Best Geography for COL and Private Cash Practice?

[Nasrudin]

Comrades. (haha)

I have recently, for personal reasons, become enormously geographically flexible.

I'm looking for up and coming economies with good cost of living and flexible psych job market with good pay that can support new entrepreneurial efforts in private practice that may or may not involve insurance.

I've got a few months to throw darts at the map and poke around markets and places.

Any ideas?

---

Members don't see this ad.

 

[dl2dp2]

If I were to do it all over again for this kind of thing, I'd probably do it somewhere in the south.

These areas are actually fairly easy to identify. What you are talking about is a metro area of over 1-2 mil total, and the practice would be located close to a suburb that has a high school rated by greatschools to be 9-10, and the median Zillow listing somewhere between 800k and 1.2M (perhaps a little lower even, 600-800k). Lots of areas like that in the South. Comparable areas in the NE and California would have median Zillow listing >1.5M.

Some ideas: Charlotte, NC, Scottsdale, AZ, Austin TX, Jacksonville, FL. IMHO you can still have a flourishing cash PP in these areas.

Problem is budding economies have very different local feels, and you don't really know what it's like until you visit.

 

[clausewitz2]

Add Louisville, KY to your list. Anyone with experience of ATL PP market? Still very reasonable cost of living but plenty of bourgie folks.

 

[Nasrudin]

If I were to do it all over again for this kind of thing, I'd probably do it somewhere in the south.

....

Problem is budding economies have very different local feels, and you don't really know what it's like until you visit.

Thanks for the ideas. Particularly the research technique. Yeah. I kind of realize I was being too wide with the lack of criteria in this department. But I want to keep my mind as open as possible.

 

[MacDonaldTriad]

The psychiatry market is crazy good about everywhere. You should consider some other criteria:
Blue vs. Red
Coast vs. no coast
Heat vs Snow
Most of these questions point to the mid Atlantic or the central coast of California is you are yes/no more than no/yes.

 

[Nasrudin]

The psychiatry market is crazy good about everywhere. You should consider some other criteria:
Blue vs. Red
Coast vs. no coast
Heat vs Snow
Most of these questions point to the mid Atlantic or the central coast of California is you are yes/no more than no/yes.

I see your point.

Hmmm. I think I want to be surrounded by an entrepreneurial culture. I’m libertarian culturally. I don’t like dumb. Or snooty. But I can deal with a wide variety of both. Because I’m also a natural heretic in either case. I want to offer my own niche practice. Whatever that may be. I guess I don’t know what that would mean in terms of market. Except that I like creative entrepreneurial energy. I’m thinking of making a niche in consulting for these types. Among other things.

I love the ocean. But I also love the desert. I like mountains. I like warm. But I can deal with the cold if other things are right. Flat plains.... I’m not sure. I don’t think so. I like forested areas. Redwoods. Whatever.

Sorry if this is overly indulgent. Perhaps it could be a thread for people who are wide open about location to discuss a variety of benefits about up and coming places across the country...?

 

[MacDonaldTriad]

I see your point.

Hmmm. I think I want to be surrounded by an entrepreneurial culture. I’m libertarian culturally. I don’t like dumb. Or snooty. But I can deal with a wide variety of both. Because I’m also a natural heretic in either case. I want to offer my own niche practice. Whatever that may be. I guess I don’t know what that would mean in terms of market. Except that I like creative entrepreneurial energy. I’m thinking of making a niche in consulting for these types. Among other things.

I love the ocean. But I also love the desert. I like mountains. I like warm. But I can deal with the cold if other things are right. Flat plains.... I’m not sure. I don’t think so. I like forested areas. Redwoods. Whatever.

Sorry if this is overly indulgent. Perhaps it could be a thread for people who are wide open about location to discuss a variety of benefits about up and coming places across the country...?

Pacific Northwest is what this sounds like to me.

 

[Psychotic]

Go west, young man...send a PM if you want to discuss...

 

[WisNeuro]

Pacific Northwest is what this sounds like to me.

After living there for several years, I'd have to ask if Nasrudin also likes 9 months of rain and no sun, followed by general drought conditions for 3 months (but at least nice sunny weather). I didn't get much of the libertarian culture there, though. It was pretty liberal, although I was in one of the major urban population centers, so that probably skews things a bit.

 

[TexasPhysician]

Most places could handle another psychiatrist. Ability to fill will vary by marketing ability, skill (patients refer to friends), website, and ease of scheduling.

 

[slappy]

What's COL?

 

[Nasrudin]

What's COL?

Cost of living.

