Higher pay in less desirable areas?

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I was hoping that people might comment on whether less desirable areas truly pay better vs. simply making more money because you work more hours. One of the recent graduates at my residency program expressed her opinion that people in Texas at least were not paying particularly well (by anesthesia standards) unless you went out into the rural areas and took jobs that others don't seem to want. Is there some consistency to the idea that there are higher paying jobs to be had in areas where most people don't want to live, or is this simply something that is only true in rare instances? It would seem that many of the less desirable areas would also have a worse payer mix and subsequently they would pay less rather than more. It doesn't seem to me that there are a lot of places that have well insured individuals living away from population centers in less desirable areas.
 
Generally speaking, less desirable places to live = more money. The hospital typically offers up a stipend to increase the salary and cover the shortfall from the underinsured.
 
It's a complicated question to answer.

Less desirable location has lots of meaning.

If you are saying "rural" aka 1 plus hours from even the outer suburbs of a major city. That's what I consider less desirable. Basically means u are 1.5 hours from a major international airport.

But some people consider less desirable like a mid size city say Knoxville TN or Wichita Kansas which have between 350-600k residents.

I can tell u in places like Wichita and Knoxville the previous anesthesia practices were making a killing due to strong commercial payer mix. The big Knoxville group sold out to mednax a couple of years ago. But those guys made $$$.

If you are talking a real rural area. Than the income varies. It all depends how much funding administration is willing to pass on to the anesthesia provider. (Aka. How much subsidy is being routed to anesthesia). A rura North Carolina practice 90 minutes away from a real city (triangle area). That's rural. I know for a fact. The MD is sole MD. Hospital gives him $900k for 24/7 coverage 52 weeks out of the year. They cover the 4 CRNAs seperately. He than takes 12 weeks off and pays my friend $200k to cover those 12 weeks.

So he nets $700k for 40 weeks coverage (on backup call every night). They do between 16-25 operating room (non GI cases) a week and deliver 275-320 babies a year. Your typical rural hospital.
 
As aneftp says, it's complicated. Some of the most desirable areas are also the best paying because of payer mix/efficiency/productivity.
 
nimbus said:
As aneftp says, it's complicated. Some of the most desirable areas are also the best paying because of payer mix/efficiency/productivity.
Click to expand...

...But not the best paying for new grads who will never be partners at these places
 
I have done the BFE thing for most of my PP life. Killed it out there.
Now that I'm working in a desirable area with countless outdoor activities and lots of city life, I wonder if I made the right decision.
I can never get the time I spent in BFE back.
Last month I was in knee deep powder one afternoon and surfing some large swells the next morning then saw one of the best TOOL concerts that evening.
You can't put a price on that.
Choose wisely.
 
Supply and demand - true and relevant as ever.
 
sevoflurane said:
I have done the BFE thing for most of my PP life. Killed it out there.
Now that I'm working in a desirable area with countless outdoor activities and lots of city life, I wonder if I made the right decision.
I can never get the time I spent in BFE back.
Last month I was in knee deep powder one afternoon and surfing some large swells the next morning then saw one of the best TOOL concerts that evening.
You can't put a price on that.
Choose wisely.
Click to expand...

Where is this heaven? I want to go to there.....


I am only a few years out and debating on leaving a decent area for BFE. My wife likes our area and the more years that go by its harder to uproot the kids but maybe.
 
TOOL recently played shows in Florida and North Carolina, and around the rest of the South in Jan. Am I warm?
 
It is a lot easier said then done to go to small town BFE with small town family politics as a complete outsider with no ties. Even harder to bring a spouse or S.O. with no ties and say to him/her "go make friends". If you are a very outgoing, social, people person it is a lot easier to make it work.

It certainly can be done, but don't just fantasize about the paycheck and low cost of living. There are some less than obvious trade offs as well as the obvious ones- cultural and educational opportunities for family, diversity, etc.
 
Random Resident said:
Miami does sound fun.
Click to expand...
Miami is fun when u are young and no kids. Sounds glamour with beach and sun.

But most working people have moved north ward away from Miami.

Like I said. Desirable can have different meanings. I turned down a Los Angeles job with my brother (good part of LA) making 400-500k a couple year ago cause my wife didn't want to move there.

13.25% state income taxes (1 million or more) or 11.25% state income taxes for 500k for more.

Very high cost of living.
 
I think the obvious theme Sevo points out is the financial freedom that working in BFE for many years gave him. And financial freedom in my opinion is way more important than having to slog it out a few years in the middle of nowhere.

That said I chose sowmthing in the middle, not a massive paycheck or my ideal location but decent place to live and living.
 
A Witty Fool said:
TOOL recently played shows in Florida and North Carolina, and around the rest of the South in Jan. Am I warm?
Click to expand...

Sevo made so much $$ working in BFE that he actually had TOOL play a private show in his living room. Maynard brought some of his wine and Sevo treated them to the best latte they've ever had. Good times, good times.
 
