Difficulty Deciding On CAP Fellowship Due to Personal Complications

[kelminak]

Hey there,

Apologies for the very long read, but I've unfortunately wrapped myself into a web of issues that has effectively paralyzed my path forward, and I could desperately use some outside insight from people with more experience than myself.

I'm a PGY-2 who semi-recently became interested in pursuing a CAP fellowship. I entered residency thinking "absolutely no way would I want to work with kids, they're awful!" but life is funny and I found that the stressors associated with working with children (total lack of insight, horrible parents, etc.) are drastically easier for me to tolerate than working with adults. I should also note that I am extremely interested in working entirely remotely from home, and I'm not sure how amenable working virtually is to working with children at least partially (I'm not opposed to a mix of patients). I am flexible to the type of practice within this though (inpatient/outpatient coverage or a mix).

My program is a community program in a semi-rural area that only recently opened its CAP fellowship within the last couple years. There are effectively no elective options available and no specialty clinics available either. While I love my department and the people, I additionally loathe the town that I'm in. The culture here is abysmal and backwards to the point where specifics would likely out myself, but I have a hard time imagining signing up for a bonus year here.

Now here's where I messed up even worse: I bought a house here. It wasn't a bad idea at the time - rates were incredible, my house is large and a massive quality of life upgrade, and my wife is happier for it too. However, I purchased it knowing that the likely breakpoint for at least coming out even would approximately be 4 years, and considering I wasn't going to do CAP, it seemed like a reasonable choice. My wife and I basically are only interested in programs close to where we ultimately want to end up, and that only leaves two big-name programs in that area. I could beg her to go elsewhere to expand my options, but frankly I don't feel that motivated to end up somewhere for 2 years just to move yet again to where these two programs are for my attending career.

So there's effectively 3 paths foward:

1. I can stay at my home program, deal with the extra year of living here, and get my CAP training despite my worry about the quality of the training.
2. I could apply to effectively the other 2 programs in our state that are probably drastically higher quality which I don't know if I can actually get into (neither of them outwardly appear DO-friendly), sell my house and deal with moving for the 6th time since my training started which my wife and I hate, and live in a tiny apartment compared to my house all for the prospect that maybe the training at these big names are worth the hassle?
3. Say screw it, not do CAP, put in my time and just get it over with.

I've spun my wheels on this for months and frankly I'm not making any progress on this choice. I'd be happy to provide more detail if needed, but I'd love to hear other people's thoughts on this. Am I making a bigger deal out of CAP training than I should, and disrupting my life for a big name isn't worth it? Is getting CAP training pointless if I want to work completely virtually?

If you've read all of this, thank you so much for your time and I appreciate your input.

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[hamstergang]

While you don't necessarily want to keep putting off enjoyment for another time, I would suggest keeping in mind that whatever you do over the next 2-3 years will set you up for decades of work beyond. Don't be too short-sighted. (I'm not advocating for any option, just advocating to keep this in mind.)

 

[Bartelby]

You have already bought the house and need to sell it. I agree with hamstergang that spending an extra year in CAP training seems well worth it given that it shapes the next 30-40 years of your practice!

My advice:
Apply for CAP. Rank the two programs in the area you want to end up #1 and 2. Rank your program #3. You will likely get to fast track to the place you want to end up (and again you will need to ditch the house soon anyway). If you don't match there, spend the extra year where you are and leave ready for the career you want.

 

[calvnandhobbs68]

I mean you don't HAVE to fast track. If you figured you'd break even at about 4 years, you can just do 4 years at your current program and then do 2 years CAP at one of the other programs. That also might give you more flexibility to setup an "away" month or something at one or both of the programs to get yourself exposure/visibility there (if you're really worried you might not match) and get more exposure to the programs, especially because, to be honest, your required child exposure in residency tends to be pretty minimal.

It is an extra year but in the short term may financially stress you out less and most places PGY-4 is pretty easy...plenty of the PGY-4s in our program spent half the time moonlighting which can easily put your total income to 100K+ that year, so softens the one year loss of attending income.

