Job vs. Location

[Messerschmitts]

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Dear colleagues,

I've been on this board since I was pre-med, and now I'm 1.5 years into my post-residency attending career as an outpatient psychiatrist (how time flies!). However I'm in a bit of a life dilemma right now. I actually think it's the opposite dilemma as most of my colleagues. I hear a lot of people hate their jobs but love their current geographical location. I LOVE my job, but am increasingly unhappy with my location.

I live in the periphery of the Bay Area in California right now. I grew up in California but as time passes I am increasingly unhappy living in this area. A remotely nice house is 700K to $1 million dollars. My wife doesn't work (she's a stay at home mom with our new baby), I'm paying off my med school loans and her college loans, we're living in a 2 bedroom apartment that we pay ~$2000/month for. And this is in a rural exurb of San Jose. In San Jose it'd be $2500/month. The housing market has recovered, and prices are rising rapidly. People are out-biding each other. It may be another decade before the market crashes again. Taxes are so high. I am also a firearms enthusiast and love target shooting, and the politics of this state make it increasingly impossible for me to pursue my hobby. Also we have no family here. My wife is from Kentucky and would love to move back there. My much smaller family is in Los Angeles. I would love to live in Arizona, which would be much cheaper than CA but equally close to my family in Los Angeles compared to my current location. Or we could go to Kentucky.

However, I absolutely love my current job, I truly doubt could get a better one anywhere as a psychiatrist. My staff love and respect me, and I love and respect them. I get along great with them. Literally as I was typing this post bitching about California, my HSR (front desk clerk) came by to give me a Christmas present and I had to give her a big hug. I get a ridiculous amount of vacation a year. I've never heard of any other psychiatry job with as much vacation + education time. I get great benefits and a pension. I have tuition reimbursement for CMEs and licensing fees. I work for County so I get a lot of no-shows, and I get to relax when they don't show up. I get a full 30 mins with each f/u, 60 mins for new patients. I have no call! The pay is not that great by Californian standards but it's not really bad for the amount of work I do. I feel like I scored a dream job, SO HAPPY and relaxed at my job (90% of the time), but so upset when I come home to my 900 sq ft apartment that I'm paying $2000/month for, not even in San Jose.

What would you do in my situation?

 

[MacDonaldTriad]

There are probably good jobs in cheaper places, but cheaper places have other ways of letting you down. You could stay and maybe do some moonlighting to get out of the apartment, or you could move and risk the job satisfaction. Only you can determine which one you mind less. The combination of the stay at home mom – wife with the expensive location has you in this dilemma. What would make you more and what would make less miserable? 8 – 10 hours of extra work, or a new job? I’m very glad my family went the other way when I was in diapers. Expensive places make for more life opportunities and experiences in ways even more money cannot. Just my two cents, there are lots of nice places with less cost.

Is there a career latter at your county job? Some sort of senior psychiatrist? Most psychiatrists shy away from doing management and you may be able to get a little more money and work with your team if you take on other tasks.

 

[F0nzie]

Maybe moonlight or take some call to make up for the difference in cost of living. You seem happy and relaxed enough to have room for more action.

 

[notdeadyet]

Are you CalPERS or somesuch for retirement? It'd be a shame to lose out on that.

You don't need to leave the state to get a different culture. Head further from the coast and you'll find things get very red very quick. Much cheaper standard and sometimes even higher pay and you'd potentially keep your retirement intact for a similar county job.


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[Messerschmitts]

Are you CalPERS or somesuch for retirement? It'd be a shame to lose out on that.

You don't need to leave the state to get a different culture. Head further from the coast and you'll find things get very red very quick. Much cheaper standard and sometimes even higher pay and you'd potentially keep your retirement intact for a similar county job.


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CalPERS is pretty great. I just started, so if I cut my losses now it wouldn't be so bad but it's pretty sweet, and sad to lose out on.

As far as culture goes though, my main sticking point is firearms, and for that issue it doesn't matter where you go in this state, within California the gun laws are going to be extremely oppressive (or "progressive" depending on your viewpoint). For example there's a push for new laws to require all gun owners to buy liability insurance. I don't want to turn this thread into a debate on gun politics so I won't enumerate the reasons I find this utterly absurd.

The bottom line though is that I think I would either stay put, or I would move to a state with cheap housing and low burden on gun owners. It wouldn't be worth it for me to go through all the trouble of moving jobs to stay in California.

