MD & DO How much did/will COL impact your preferences of where to attend residency?

[Darrow O'Lykos]

Title pretty much sums it up. I was thinking ahead to when I will apply to residency and started pondering how much self-selection happens when composing program lists and rank lists in regards to some of the less obvious factors for an applicant (ex: a rockstar applicant could theoretically match anywhere, but wants to avoid some of the higher costs of living areas and ranks Cleveland or Mayo higher than other elite programs located in NY, LA, etc. and matches). Extrapolating that thought out further, do mid-tier programs located in higher COL (desirable) areas become anymore attainable compared to similarly ranked programs located in lower COL areas? Or are costs largely an afterthought for most and they just want to live in those areas no matter what?

Clearly are there are a myriad of factors when comparing any two programs, and geographic ties to an area probably dictate lists more than the inherent COL of a program's area does. I'm guessing this is likely not important to most, but I am just curious what some peoples' thoughts are on the matter.

This conversation is probably moot anyway given how application numbers have skyrocketed to pretty much cover the entire country anyway.

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[operaman]

Was huge for me. Didn’t even apply to a number of programs in high COL areas. I think this has a massive impact. I’d do it again too - residency has enough stress without having to worry about paying your bills.

 

[GoSpursGo]

Had a massive effect, particularly for fellowship. My significant other (now wife) actively moved programs on the west coast down my rank list for this exact reason.

 

[Darrow O'Lykos]

Had a massive effect, particularly for residency. My significant other (now wife) actively moved programs on the west coast down my rank list for this exact reason.

That's awesome that she did that. Good for y'all, and glad it worked out.

Was huge for me. Didn’t even apply to a number of programs in high COL areas. I think this has a massive impact. I’d do it again too - residency has enough stress without having to worry about paying your bills.

That's interesting--I didn't think such wisdom/common sense would be that prevalent amongst med students shooting for residency spots (and perhaps I'm overestimating the current med student generation's laissez-fare attitude in regards to money and debt).

I'm in school in Texas and wouldn't mind staying for residency, but my significant other (not a med student) grew up on the west coast in a high COL area. I'd like to match there and to live there after residency, so that's what got me wondering how competitive some of the mid-tier programs on the west coast are, and if COL dissuades some people from even applying out there.

So would both of you agree then that COL factors took precedence for you over other factors like program culture, previous fellowship placements, etc.?

Appreciate the responses, and cheers.

 

[GoSpursGo]

So would both of you agree then that COL factors took precedence for you over other factors like program culture, previous fellowship placements, etc.?

Obviously only to a certain extent. Like I would not recommend going to a community program in Montana over Harvard. But if you're dealing with two "good" programs which are at least similar in terms of appeal, then I would say that I valued COL over a marginal reputation benefit.

 

[lanzhou_lamian]

Definitely impacting mine. There are some locations that I really enjoy but I recognize would be really hard to live in on a resident salary.

 

[Captain_Falcon]

Definitely a huge factor. If I won't be able to afford at least a 3 BR place (i have a family) on a resident salary only then I'm not wasting my time or the programs time as they'd be at the bottom of my list

 

[Darrow O'Lykos]

Definitely impacting mine. There are some locations that I really enjoy but I recognize would be really hard to live in on a resident salary.

Agreed. If my SO wasn't already well into their career/if we weren't in a position where their family would help if I matched in her expensive hometown, it probably wouldn't even be a thought.

 

[LunaOri]

Agreed. If my SO wasn't already well into their career/if we weren't in a position where their family would help if I matched in her expensive hometown, it probably wouldn't even be a thought.

I would make certain that your relationship will last, before matching to an area where you wouldn’t be able to support yourself if things didn’t work out with your SO.

 

[Darrow O'Lykos]

I would make certain that your relationship will last, before matching to an area where you wouldn’t be able to support yourself if things didn’t work out with your SO.

Oh yeah I wouldn’t do that without being engaged/married beforehand.

 

[Wordead]

Title pretty much sums it up. I was thinking ahead to when I will apply to residency and started pondering how much self-selection happens when composing program lists and rank lists in regards to some of the less obvious factors for an applicant (ex: a rockstar applicant could theoretically match anywhere, but wants to avoid some of the higher costs of living areas and ranks Cleveland or Mayo higher than other elite programs located in NY, LA, etc. and matches). Extrapolating that thought out further, do mid-tier programs located in higher COL (desirable) areas become anymore attainable compared to similarly ranked programs located in lower COL areas? Or are costs largely an afterthought for most and they just want to live in those areas no matter what?

Clearly are there are a myriad of factors when comparing any two programs, and geographic ties to an area probably dictate lists more than the inherent COL of a program's area does. I'm guessing this is likely not important to most, but I am just curious what some peoples' thoughts are on the matter.

This conversation is probably moot anyway given how application numbers have skyrocketed to pretty much cover the entire country anyway.