 

[clozareal]

I'm a PGY-2 who semi-recently became interested in pursuing a CAP fellowship. I entered residency thinking "absolutely no way would I want to work with kids, they're awful!" but life is funny and I found that the stressors associated with working with children (total lack of insight, horrible parents, etc.) are drastically easier for me to tolerate than working with adults. I should also note that I am extremely interested in working entirely remotely from home, and I'm not sure how amenable working virtually is to working with children at least partially (I'm not opposed to a mix of patients). I am flexible to the type of practice within this though (inpatient/outpatient coverage or a mix).

It's funny how that happens. I love working with kids and their parents, more than adults only for the most part.

I know several child and adolescent psychiatrists who work mostly if not all virtually. It would probably be difficult to see young, young children but not impossible and during the pandemic, we were seeing young children only virtually anyways. You're good until 2024 for prescribing stimulants to kiddos virtually and we don't know what it's going to look like after that yet. If you want to be 100% remote, then do it.

My program is a community program in a semi-rural area that only recently opened its CAP fellowship within the last couple years. There are effectively no elective options available and no specialty clinics available either. While I love my department and the people, I additionally loathe the town that I'm in. The culture here is abysmal and backwards to the point where specifics would likely out myself, but I have a hard time imagining signing up for a bonus year here.

Fast-track then.

Now here's where I messed up even worse: I bought a house here. It wasn't a bad idea at the time - rates were incredible, my house is large and a massive quality of life upgrade, and my wife is happier for it too. However, I purchased it knowing that the likely breakpoint for at least coming out even would approximately be 4 years, and considering I wasn't going to do CAP, it seemed like a reasonable choice.

Do the math on selling the house vs making it a real estate investment. If you choose the latter, consider whether you want to manage it yourself (and then claim REPS status for tax advantages) or hire a property manager. If you choose the former, you might not recoup all of your closing/selling costs, but in the long run it will be okay. Take it as a lesson. You had a great quality of life for 3 years which isn't anything to also scoff at. These decisions aren't entirely numerical.

My wife and I basically are only interested in programs close to where we ultimately want to end up, and that only leaves two big-name programs in that area. I could beg her to go elsewhere to expand my options, but frankly I don't feel that motivated to end up somewhere for 2 years just to move yet again to where these two programs are for my attending career.

Then try to match in that area. If not, stick it out for another year, get additional adolescent experience and then say that you only treat 13-26 year olds in your practice. You can also consider joining a group practice that treats CAP and learn from a supervisor. You don't need a CAP fellowship to treat teens. The younger you go, the more the standard of care is to have a fellowship though. It depends on the area you're in. It's hell of a lot better than midlevels that are treating "from birth to death." If you don't get into those two programs fast tracking, then you can apply again after your 4th year. Don't rank your home program if you don't want to be there and you think it'll offer you a subpar education and training compared to the two that you want to go to. Although two extra years of training will be a hit financially...

So there's effectively 3 paths foward:

1. I can stay at my home program, deal with the extra year of living here, and get my CAP training despite my worry about the quality of the training.
2. I could apply to effectively the other 2 programs in our state that are probably drastically higher quality which I don't know if I can actually get into (neither of them outwardly appear DO-friendly), sell my house and deal with moving for the 6th time since my training started which my wife and I hate, and live in a tiny apartment compared to my house all for the prospect that maybe the training at these big names are worth the hassle?
3. Say screw it, not do CAP, put in my time and just get it over with.

Number one sounds like the most realistic option. You can take all 3 paths. You should fast track and apply to all 3 and rank your home program as number 3. You might not get into any of them which will then default to option 3. You're welcome to PM me which 2 programs those are.

I've spun my wheels on this for months and frankly I'm not making any progress on this choice. I'd be happy to provide more detail if needed, but I'd love to hear other people's thoughts on this. Am I making a bigger deal out of CAP training than I should, and disrupting my life for a big name isn't worth it?

CAP is worth it if you think it will give you longevity in your career. It depends on yours and your wife's financial goals, but also your personal fulfillment into your career. You're not doing her a favor if you hate your job. It might not be as strong as hating one and loving the other. It might be that you're okay with adult and you would enjoy working with children more.