 

[sunlioness]

Hmm. I wonder if you could find something on the AZ/CA border. Work in CA. Live in AZ. I don't know much about that region of the country though. Just know that it exists and probably needs psychiatrists.


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[wolfvgang22]

The grass is always greener on the other side. I'd stay put.

 

[notdeadyet]

As far as culture goes though, my main sticking point is firearms, and for that issue it doesn't matter where you go in this state, within California the gun laws are going to be extremely oppressive (or "progressive" depending on your viewpoint).

Ah. When you said you were a "firearms enthusiast" and "love target shooting," I assumed your complaint was the difficulty getting ammo or finding a decent firing range, which can be hard in the more liberal counties. There are cities along the coast in which it's nigh on impossible.

I consider myself a firearms enthusiast too. But I'm okay with not being able to buy an AR-15 (and can actually have a reasonable facsimile, though the bullet button makes it hard to pretend to be Rambo). I'm also okay with having a 10 round magazine in a pistol that anywhere else I could have a 15 round magazine. I'm also okay with waiting periods, background checks, mandatory gun locks, and getting rid of the gun show loopholes.

I totally get not wanting to turn this into a gun debate. I'm just tossing out there that you can be a gun enthusiast who exercises his hobby and his Second Amendment rights to gun ownership in California. You are just required to make some compromises. I do, and I don't think this prohibits me from being an enthusiast.

Re: CalPERS, if you can at least stick it out until you hit your cliff, at least you'll have a bit of that retirement following you around. If the gun laws are a sticking point, you're right that a move in-state won't help you. If you move to some of the Sierra counties, guns will outnumber people and you can write away for a CCW permit on the back of a cocktail napkin, but you will still have to forego full auto and big magazines. If you're really pulling for that, you'll have to head east.

 

[Messerschmitts]

Ah. When you said you were a "firearms enthusiast" and "love target shooting," I assumed your complaint was the difficulty getting ammo or finding a decent firing range, which can be hard in the more liberal counties. There are cities along the coast in which it's nigh on impossible.

I consider myself a firearms enthusiast too. But I'm okay with not being able to buy an AR-15 (and can actually have a reasonable facsimile, though the bullet button makes it hard to pretend to be Rambo). I'm also okay with having a 10 round magazine in a pistol that anywhere else I could have a 15 round magazine. I'm also okay with waiting periods, background checks, mandatory gun locks, and getting rid of the gun show loopholes.

Wow, a fellow physician, in California, who enjoys owning and operating firearms!! I did not think another one existed! What are the chances.

I don't have an AR-15 for the very reason of the bullet buttons, it makes in impractical for any purpose other than target shooting, so I have a Springfield M1A and a Ruger Mini 14, both of which don't have any of the "evil assault weapon" features. I am cool with waiting periods, background checks. Not cool with mandatory liability insurance for gun owners. Also not cool with banning online sale of ammunition. It is significantly cheaper to order ammo online in bulk than to get them from the store, so if they ban online ammo sales, it becomes prohibitively expensive for me to do target shoot. 10 round limits are problematic with me, but I won't get into the nitty gritty.

I agree life is all about compromises. If I want to live in this state, and enjoy what this state has to offer, I need to play by their rules. But if they get to the point where they ban online ammo and mandate liability insurance, then I feel like I need to make a choice to leave the state, or leave my hobby and focus on other things.

Lastly I want to of course reiterate guns are an important part, but only part of my dissatisfaction with this state. The housing issue and cost of living are much bigger problems.

 

[DuskPhilosophy]

Wow, a fellow physician, in California, who enjoys owning and operating firearms!! I did not think another one existed! What are the chances.

I don't have an AR-15 for the very reason of the bullet buttons, it makes in impractical for any purpose other than target shooting, so I have a Springfield M1A and a Ruger Mini 14, both of which don't have any of the "evil assault weapon" features. I am cool with waiting periods, background checks. Not cool with mandatory liability insurance for gun owners. Also not cool with banning online sale of ammunition. It is significantly cheaper to order ammo online in bulk than to get them from the store, so if they ban online ammo sales, it becomes prohibitively expensive for me to do target shoot. 10 round limits are problematic with me, but I won't get into the nitty gritty.

I agree life is all about compromises. If I want to live in this state, and enjoy what this state has to offer, I need to play by their rules. But if they get to the point where they ban online ammo and mandate liability insurance, then I feel like I need to make a choice to leave the state, or leave my hobby and focus on other things.