 

[FlowRate]

I see your point.

Hmmm. I think I want to be surrounded by an entrepreneurial culture. I’m libertarian culturally. I don’t like dumb. Or snooty. But I can deal with a wide variety of both. Because I’m also a natural heretic in either case. I want to offer my own niche practice. Whatever that may be. I guess I don’t know what that would mean in terms of market. Except that I like creative entrepreneurial energy. I’m thinking of making a niche in consulting for these types. Among other things.

I love the ocean. But I also love the desert. I like mountains. I like warm. But I can deal with the cold if other things are right. Flat plains.... I’m not sure. I don’t think so. I like forested areas. Redwoods. Whatever.

Sorry if this is overly indulgent. Perhaps it could be a thread for people who are wide open about location to discuss a variety of benefits about up and coming places across the country...?

You might enjoy Reno. Large influx of people and other tech investment thanks to gigafactory and I think some large data warehouse. Easy access to Tahoe. Places like Galena and Caughlin Ranch have average Zillow listings in the ranges mentioned earlier and can be rather pretty, in their own right. If you want to go bigger, Denver and surrounding cities are similar.

Denver suffers from lots of immigration (housing and traffic get worse by the day). I haven't visited Reno in a long time, not sure how seriously it's being affected by similar issues.

Both are relatively low COL, although not bargains.

 

[Nasrudin]

After living there for several years, I'd have to ask if Nasrudin also likes 9 months of rain and no sun, followed by general drought conditions for 3 months (but at least nice sunny weather). I didn't get much of the libertarian culture there, though. It was pretty liberal, although I was in one of the major urban population centers, so that probably skews things a bit.

You know that's an interesting thing that I hadn't realized how important it was until a recent experience doing my 6 month senior inpatient rotation in a windowless, sunless, room. And then after going to psychotherapy conference in Anaheim, California and I got a couple days of sun sitting by the pool in between lectures and my mood and energy and general well-being got a huge boost. I probably was vitamin D deficient. But after that embodied experience I think I will be wary of long, dark, or dreary seasons.

 

[WisNeuro]

You know that's an interesting thing that I hadn't realized how important it was until a recent experience doing my 6 month senior inpatient rotation in a windowless, sunless, room. And then after going to psychotherapy conference in Anaheim, California and I got a couple days of sun sitting by the pool in between lectures and my mood and energy and general well-being got a huge boost. I probably was vitamin D deficient. But after that embodied experience I think I will be wary of long, dark, or dreary seasons.

I'd stay away from the PNW then, or at least large portions of it. I thought I could hack it, but after a few years, it really started to wear me down. I enjoy distinct seasons and a decent amount of sunshine, so I'm happy with my Midwest locale. Winters/snow/cold don't bother me at all, which is the only real drawback for most.

 

[boogaaloo]

Go to LA or SF. Lots of money there. And lots of worried well people who would actually pay for the pseudoscience that is psychotherapy

 

[deleted343839]

Hmmm. I think I want to be surrounded by an entrepreneurial culture. I’m libertarian culturally. I don’t like dumb. Or snooty. But I can deal with a wide variety of both. Because I’m also a natural heretic in either case. I want to offer my own niche practice. Whatever that may be. I guess I don’t know what that would mean in terms of market. Except that I like creative entrepreneurial energy. I’m thinking of making a niche in consulting for these types. Among other things.

Someone else suggested checking out Austin, and I agree. It's hot, sunny, on the edge of interesting geography, quality of life is good, socially liberal. Plenty of young higher-functioning professionals willing to pay cash. And there is a new medical school if that is meaningful to you.

 

[notdeadyet]

Go to LA or SF. Lots of money there.

If you're truly geographically promiscuous, I'd avoid SF or LA. Both have good pay but also incredibly high cost of living. I wouldn't live in coastal California unless I really loved coastal California (and there's a lot to love).

 

[notdeadyet]

Nasrudin- If you were looking for a good inpatient gig, I'd take your tack of looking for up and coming economies with good cost of living and flexible job market with good pay. Because when it turns out you're wrong with your assumptions, or the local economy turns, or the flexible job market remains flexible (and changes), you get get up and move easily enough.

Though it probably goes against conventional wisdom, if you're interested in setting up a cash private practice and are entrepreneurial, my first question would be where do you want to live. If you are ambivalent or don't know, I'd spend more time figuring out where you would like to really live long term. What excites you culturally, what are your hobbies, what physical environment is most satisfying. If you were given a nice fat stipend to live someplace, where would it be? If you can't answer that, you need to before deciding where to move.