Is getting CAP training pointless if I want to work completely virtually?

Depends on what you mean by pointless. Financially speaking, CAP can be more lucrative if you do cash pay and are in a market to sustain it, it gives you a niche to fill up easier, but for insurance it might not be that much higher depending on your location. If you're talking about career fulfillment, then that's that's a personal decision. You can work virtually with kids and in fact, parents often like this. I often see children during the school day where the parents go to the office to pick up their kid and they see me from the car for 30-60 minutes then go back to school, or the teen goes to the nursing office for 15 minutes to talk to me and then I see the parents for 15 minutes virtually. It's more of a recent trend that kids will be between school and extracurriculars and the family will find it more convenient not having to commute to your office.

If you've read all of this, thank you so much for your time and I appreciate your input.

 

[mistafab]

Dude I can feel the desperation you're in through your post.

Breath!

You're actually in a good spot. 1-2 years is really a drop in the bucket of life anyway. Most importantly - do a job you want. Do CAP if you want to. Staying in your house for another year or two is literally not even worth factoring in your final decision - making or losing a couple thousand dollars is not even worth thinking about - you're a doctor and will never struggle for cash.

I would just weigh that happy wife/happy life with your desire for CAP. In that sense, just do your CAP in any location that your wife will be happy with. Overall, the quality of your training lifelong will be more determined by your desire to learn and personal ability rather than the program you spend one or two years in.

 

[Celexa]

I agree with everyone here that if your heart is in child then you should do child, and losing some money on the house may just be the price you pay. We all have regrets in life. That's how we learn.

Covid pushed us forward into telemedicine and their major advantages of that. But there are also major, major limitations. In private practice when can shape the patients you accept around these limitations. But if you plan to practice substantially telemedicine going forward it's all the more important that you get very high quality training.

We are conditioned in medical training to view everything as one shot only, All or Nothing when it comes to the next stages. But this becomes less and less true as you move forward. And in the end when you are in attending, a job just becomes a job again. This is not a decision you have to make 100% now. Nor is it a decision that you are locked into. For example, if for personal reasons you need to stay in a geographic area, you can apply fast tracking to the programs in the geographic area and then only rank those. You would do this if doing a fourth year in your home program would be preferable to going somewhere else for the fellowship. Then either you match, and that's great, or you take your fourth year which hopefully has a decent amount of elective time and you network and potentially doing an away rotation and contact the programs that you really want to be at and ask what you can do to make your application stronger. Even places that are traditionally not DO friendly will bend if they know and like you.

 

[kelminak]

You have already bought the house and need to sell it. I agree with hamstergang that spending an extra year in CAP training seems well worth it given that it shapes the next 30-40 years of your practice!

My advice:
Apply for CAP. Rank the two programs in the area you want to end up #1 and 2. Rank your program #3. You will likely get to fast track to the place you want to end up (and again you will need to ditch the house soon anyway). If you don't match there, spend the extra year where you are and leave ready for the career you want.

I think this is the most likely plan. It's just hard to stomach another move since we've done it so many times so far, but if that's where we want to end up anyway, getting there a year sooner won't be a downgrade even if we have a smaller house (or really commit and just buy a house up there).

I mean you don't HAVE to fast track. If you figured you'd break even at about 4 years, you can just do 4 years at your current program and then do 2 years CAP at one of the other programs. That also might give you more flexibility to setup an "away" month or something at one or both of the programs to get yourself exposure/visibility there (if you're really worried you might not match) and get more exposure to the programs, especially because, to be honest, your required child exposure in residency tends to be pretty minimal.

It is an extra year but in the short term may financially stress you out less and most places PGY-4 is pretty easy...plenty of the PGY-4s in our program spent half the time moonlighting which can easily put your total income to 100K+ that year, so softens the one year loss of attending income.

If I'm honest, if I don't fast-track, I likely won't do it at all. I like working with kids, but I definitely am not one of those "it's my life's calling" kinds of people. I've just enjoyed the work more for the most part.