Lastly I want to of course reiterate guns are an important part, but only part of my dissatisfaction with this state. The housing issue and cost of living are much bigger problems.

Have you looked into working in Nevada?

 

[keifernny2]

I'm not a gun owner, but I still have an umbrella liability policy, and I don't know of any physicians that don't. It's pretty cheap for me (like, $100/ year).
There have been cases where family members of mass murderers have been sued and insurance is useful, even without a liability law.
http://www.cleveland.com/metro/index.ssf/2014/05/tj_lane_family_settles_wrongfu.html

Anyway, regarding the job situation : The surveys say most physicians change jobs within the first 2 years. The question is, where do you want to be (financially, housing, relationship, etc) in 10 years, and can you get there on your current path? I'm in a rural area with high pay and reasonable housing, but there's no way I can stay here forever. The only restaurants in my city are Olive Garden and 3 different varieties of fast-casual steakhouse. The question about moving for me is simply...when will I do it, and how much money can I make now, before I move to the higher cost of living /lower salary location.

Also , I don't know the telemedicine laws in CA, would you be able to relocate and keep working at this same agency part time from somewhere else via tele?

 

[Messerschmitts]

getting rid of the gun show loopholes.

Just an FYI, I don't know for sure in other states, but at least in CA there is no "gun show loophole". If you buy something at a gun show, it's the same FFL background check, same DROS procedure, same 10-day waiting period.

 

[Messerschmitts]

Have you looked into working in Nevada?

Nevada is on my consideration list. I actually like the idea of the Reno-Sparks area, but I need to spend some time exploring it, a lot of people tell me it's really run down. However, I think if I stay on the western half of the country I prefer Phoenix, AZ because it would be much closer to Los Angeles so I could still drive to visit my parents.

 

[Messerschmitts]

The question about moving for me is simply...when will I do it, and how much money can I make now, before I move to the higher cost of living /lower salary location.
Also , I don't know the telemedicine laws in CA, would you be able to relocate and keep working at this same agency part time from somewhere else via tele?

I totally understand where you were coming to from, most people I know wouldn't want to live in a rural area far from a big city. Most doctors I know especially want to be in NYC, Chicago, SF Bay Area, or Los Angeles, one of the hip, bustling, expensive, coastal places. I guess I am wanting going in the opposite direction, sort of. I don't necessarily want to go somewhere too rural but I'm trying to get away from the higher cost of living/lower salary areas.

We don't have telemedicine, I don't think they'd hire me to do telemedicine from another state anyway, not that I'd particularly want to.

 

[sunlioness]

Having just moved from a more rural low cost of living higher salary area to a big metro high cost of living low salary area .... All I can say is, don't. I mean unless you have a strong reason and solid budgeting skills. Stay in the low cost high salary area and fly wherever you want on weekends. That's what I should've done.

So making the opposite move makes sense.

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[J ROD]

Personally, I live in the South where you can get 2x-3x the house for the money and of course we have guns everywhere.

I like the rural and low cost of living. Plus, there is a demand all over. Nice folks in the south too. Maybe I should shut up.......

 

[keifernny2]

My particular low cost high salary area has no real airport within 100 miles. But I do agree, if there were an airport it would make things much easier to do weekend trips. Keep in mind though, a weekend trip involves flight connections and transportation within the city, so unless you have a 3 or 4 day weekend it often isn't worth it. When I lived in a medium size city area, my spouse and I used to go to orchestra concerts on weeknights, plays and shows frequently, nba / nfl games, and it didn't require the planning that it does now to do so. Also, in a rural area, your patients all know where you live and you run into them constantly (especially when there is only one Walmart in town). Unless you want to drive a Chevy, there won't be many others in town with a 5 series or E class, so you're pretty identifiable. Your nearest dealer will be pretty far away when you need service. These are all the little things. On the plus side, we've started ordering meals online from hello fresh and can make decent meals at home, which does reduce the problems of not having a decent grocery store.


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[sunlioness]

You really want a small town in the middle of nowhere with a university in it. It adds some of the culture. My town had an Amtrak stop and an airport with multiple flights per day to two major hubs. There were also four big city airports within three hours. And some other dinky towns with small airports. You could go anywhere in the continental US for a weekend. But part time would've been feasible.

