Deciding between practice options

[GSD_MD]

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I am in my fellowship (surgical subspecialty) and trying to decide between 2 practice options. I've asked a hundred trusted people about this and now have resorted to asking complete strangers for help 🙂.

One is a "privademic" practice that I am very familiar with. This market really needs my specialty and I could probably be very busy from the start. This practice affords the opportunity for working with residents/fellows, doing research, and being involved in my subspecialty society. However, the city is a B- and a place that I probably won't consider living long-term (my SO definitely won't). Money is X per year. Job is super stable as this group dominates the market, owns 2 ASCs, 3 MRIs, PT, DME, etc. Also current partners in my subspecialty aren't the best mentors / co-partners.

Job 2 is a private practice in my (and my SO's ideal city - all her family lives here). Market is more saturated (would take a few years to get busy), but I would be taking over for a retiring surgeon who is currently very busy. Clear path to partnership in 2 years. Non-compete clause (ughh). One of the top 2 or 3 groups in the city (but not the biggest). Zero academic involvement. Money is 1.75 - 2x for the top 3 earners in my subspecialty over the last 2 years. Good but not great ancillary $.

I know these are very different practice settings, but I am torn because I like / dislike things about them both. Ideally, I would move job #1 to city #2, but that isn't happening. It is hard to predict what I am going to want 5-10 years down the road and I wanted to get others' perspective on how to approach this decision.

Thanks.

 

[NewCanadian]

I'm a complete stranger. but you did invite responses from complete strangers. My impression from your post is you want Job 1 and it fits with your desires. Job 2 is not your ideal job, but it is the location that appeals to you.

Put aside the location for a moment, and look again at the two jobs. which one is better for you?

Put aside the jobs, and look at the locations. The locations are more about your personal life outside work. do you think you could take job one, the one it seems you want, and look at the location in more detail and see if you could find something in that city to satisfy your personal life? have you overlooked something in location one?

 

[Winged Scapula]

Another complete stranger here:

If your SO will not consider living in Town A, then why are you even considering it? It makes no sense to me to build a practice there, even if its your ideal practice situation, to come home to someone who is miserable.

It sounds like choice B has some drawbacks (the non-compete is pretty standard) but walking into a well established practice with someone who is retiring soon is a pretty sweet deal.

 

[GSD_MD]

Thanks for the replies.

My SO will consider living there, but only for the short term (doesn't want to raise kids there so we have until kindergarten so she says). We would really be using Job A to buy time until a job in a better city opens up (ie Job A in City B or X etc). Job A is pretty sweet in terms of balance between the pros of academics and private practice -ish pay, but I am afraid this opportunity in City B is too good to pass on.

 

[shopsteward]

Does this have to be a binary choice? Other practices in Town A, or jobs in towns near Town A come to mind as options.

 

[colbgw02]

Take Job B. In my opinion, good job in ideal location >>>>> great job in okay location. Square that if it means making your SO happy. Cube it if the great job would be a stepping stone anyway. Who is to say what opportunities will be available between now and when the oldest hits kindergarten? You could end up feeling stuck in Job A if the right opportunity isn't available, and the longer you stay there the harder it'll be to leave, professionally speaking.

 

[Shikima]

I'm reminded of an old saying; Happy Wife, Happy Life.

 

[NotAProgDirector]

You. have asked 100 people you trust, and still don't have the "right" answer. Asking complete strangers on SDN is unlikely to change that. The simple truth here is that there is no "right" answer. Both jobs have positives and negatives. Job A sounds better for your career (if you want teaching/academics), Job B is better for family. Either you're taking Job A to help build your career and sacrifice some family happiness in the short term, or you take Job B and sacrifice some career potential for family happiness. Neither decision is permanent -- you can always change jobs (although if you're building a practice, that's more difficult).

This is one of those life choices where you just have to pick one path and be happy with it.

 

[Gastrapathy]

Wasting the 5 years it will take to build up a practice and then moving to City B is dumb.

 

[caffeinemia]

Happy wife. HAPPY LIFE.

 

[VentJockey]

Option A: Lower salary in a city you don't want to live in.

Option B: Higher salary in a city you want to live in, and you don't have residents to give you added liability.

Hmmmmm tough choice....

 

[dozitgetchahi]

Option A: Lower salary in a city you don't want to live in.

Option B: Higher salary in a city you want to live in, and you don't have residents to give you added liability.

Hmmmmm tough choice....

Yeah, I agree with this. Personally I think job B sounds like a no-brainer, but that could be just because my interest in academia is dwindling with each passing day.

 

[GSD_MD]

Appreciate the replies.

I think I am leaning towards option B, its not my ideal practice setting (actually enjoy the idea of working w residents / fellows) however, the good really outweighs the bad and I see kicking myself more about missing the opportunity afforded by job B MORE than over turning down job A.

I guess I could always go back to academics if I really missed it that much. Another opportunity to get busy quickly in this particular market may never arise again. The worst case scenario would be to take option A, realize it was a mistake to not take option B, and move on to a lesser job C in city B.

I recognize this is a "good" problem to have, but it is a problem nonetheless. Compounded by the fact that my mentors at Job A are really counting on me coming back.

 

[RadOncDoc21]

Appreciate the replies.

I think I am leaning towards option B, its not my ideal practice setting (actually enjoy the idea of working w residents / fellows) however, the good really outweighs the bad and I see kicking myself more about missing the opportunity afforded by job B MORE than over turning down job A.

I guess I could always go back to academics if I really missed it that much. Another opportunity to get busy quickly in this particular market may never arise again. The worst case scenario would be to take option A, realize it was a mistake to not take option B, and move on to a lesser job C in city B.

I recognize this is a "good" problem to have, but it is a problem nonetheless. Compounded by the fact that my mentors at Job A are really counting on me coming back.

I was in a similar position, great job opportunity in a city I didn't want to be in versus a good job in a city I wanted to live in. I chose option B and extremely happy with my decision.

Good luck to you, it is a good position to be in and I'm sure you will make the right decision!