The reason is that unlike the inpatient gig mentioned above, if you're at all good, you will (slowly) build up a cash-only private practice. You'll do that by building up word of mouth and a good reputation. Once you have a good reputation, you can start exploiting it for your entrepreneurial activities. This takes a while and is hardest up front and you will be reluctant to walk away. Despite what some may tell you, almost no one will want to buy a practice from anyone so you will be walking away from a lot when you try to move.

Since you're likely going to get tucked in wherever you move, figure out where you want to live and where you'll be happy. Check out the business climate of that place or those places. If it's outright hostile, check it off the list. But if it's anything else, you can make it work.

You're much more likely to be miserable because you're somewhere you want to live than because you can't succeed as a psychiatrist. If the failure is because you can't make $500/hour for 40 hours a week treating the walking well, it's a failure of unrealistic expectations, not the business climate. If the failure is because you can't build up a private practice, it's a failure of business acumen, not business climate.* But a much more likely outcome is being miserable because you have a reasonably successful practice in a place you loathe to live. With a bit of intelligence, patience, and work ethic, you will make a very nice living no matter where you live. I wouldn't intentionally target somewhere I don't want to live just because you can do the same by being less smart, less patient, or lazier.

* - don't mean to imply all failed psych practices are due to failed psychiatrists, but most that I've heard of are due to folks not outsourcing what they should have outsourced, poor negotiating with insurers, lack of networking, or just plain having a bad business plan ("I want to create a practice of mostly SSRI management patients with mild depression and anxiety. Cash only, please.").

 

[dl2dp2]

Hmmm. I think I want to be surrounded by an entrepreneurial culture. I’m libertarian culturally. I don’t like dumb. Or snooty. But I can deal with a wide variety of both.

On a second thought, you might have fun with the fancy markets. The best entrepreneurial culture in the US are really at the major tech hubs (SF, NYC, LA, and secondarily Boston and Seattle). You'll def meet more people in these locations than in Charlotte, NC. Austin is a good thought but I suspect you'll get bored, because let's be honest, people who move to Austin are all of a certain type.

I've also noticed that big markets are much more libertarian fiscally. Yes, taxes are high, but private opportunities are much more plentiful (what they call "the startup ecosystem"). In smaller places, if you are a consultant (either clinical or not), often your options (referral sources) are limited to large non-profits and government agencies. A different way to say this is in large markets, if you are bored with cash private practice there are lots of other fun things to do that are not available in smaller, "more affordable" markets.

W.r.t. cost of living, yes, Palo Alto will bankrupt you. Have you seen the latest 3M house sold? It looks like a pile of garbage on Redfin. *HOWEVER*, in large markets, you can almost ALWAYS find areas where things are much more reasonable. You'll have longer commutes, but if you are private practice, you can easily structure your day in a more reasonable way--come in 2-3 long days a week, for example, and telecommute the rest of the time. People obsess about geographical arbitrage, but they don't get that within a single metropolitan area, there's also "time arbitrage". Cost of living is wildly different between parts of Queens and Tribeca, even though in both cases the local public schools are rated 10/10. Just some food for your thought.

I would suggest looking into peripheral parts of major markets (for example Vallejo up to wine country, and upper Hudson Valley, parts of lower Orange County, etc.). You can sort of fabricate an Austin-ish experience but end up with more.

 

[MacDonaldTriad]

Nasrudin, you are the perfect articulate stem cell in a market that is desperate for psychiatrists. Of the three or four medical schools in my area, all are trying to hire. Trust me, the world is your oyster, you just need to define what you want. If what you want is money, stay out of academics. If you want a position more than you want a job, stay in academics.

 

[terminallychill]

Comrades. (haha)

I have recently, for personal reasons, become enormously geographically flexible.

I'm looking for up and coming economies with good cost of living and flexible psych job market with good pay that can support new entrepreneurial efforts in private practice that may or may not involve insurance.

I've got a few months to throw darts at the map and poke around markets and places.

Any ideas?

you're probably going to end up in so cal.

 

[NontradCA]

Whale’s Vagina.

 

[MacDonaldTriad]

Whale’s Vagina.

My pop culture knowledge is weak, but is this a complement or disparagement, or what does it mean?

 

[kaysisiel]

My pop culture knowledge is weak, but is this a complement or disparagement, or what does it mean?

Haha San Diego

 

[MacDonaldTriad]

So Whales Vagina means San Diego? Do San Diegans know this?

 

[NontradCA]

So Whales Vagina means San Diego? Do San Diegans know this?