I'm giving serious consideration to seeing if they'll take me back.


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[MacDonaldTriad]

Hmm. I wonder if you could find something on the AZ/CA border. Work in CA. Live in AZ. I don't know much about that region of the country though. Just know that it exists and probably needs psychiatrists.


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I've driven from AZ to CA once. It is the very definition of no man's land. I've never been anywhere more full of nothing.

 

[Messerschmitts]

Unless you want to drive a Chevy, there won't be many others in town with a 5 series or E class, so you're pretty identifiable.

#Firstworldproblems

Ha ha ha big spender I'm still driving my Ford Fiesta! Well, maybe if I lived somewhere like that I could afford a Mercedes. I run into my patients a lot at our Walmart too. I rarely run into them at Costco though...membership fees keep them out. I guess in some ways, my town is the worst of both worlds. It's small and rural but because it's an exurb of San Jose we get the crazy home prices and cost of living. Most of my patients survive by living with 8 other family members in a 1 bedroom apartment, or in grandmother's house that was purchased in the 1960's.

 

[VMSmith]

I've driven from AZ to CA once. It is the very definition of no man's land. I've never been anywhere more full of nothing.

You can actually drive for over two hours and not encounter a single restroom, as we recently discovered to our agony.

 

[Shikima]

You can actually drive for over two hours and not encounter a single restroom, as we recently discovered to our agony.

Cactus didn't suffice?

 

[Doctor Bagel]

Nevada is on my consideration list. I actually like the idea of the Reno-Sparks area, but I need to spend some time exploring it, a lot of people tell me it's really run down. However, I think if I stay on the western half of the country I prefer Phoenix, AZ because it would be much closer to Los Angeles so I could still drive to visit my parents.

I get a ton of emails about jobs in Arizona which makes me think it might be a good place to look. Pretty low cost of living from what I've heard, too. Not my thing (well, maybe Flagstaff), but it might work for you.

 

[F0nzie]

You can expect 190k-200k in AZ and work 40 hrs for it. There are TONS of Nps around so not much leverage unless you put in extra hours. Cost of living is alright depending on where you live. Salaries in Tucson are slightly higher and cost of living is lower than Phoenix. Way less to do in Tucson, pop of about 500k.

If you plan on moving and staying south you should also consider TX. Salary is high. Can get a mansion in a wealthy suburb for a shockingly low price. No state income tax. Restrictions on NPs. Hangout with TexasPhysician (the ultimate perk)...

 

[Igor4sugry]

A remotely nice house is 700K to $1 million dollars. My wife doesn't work (she's a stay at home mom with our new baby), I'm paying off my med school loans and her college loans, we're living in a 2 bedroom apartment that we pay ~$2000/month for. And this is in a rural exurb of San Jose.

There is a post specifically about this situation. Read the comments, there are many from physicians in BayArea (and those that moved away).
http://whitecoatinvestor.com/financial-success-in-a-high-cost-of-living-area/

Considerations about staying in such an expensive area usually come up once kids are born.
I do want to say that some comments about moving to rural areas swing to the opposite end of what not to do. There are plenty of cities in this country that have good salaries, low cost of living, airports, great schools and neighborhoods. Think of places in Indiana, Ohio, Utah, Arizona, Colorado, Florida, KY etc. You are a physician and you can pick where to live. Try moving out to KY, see how it goes.

 

[Trismegistus4]

I totally understand where you were coming to from, most people I know wouldn't want to live in a rural area far from a big city. Most doctors I know especially want to be in NYC, Chicago, SF Bay Area, or Los Angeles, one of the hip, bustling, expensive, coastal places.

As I was just posting in the interview reviews thread, where people were discussing Charleston, SC being saturated, I thought the same thing all through medical school. But it's not just the hip coastal places. I always thought as long as one was willing to eschew maybe the top 5 big cities in the country, the job market would be wide open. But in reality, finding a job in or near even a decent medium sized city can be tough. The high demand is in the more rural areas. What's frustrating is when you give recruiters a list of cities you'd like to be in or near, and they send you jobs that are an hour away from the city. Not at all the same thing.

 

[Doctor Bagel]

You can expect 190k-200k in AZ and work 40 hrs for it. There are TONS of Nps around so not much leverage unless you put in extra hours. Cost of living is alright depending on where you live. Salaries in Tucson are slightly higher and cost of living is lower than Phoenix. Way less to do in Tucson, pop of about 500k.