Dude I can feel the desperation you're in through your post.

Breath!

You're actually in a good spot. 1-2 years is really a drop in the bucket of life anyway. Most importantly - do a job you want. Do CAP if you want to. Staying in your house for another year or two is literally not even worth factoring in your final decision - making or losing a couple thousand dollars is not even worth thinking about - you're a doctor and will never struggle for cash.

I would just weigh that happy wife/happy life with your desire for CAP. In that sense, just do your CAP in any location that your wife will be happy with. Overall, the quality of your training lifelong will be more determined by your desire to learn and personal ability rather than the program you spend one or two years in.

You are totally right that I'm freaking out. A big part of that is that if I'm going to try to get into one of the two good programs, I probably should focus a little harder or research, etc. to build up something resembling a competitive portfolio. I pretty much just have one poster and one case report so far, which is fairly underwhelming. I'm someone who has to plan everything out from the outset so that if I fail, at least I can say I tried my hardest.

I agree with everyone here that if your heart is in child then you should do child, and losing some money on the house may just be the price you pay. We all have regrets in life. That's how we learn.

Covid pushed us forward into telemedicine and their major advantages of that. But there are also major, major limitations. In private practice when can shape the patients you accept around these limitations. But if you plan to practice substantially telemedicine going forward it's all the more important that you get very high quality training.

We are conditioned in medical training to view everything as one shot only, All or Nothing when it comes to the next stages. But this becomes less and less true as you move forward. And in the end when you are in attending, a job just becomes a job again. This is not a decision you have to make 100% now. Nor is it a decision that you are locked into. For example, if for personal reasons you need to stay in a geographic area, you can apply fast tracking to the programs in the geographic area and then only rank those. You would do this if doing a fourth year in your home program would be preferable to going somewhere else for the fellowship. Then either you match, and that's great, or you take your fourth year which hopefully has a decent amount of elective time and you network and potentially doing an away rotation and contact the programs that you really want to be at and ask what you can do to make your application stronger. Even places that are traditionally not DO friendly will bend if they know and like you.

I wrote it above, but I'm definitely fast-track or bust. I like working with kids but not so much I'd take on two years more instead of one. I appreciate the insight on the telemedicine limitations. I know it won't be a perfect practice setup, but I know that from a personal perspective, my quality of life would be drastically higher in this environment and I already enjoy doing it in the limited exposure I get in residency (we cover the ED in some small regional hospitals). I do think have a big name next to me might be more appealing to some people if I ultimately want to end up running my own private practice, but I'm not sure to what extent that would affect things.

 

[TexasPhysician]

A big thing to consider is that a CAP practice is not consistent with an all virtual practice. I am CAP and I require all child patients to be in-person for evals. The “virtual people” like to disagree with me, but you will 100% miss things if you are all virtual. Children are good at minimizing symptoms. You can’t well visualize facial expressions and body movements (non-verbal communication) together on current video technology. Is the child distracted or playing another game while in session? Signs of cutting, picking, pulling hair, nail damage, etc are all harder to pick up virtually, sometimes impossible with patient cameras and connectivity issues.

EPS symptoms are also hard to visualize virtually, but often adults can describe it to you.

Additionally, even though controlled meds are still allowed at the federal level, many to all pharmacies in some areas are refusing to fill stimulants unless by a local physician that has seen the patient in person. I’m seeing many adults that are trying to switch to me because no pharmacy will fill their virtual docs prescriptions.

If being virtual only is your primary goal, I would straight pass on CAP altogether.

 

[kelminak]

A big thing to consider is that a CAP practice is not consistent with an all virtual practice. I am CAP and I require all child patients to be in-person for evals. The “virtual people” like to disagree with me, but you will 100% miss things if you are all virtual. Children are good at minimizing symptoms. You can’t well visualize facial expressions and body movements (non-verbal communication) together on current video technology. Is the child distracted or playing another game while in session? Signs of cutting, picking, pulling hair, nail damage, etc are all harder to pick up virtually, sometimes impossible with patient cameras and connectivity issues.