I think that there are so many students that want to live in those HCOL areas to the extent that it certainly does not make them more attainable. I knew plenty of relatively mediocre programs in socal, boston, nyc that had superstar applicants rank them highly. I myself ranked 2 HCOL programs above my midwest program that I eventually matched at. I don't know if I would've been happier or not being in a big urban city (probably would have in some ways), but I met my wife, bought a reasonably nice house and built up equity, put 110K into retirement accounts, and had plenty of money to do several vacations comfortably throughout residency so it worked out.

To be honest, I think it matters less for residency and more as an attending - the geoarbitrage difference in salary between a coastal city and the midwest is enormous for many specialties. The increase in salary from working in a less popular area of the country makes everything i saved in 5 years of residency basically negligible after a year or two.

 

[deleted1139416]

I think that there are so many students that want to live in those HCOL areas to the extent that it certainly does not make them more attainable. I knew plenty of relatively mediocre programs in socal, boston, nyc that had superstar applicants rank them highly.

I’ve noticed that people who don’t mind doing residencies in crazy expensive locations (like SF and Manhattan), are either 1) single or 2) have a partner with a decent job.

 

[Dral]

Not a factor at all for me. I applied to a competitive specialty so I just wanted to train somewhere.

I trained/lived in Manhattan. It was a little tough, but I made it work and LOVED it there.

As HipiMochi mentioned, I was single at the time.

 

[mistafab]

Was huge for me. Didn’t even apply to a number of programs in high COL areas. I think this has a massive impact. I’d do it again too - residency has enough stress without having to worry about paying your bills.

Same. Felt great about my decision.

 

[gyngyn]

It had no effect at all on my choice.

 

[ChordaEpiphany]

Title pretty much sums it up. I was thinking ahead to when I will apply to residency and started pondering how much self-selection happens when composing program lists and rank lists in regards to some of the less obvious factors for an applicant (ex: a rockstar applicant could theoretically match anywhere, but wants to avoid some of the higher costs of living areas and ranks Cleveland or Mayo higher than other elite programs located in NY, LA, etc. and matches). Extrapolating that thought out further, do mid-tier programs located in higher COL (desirable) areas become anymore attainable compared to similarly ranked programs located in lower COL areas? Or are costs largely an afterthought for most and they just want to live in those areas no matter what?

Clearly are there are a myriad of factors when comparing any two programs, and geographic ties to an area probably dictate lists more than the inherent COL of a program's area does. I'm guessing this is likely not important to most, but I am just curious what some peoples' thoughts are on the matter.

This conversation is probably moot anyway given how application numbers have skyrocketed to pretty much cover the entire country anyway.

As an older student it's huge for me. I have already essentially ruled out NYC and SF. A research colleague of mine started a clinical fellowship in NYC and is essentially living in a dorm in his 30s. I'm going to be 32 when I start residency, and I'll probably have a kid or two somewhere in there. No thanks.

If it came down to an entirely different tier I might consider it. Columbia/Cornell vs. mid-tier academic, maybe I bite the bullet, but that whole scenario seems unrealistic. As a resident, I'd take Durham/Baltimore/New Haven over Boston/Seattle/LA any day. Having lived in comparable places, being broke in a HCOL area kinda sucks.

 

[Gilakend]

I don't care about COL as much as I care about avoiding big cities, but the two are usually tied together.

 

[AlbinoHawk DO]

Entirely. I did not apply to any program in fellowship where COL was a problem

 

[esob]

I've recently moved several west coast programs off my application list as well due to home prices. I can see how competitive candidates for those programs would either not apply or rank them low if they have a family.

 

[Darrow O'Lykos]

As an older student it's huge for me. I have already essentially ruled out NYC and SF. A research colleague of mine started a clinical fellowship in NYC and is essentially living in a dorm in his 30s. I'm going to be 32 when I start residency, and I'll probably have a kid or two somewhere in there. No thanks.

If it came down to an entirely different tier I might consider it. Columbia/Cornell vs. mid-tier academic, maybe I bite the bullet, but that whole scenario seems unrealistic. As a resident, I'd take Durham/Baltimore/New Haven over Boston/Seattle/LA any day. Having lived in comparable places, being broke in a HCOL area kinda sucks.

I’ll be in my early 30s starting residency as well and would also like to have a kid around that time. I can’t fathom living in a shoebox with a wife and infant/toddler either.

I've recently moved several west coast programs off my application list as well due to home prices. I can see how competitive candidates for those programs would either not apply or rank them low if they have a family.

Yeah if we weren’t in a position where we’d be living at a below-market rate due to family ties, I just don’t see how it’d be even remotely possible in SoCal.

It’s interesting seeing different perspectives brought to the thread, so cheers to all.

 

[Darrow O'Lykos]

I applied to a competitive specialty so I just wanted to train somewhere.

That's the path I'm leaning towards so my preference on location is probably an infinitesimally small variable that won't matter in the end, as I imagine most other applicants will apply most places within said competitive field.