a good rep in that city.

 

[Psyxh1]

Yes you will be at a temporary disadvantage.

Every city has the following.
The idiot psychiatrist that gives every patient what they want even if it's hurting the patient such as Xanax, the one that diagnoses everyone with bipolar disorder, the one that is into some type of bogus holistic treatment (e.g. ginseng for schizophrenia), one that only spends 5 minutes per patient and is rude to them.....

By the time you finish residency you have a decent idea of who the good doctors are the vs the bad ones, the good gigs vs the bad ones, what the going rate of pay is, what to expect in terms of how easy it will be to make a private practice.

These things are location specific. You will need to have a lot of good local knowledge to figure this stuff out.

By the time I left Cincinnati my patients showed me a list of which doctor they should take to replace me. I looked at the list and was able to check off 1-avoid, 2-avoid, 3-avoid, 4-decent, 5-okay that one's good, 6-avoid, know what I exactly wanted to do had I stayed (too bad I was leaving) and entered a new place where it took me about 6 months to realize I wasn't going to like my job, another 6 months to figure out what was the best exit strategy (and I really had to actively network on that one) and then eventually get out of it.

Been in the new location for 1.75 years now and I still don't know anywhere near of what I knew of Cincinnati in terms of psych opportunities. By the time I left Cincinnati almost every mental health provider knew who I was and I established a good rep in that city.

Thanks for the reply! If I recall correctly your residency training was in New Jersey. If you were able to establish such a good reputation and network in Cincinnati after moving from NJ, does that mean there still is hope for faring all right if one chooses to move to a different city/state after residency?

 

[whopper]

Yes but it'll take a few years to get yourself to what you would've been had you stayed in the same area as residency.

 

[Psyxh1]

Yes but it'll take a few years to get yourself to what you would've been had you stayed in the same area as residency.

I see. Would trying to obtain a fellowship and completing it in the city you want to live in be a good way to transition to the area and still make connections and a name for yourself?

 

[whopper]

It could but it could also put you in an area with lack of exposure. E.g. if you're working in a jail in forensic psychiatry you will learn that jail and hardly anything else cause that jail is isolated.

My own fellowship was perhaps the best networking experience ever cause I had to go to every single hospital in the city with a psych unit biweekly, work at a psych community center and work in a university.

 

[OldPsychDoc]

It depends quite a bit on a) where you're from, b) where you're doing residency, and c) market conditions where you want to go. In my case, I was returning "home" after doing residency 12 hours away, but I knew a little about the system, and the market was needy enough enough that everyone was thrilled to get me back. That said, our best source of new hires is our own residents--and you'll definitely have some "ins" where you train.

 

[yanks26dmb]

Hi everyone,

So I matched to a program much farther from the region/city I would ultimately like to live in. Will I really be at a disadvantage if after completing residency I try to find a job in the region I'm moving from? Is it that difficult to obtain positions in a different state/area from where you completed residency? Thanks in advance.

Wouldn't locums be a pretty good option while you established yourself in your new location?

 

[so721]

I'm concerned because my residency is on the whole other side of the country from where I want to eventually practice. We never prescibe any benzo's on an outpatient basis. The patient population is primarily substance abuse and malingerers looking for a place to stay in our ED.

 

[notdeadyet]

Most locales will have jobs that are less than competitive. Take one for a year and network to get the lay of the land. It won't take too long to catch up.

Whopper's advice is definitely not limited to forensics. Any fellowship you take will give you fair-to-good insight about that particular academic site, but you wouldn't have any better insight into the mental health layout of the community at larger than you would if you just took any job in that community.

 

[withoutface123]

Call me a bit bitter after the results of the match, but I just dread that I'll hear four years of "you can be a psychiatrist anywhere you want!" only to hit another bottleneck of market competition.

 

[downwithDTB]

Call me a bit bitter after the results of the match, but I just dread that I'll hear four years of "you can be a psychiatrist anywhere you want!" only to hit another bottleneck of market competition.

The difference is that the supply of med students wanting to become x can vary greatly, and generally increases with the number of seats in med school, whereas the supply of newly graduated residents in x is less varient from year to year. However, there is discussion of increasing funded residency slots, so saturated markets will probably get worse.

Also, a job is very different from a good job. The prevailing wisdom seems to be 1) don't worry, if you go to the worst residency you can get a job wherever you want 2) yet many people are working less than ideal jobs 3) which leads me to conclude that either they are terrible people, or residency/connections/competency/experience or some other factor is very important for getting good jobs meaning that there really is competition.

 

[Shikima]

Call me a bit bitter after the results of the match, but I just dread that I'll hear four years of "you can be a psychiatrist anywhere you want!" only to hit another bottleneck of market competition.

There is no competition. Well, NYC would be the exception. Most every where else is pretty open. If you're flexible, the rewards are well more than you imagined.

 

[yanks26dmb]

Couldn't someone conceivably do telepsych from anywhere and make good money working from home 50 hours a week?

Would seem to solve the location problem....

 

[Psyxh1]

Also, a job is very different from a good job. The prevailing wisdom seems to be 1) don't worry, if you go to the worst residency you can get a job wherever you want 2) yet many people are working less than ideal jobs 3) which leads me to conclude that either they are terrible people, or residency/connections/competency/experience or some other factor is very important for getting good jobs meaning that there really is competition.

Is it really that hard to get a "good" job? I understand that relocating to a new area makes things more difficult when you first start off but is it really such a huge disadvantage? Also is it so much so that it would take a very long time to catch up?