EPS symptoms are also hard to visualize virtually, but often adults can describe it to you.

Additionally, even though controlled meds are still allowed at the federal level, many to all pharmacies in some areas are refusing to fill stimulants unless by a local physician that has seen the patient in person. I’m seeing many adults that are trying to switch to me because no pharmacy will fill their virtual docs prescriptions.

If being virtual only is your primary goal, I would straight pass on CAP altogether.

I appreciate your honest input. Do you think it would be reasonable to structure a practice as 1-2 days in-person for intakes, and then the rest of the week is virtual follow-ups? I do need to work for a non-profit hospital system for a while, so I understand there's going to be limitations on how I practice.

I was kind of hoping that I could reach out to some more rural areas that need psychiatrists badly and might be willing to be flexible with something like covering some ED patients at some small hospitals + some clinic patients to make sure I have enough productivity? The community residency program I'm at right now has the same attendings running around covering 1-3 services, but I have no frame of reference if that's common elsewhere. I'm pretty flexible with how I practice if it lets me be remote.

There is absolutely limitations to practicing virtually and I don't want to downplay that in any way. At least in my mind, having access to a psychiatrist at all is better than not and I have mostly enjoyed working in rural communities that have a tremendous demand for psychiatrists in any capacity. Would you agree in that regard?

 

[TexasPhysician]

I appreciate your honest input. Do you think it would be reasonable to structure a practice as 1-2 days in-person for intakes, and then the rest of the week is virtual follow-ups? I do need to work for a non-profit hospital system for a while, so I understand there's going to be limitations on how I practice.

Sure. A hybrid practice is quite reasonable.

There is absolutely limitations to practicing virtually and I don't want to downplay that in any way. At least in my mind, having access to a psychiatrist at all is better than not and I have mostly enjoyed working in rural communities that have a tremendous demand for psychiatrists in any capacity. Would you agree in that regard?

I’m involved with evaluating psychiatrists to determine if they meet standards of care. Having access to a psychiatrist is not necessarily better than having none at all.

 

[calvnandhobbs68]

I’m involved with evaluating psychiatrists to determine if they meet standards of care. Having access to a psychiatrist is not necessarily better than having none at all.

Yeah this is a slippery slope to start going down.

It’s a bit of a different argument than the virtual vs in person thing because there are certainly plenty of excellent doctors who do all or mostly virtual since 2020, but one has to be careful with the overarching argument of “access to anything of X category is better than access to nothing of X category”. It’s the same overall argument NPs and virtual pill mills use.

 

[Candidate2017]

You are where you are due to the choices you make (plus some amount of luck), and you get what you put in (or didn't put in). Everything builds upon prior choices. So, I've never heard any doctor express regret about positioning themselves to attain the best possible training, which will open up more options. For me, the overarching question to guide my decision would be, "How do I get the best training?" CAP vs. general, X vs. Y location, sell vs. not sell house, remote vs. inperson psychiatry... those are questions for later.

Dude I can feel the desperation you're in through your post.

It seems they feel stuck or trapped. But people are not as trapped as they believe they are. This is where therapy is useful.

 

[Stagg737]

If I'm honest, if I don't fast-track, I likely won't do it at all. I like working with kids, but I definitely am not one of those "it's my life's calling" kinds of people. I've just enjoyed the work more for the most part.

You've mentioned a few times you prefer working with kids, but why? It might be helpful if people understood why you prefer working with kids or why you don't like working with adults, especially since it sounds like the culture of the adults you're working with may actually be playing a fairly significant role in your views on them. Not trying to push you away from CAP, but psychiatry is in such high demand that I just wonder if working with adults in an geography you find more desirable would impact your view on treating adults.

There is absolutely limitations to practicing virtually and I don't want to downplay that in any way. At least in my mind, having access to a psychiatrist at all is better than not and I have mostly enjoyed working in rural communities that have a tremendous demand for psychiatrists in any capacity. Would you agree in that regard?

