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So the title there is the gist of the question. Currently I work in a medium size community hospital and do a lot of clinical duties (work in ER, dose/monitor abx, dose/monitor anticoagulants) as well as some distributive and order entry duties. I am probably going to have to move to the East Coast where I have NO connections. I am trying to think about what my next step should be. Is someone like me competitive for a clinical position as is, or should I consider going back to do a PGY1. PGY1 seems like it might be interesting at large academic institution to get some exposure to other areas like inpatient onc, organ transplantation etc. Any thoughts? Also, how are residencies in NJ and NY?