If you plan on moving and staying south you should also consider TX. Salary is high. Can get a mansion in a wealthy suburb for a shockingly low price. No state income tax. Restrictions on NPs. Hangout with TexasPhysician (the ultimate perk)...

So you really feel like it's pretty clear that NPs have lowered salaries in your area? I'm in an independent practice state, but I think our shortage is so severe that it hasn't mattered so far. About the cheap houses in Texas, the downside is that you never accrue in value in your real estate. I'm surrounded by west coast types who all have this family wealth secondary to real estate gains, and you don't get that in my parts. Although if I returned home, I could buy a really nice house for maybe $350k and make the same money I'm making here. No skiing, no proximity to the coast, weather kinda sucks, everything is uglier, it gets old to always be an outsider because you're not a Baptist, etc so there are costs, though.

 

[F0nzie]

So you really feel like it's pretty clear that NPs have lowered salaries in your area? I'm in an independent practice state, but I think our shortage is so severe that it hasn't mattered so far. About the cheap houses in Texas, the downside is that you never accrue in value in your real estate. I'm surrounded by west coast types who all have this family wealth secondary to real estate gains, and you don't get that in my parts. Although if I returned home, I could buy a really nice house for maybe $350k and make the same money I'm making here. No skiing, no proximity to the coast, weather kinda sucks, everything is uglier, it gets old to always be an outsider because you're not a Baptist, etc so there are costs, though.

There's plenty of psych np coverage from what I have seen. I don't know how it affects my salary but it certainly isn't helping it go up. When I cut my hours an Np swooped down and snagged them in no time. Probably the best way to get a raise is to jump ship and get a new job (I've noticed a lot of psychiatrists do this). I really like the staff and my patients at the CMHC though so I am hesitant to look elsewhere. I have been with the company for almost 3 years now. Lots of good people and drama. 🙂

 

[Rogue Penguin]

Ya know, Kentucky REALLY needs good psychiatrists. My best friend, an Ivy League grad with potential to do great things, died in Kentucky in no small part due to sub-par psychiatric treatment. And Louisville is actually a really cool city with lots to do and tons of great food. SUPER low cost of living. Like I could by a house in a hip area near downtown as a resident if I go there.

 

[Comanaprocil]

I'd say move - but don't rush it. You are in the perfect position to negotiate another dream job, because you're not under pressure to leave your current one and you actually like it! Also, as another poster said, most people leave their first job out of training after 1 or 2 years for a variety of reasons. Most, if not all, of the people I graduated residency with were in new jobs after 2 years out from training, myself included. Also, now is the time to be saving, not flushing money down the toilet paying rent. If you move to a place with a higher salary and lower cost of living, you can save a lot more, and will probably have enough to travel to the big city whenever you feel like it. Or add to your gun collection! You may even have the option of making a good salary while working part-time, which leaves more time to spend with family and your guns. 😉 As we get older our priorities change, I'm considering making the same kind of move to a lower cost of living area in a year or two as well. Let us know what happens, and good luck to you!

 

[WingedOx]

I'd say move - but don't rush it. You are in the perfect position to negotiate another dream job, because you're not under pressure to leave your current one and you actually like it! Also, as another poster said, most people leave their first job out of training after 1 or 2 years for a variety of reasons. Most, if not all, of the people I graduated residency with were in new jobs after 2 years out from training, myself included. Also, now is the time to be saving, not flushing money down the toilet paying rent. If you move to a place with a higher salary and lower cost of living, you can save a lot more, and will probably have enough to travel to the big city whenever you feel like it. Or add to your gun collection! You may even have the option of making a good salary while working part-time, which leaves more time to spend with family and your guns. 😉 As we get older our priorities change, I'm considering making the same kind of move to a lower cost of living area in a year or two as well. Let us know what happens, and good luck to you!

Yeah, I actually like both my job and the city I live in, but my entire family will probably be living in the Denver area in the next 5 years (along with a ton of my and Ms Ox's previously midwestern friends). Plus, the schools in Chicago are either awful, expensive, or require a bribe to get into while still being overcrowded, so we need to consider that in the next few years. I almost moved out there after residency but had a really good offer at my current job before I even started looking out west, so inertia won the day. Neither of us are ready to move yet, but I have some time to put some feelers out into that job market in the next few years before jumping into a job that's a lifestyle downgrade from my current one.