I would say that from a purely access/availability standpoint, virtual is absolutely viable for kids or adults. My clinic is telehealth only to rural areas, and my biggest problem is not getting patients, but sometimes figuring out who will take over prescribing some of their meds once they're stabilized as I'm a consult clinic and some of their PCPs won't do it.

 

[comp1]

So I don't know much a lot about CAP, but I do know that pretty much everyone I interview is looking for a 100% virtual job. Unfortunately...very few employers are looking for 100% virtual employees. I also know that CAP is slightly more in demand than general adult psych. Thus, I think you might have a little better chance of getting that 100% virtual job that everyone is competing for. Definitely concur that you need to be balancing the rest of your life with one year in an annoying town. You're going to be fine on the house regardless. I don't even think that should be a consideration.

 

[FlowRate]

Just to clarify...

You're in psych residency and own a home. If you sell after 3 years you're out how much, roughly? $20k? Did you do a 0% down payment or do you have at least some equity? Have prices in your area not risen over the last 2 years? Do you have an emergency fund you can tap?

You want to live in this state but not in this exact location. So you want to sell your house in 3-5 years, regardless. Best case, 5 years from now, maybe you're up $20k?

So you're considering delaying a year of CAP attending earnings (net about $200k more than you're earning in residency) for the sake of saving $20k? Or considering sacrificing the quality of CAP training for $20k and to temporarily stay in a location you don't want to be in long-term, anyway?

Can you not rent the house? You're planning to be in-state anyway.

 

[kelminak]

You've mentioned a few times you prefer working with kids, but why? It might be helpful if people understood why you prefer working with kids or why you don't like working with adults, especially since it sounds like the culture of the adults you're working with may actually be playing a fairly significant role in your views on them. Not trying to push you away from CAP, but psychiatry is in such high demand that I just wonder if working with adults in an geography you find more desirable would impact your view on treating adults.


I would say that from a purely access/availability standpoint, virtual is absolutely viable for kids or adults. My clinic is telehealth only to rural areas, and my biggest problem is not getting patients, but sometimes figuring out who will take over prescribing some of their meds once they're stabilized as I'm a consult clinic and some of their PCPs won't do it.

It's a combination of enjoying the complexities of working with children and also being able to tolerate the less-enjoyable aspects of child psychiatry significantly more. For example, I seriously do not mind if I have to tell a parent I won't admit their child over some household drama, but having to kick out people abusing the ED system because they are homeless without making an effort to use resources we provide them drains me instantly. That's just one example, but I could come up with a similar list of how I simply find myself more rewarded at the end of the day working with kids. Also there's this sort of feeling I have that children still "have a chance" to head their life in the right direction, whereas with adults I very frequently feel like so much is messed up already that I'm just gluing the pieces together. That's not to disparage adult psychiatry, but I just find the child population more rewarding in that regard.

Maybe I'm also a kid at heart? I was (and maybe still am) the "rebellious" emo kid with emotional issues that got through it, and I love talking about stuff like video games, etc. all day.

Just to clarify...

You're in psych residency and own a home. If you sell after 3 years you're out how much, roughly? $20k? Did you do a 0% down payment or do you have at least some equity? Have prices in your area not risen over the last 2 years? Do you have an emergency fund you can tap?

You want to live in this state but not in this exact location. So you want to sell your house in 3-5 years, regardless. Best case, 5 years from now, maybe you're up $20k?

So you're considering delaying a year of CAP attending earnings (net about $200k more than you're earning in residency) for the sake of saving $20k? Or considering sacrificing the quality of CAP training for $20k and to temporarily stay in a location you don't want to be in long-term, anyway?

Can you not rent the house? You're planning to be in-state anyway.

I did get a 0% down payment. Zillow's estimate for an at-a-glance look shows the house value at approximately 46k above what we paid for it already, so honestly if things continue to trend in that direction, it's pretty unlikely we'd lose money anyway. I think the bigger hang up is having to move again and downgrading to a rented place unless I fully commit to buying a second home. Since my medical school training has started, we've moved 5 times total and the prospect of having to do it once for fellowship and then possibly again for fellowship is fairly daunting. Despite not liking the town we're in, the house we're in provides a lot of space and it's strongly doubtful we could afford something similar in the higher cost of living area. It's kind of a happy wife (and me)/happy wife thing. It's mentally draining to keep having to relocate ourselves so much, but she we did talk and she said we could deal with it if it's truly what I need to do for my training.