SaltyDog said:
Sevo made so much $$ working in BFE that he actually had TOOL play a private show in his living room. Maynard brought some of his wine and Sevo treated them to the best latte they've ever had. Good times, good times.
Click to expand...

Haha... Nice one Salty.

I hope you caught TOOL on stage, cuz I caught them in your back yard.

IMG_5787_zpstgjkffu8.png


IMG_4921_zpsvlkjkfrw.jpg
 
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The point of my post is that BFE is a strategy to financial freedom, but it comes at a great cost.
I couldn't wait to to get out of there.
Again, choose wisely. There are groups that are doing very well in great locations.
Overall, I'm happy with my decision, but I question the time spent in "purgatory".
 
aneftp said:
Miami is fun when u are young and no kids. Sounds glamour with beach and sun.

But most working people have moved north ward away from Miami.

Like I said. Desirable can have different meanings. I turned down a Los Angeles job with my brother (good part of LA) making 400-500k a couple year ago cause my wife didn't want to move there.

13.25% state income taxes (1 million or more) or 11.25% state income taxes for 500k for more.

Very high cost of living.
Click to expand...

I was joking in reference to the powder in Florida. I prefer bfe and 100 acres of land.
 
sevoflurane said:
PB :artist:
Click to expand...

Seriously, next time you're in the neighborhood drop me a line. There are literally at least 20 other breaks within a 15 min drive that woulda been better than PB.

P.S. Trying real hard to figure out what the hell that emoji means.
 
sevoflurane said:
The point of my post is that BFE is a strategy to financial freedom, but it comes at a great cost.
I couldn't wait to to get out of there.
Again, choose wisely. There are groups that are doing very well in great locations.
Overall, I'm happy with my decision, but I question the time spent in "purgatory".
Click to expand...

In terms of work location, it also somewhat depends on work hours and vacation. I currently work in a place I'd have never guessed I would live but I love the work environment and 12 weeks of vacation plus 3/4 of weekends off means I can get out of town very frequently to do whatever I want. On a random Tuesday if I get out of work at 5 PM it doesn't matter if I live in NYC, Hawaii, or middle of nowhere flyover country, I'm still going home to the wife and kids and cooking dinner and having some family time. To me it's only the weekends and vacation when I'd be doing anything differently.
 
Mman said:
In terms of work location, it also somewhat depends on work hours and vacation. I currently work in a place I'd have never guessed I would live but I love the work environment and 12 weeks of vacation plus 3/4 of weekends off means I can get out of town very frequently to do whatever I want. On a random Tuesday if I get out of work at 5 PM it doesn't matter if I live in NYC, Hawaii, or middle of nowhere flyover country, I'm still going home to the wife and kids and cooking dinner and having some family time. To me it's only the weekends and vacation when I'd be doing anything differently.
Click to expand...

For the most part I agree with you, but it also depends on where you're at in life. It's real easy to take advantage of that vacation time and those weekends off to get out of BFE when your single or at least don't have kids. But then when you've got young kids travel becomes a logistical PITA and when they get older they have extracurriculars (sports games, school projects, set vacations time from school, etc.) which all effectively chain you to Bumblescum, BFE despite your cush work schedule.
 
SaltyDog said:
For the most part I agree with you, but it also depends on where you're at in life. It's real easy to take advantage of that vacation time and those weekends off to get out of BFE when your single or at least don't have kids. But then when you've got young kids travel becomes a logistical PITA and when they get older they have extracurriculars (sports games, school projects, set vacations time from school, etc.) which all effectively chain you to Bumblescum, BFE despite your cush work schedule.
Click to expand...

I find traveling with kids to not be terribly difficult. Sometimes they come for the ride, sometimes the grandparents stay with them.
 
Well, I'd like to keep my exact location private, but there are a handful of you guys that either know me personally or have pinned it down.
Regarding Mman's post. I was taking 13 weeks at my last BFE gig. That was an absolute necessity to keep me level headed.
Salty is right, it was a little bit of a PITA to get to the mountains, beach, etc. Now I take full advantage of my post-call days: snowboarding, mountain biking, in the water, etc--> no need to schedule a vacation. It's just there.

BFE is a great strategy. I would probably do it again. But knowing what I know now, it would not be such an easy decision.
For the young anesthesia jedi's out there... choose wisely. If you get an opportunity to get into a group in your ideal location, the money lost vs. going to BFE might just be worth it. My 2cents.
 
I'm going to be having this debate soon, but I'll likely be moderate sized city for OK pay vs 30-45!min away for better pay.

Think about it way too much. Gah.
 
I didn't want my child to be the only ethnic kid at her school. And I didn't want to live without great food. I have a friend who interviewed for a job in a small town in southern Oregon. They took him to the best restaurant in town.....Denny's.
 
nimbus said:
I didn't want my child to be the only ethnic kid at her school. And I didn't want to live without great food. I have a friend who interviewed for a job in a small town in southern Oregon. They took him to the best restaurant in town.....Denny's.
Click to expand...

i sort of agree about food, but I can probably count on 1 hand the number of times I go out to eat on a week night.
 
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