I definitely could rent the house in the short-term. I'm pretty inexperienced with it and would probably need someone to manage it while I focused on training, but it could be done.

 

[Merovinge]

It's a combination of enjoying the complexities of working with children and also being able to tolerate the less-enjoyable aspects of child psychiatry significantly more. For example, I seriously do not mind if I have to tell a parent I won't admit their child over some household drama, but having to kick out people abusing the ED system because they are homeless without making an effort to use resources we provide them drains me instantly. That's just one example, but I could come up with a similar list of how I simply find myself more rewarded at the end of the day working with kids. Also there's this sort of feeling I have that children still "have a chance" to head their life in the right direction, whereas with adults I very frequently feel like so much is messed up already that I'm just gluing the pieces together. That's not to disparage adult psychiatry, but I just find the child population more rewarding in that regard.

Maybe I'm also a kid at heart? I was (and maybe still am) the "rebellious" emo kid with emotional issues that got through it, and I love talking about stuff like video games, etc. all day.



I did get a 0% down payment. Zillow's estimate for an at-a-glance look shows the house value at approximately 46k above what we paid for it already, so honestly if things continue to trend in that direction, it's pretty unlikely we'd lose money anyway. I think the bigger hang up is having to move again and downgrading to a rented place unless I fully commit to buying a second home. Since my medical school training has started, we've moved 5 times total and the prospect of having to do it once for fellowship and then possibly again for fellowship is fairly daunting. Despite not liking the town we're in, the house we're in provides a lot of space and it's strongly doubtful we could afford something similar in the higher cost of living area. It's kind of a happy wife (and me)/happy wife thing. It's mentally draining to keep having to relocate ourselves so much, but she we did talk and she said we could deal with it if it's truly what I need to do for my training.

I definitely could rent the house in the short-term. I'm pretty inexperienced with it and would probably need someone to manage it while I focused on training, but it could be done.

That's almost exactly how I feel about CAP and am beyond pleased to practice nearly 100% child/adolescent. Great reason to go into the field.

Now regarding the house, moving sucks, I have actually moved 14 times in the past 20 years, although only 2 of those 14 times with a child. That said, it's a bad week and easily worth the cost of admission for changing the trajectory of your life. Having left a very undesirable part of the country a few years ago to move to a great part of the country, I think you would be surprised how happy your wife may be taking the trade off for a smaller place.

 

[TheRightMedication]

I'm thumbs-upping flowrates post as hard as I possibly can. Forget the house! Keep your eye on these other very big decisions.

 

[calvnandhobbs68]

I did get a 0% down payment. Zillow's estimate for an at-a-glance look shows the house value at approximately 46k above what we paid for it already, so honestly if things continue to trend in that direction, it's pretty unlikely we'd lose money anyway. I think the bigger hang up is having to move again and downgrading to a rented place unless I fully commit to buying a second home. Since my medical school training has started, we've moved 5 times total and the prospect of having to do it once for fellowship and then possibly again for fellowship is fairly daunting. Despite not liking the town we're in, the house we're in provides a lot of space and it's strongly doubtful we could afford something similar in the higher cost of living area. It's kind of a happy wife (and me)/happy wife thing. It's mentally draining to keep having to relocate ourselves so much, but she we did talk and she said we could deal with it if it's truly what I need to do for my training.

I definitely could rent the house in the short-term. I'm pretty inexperienced with it and would probably need someone to manage it while I focused on training, but it could be done.

Oh yeah just sell the house then you'll break even at least even with closing costs and commission.

Renting it out may or may not work because you will likely have to look for a new place to rent while you're trying to rent it out, so you'll have to convince a new landlord that you can swing the mortgage payment + new rent payment if needed on a fellow salary. Don't know what your mortgage is but that might be a stretch (unless your wife also works, then that probably becomes less of an issue).