Practice Location

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So this thread is about the best places to practice. I'm sending this out to hear what everyone thinks, as there are a few people getting close to real job application season. And as much as I like to move every 5 years, my wife doesn't find this ideal, and would like to find a homestead.
So I'm asking everyone's opinions and experiences.
I have my own personal choices, but don't want people to not post good (and bad) places as I don't want this just for me, but for everyone.
Specifically, while practice environment, geography, night life, etc are important, I want to use the collective to hear about the places I haven't been, or heard about on No Reservations.
Don't hold anything back.
Also, Apollyon, please post pictures of Hawai'i, because I'm still jealous. Also, do they need a pediatrician there (the wife gets bored at home)?
 
just kidding... for real it sucks
 
Close to job application season? You're graduating in 2011 then? Seriously, you should already have applied by now and should have your contract signed by March if you want to start working in July. Most hospitals require 3 months to grant you privileges, while most hospitals require 6 months. Sign in March, work in September.
 
I looked all over the country and ended up in the southwest. I really love it here and am happy that I (and my wife) had the guts to move somewhere totally new. That freedom allowed me to look for and take what was the best job/location combination for us. It sounds like you are in the same boat, so I encourage you to search far & wide with an open mind.

Personally, I know that New Mexico needs EM docs, is a beautiful place to live (if you can appreciate desert beauty), and has a pretty nice cost of living. However, the state is poor, and the relative lack of hospital beds in the state leads to outpatient management of a lot of things that might get admitted elsewhere. Fortunately, at least where I work, the protection from malpractice is fantastic.
 
Wisconsin is a great place to be--excellent malpractice climate with caps, low cost of living, high salaries (many paying $200-300/hr), 4 seasons climate, and some really cool university towns (well, only Madison)
 
Tiger26 said:
Wisconsin is a great place to be--excellent malpractice climate with caps, low cost of living, high salaries (many paying $200-300/hr), 4 seasons climate, and some really cool university towns (well, only Madison)
Click to expand...

Hey! Milwaukee is pretty cool too...
 
I stayed in TX. The high hourly wages combined with tort reform and relatively low housing costs is a good combination. Looked in AZ and CA, but just couldn't justify short changing myself after spending so many years getting to this point.
 
Derek said:
I stayed in TX. The high hourly wages combined with tort reform and relatively low housing costs is a good combination. Looked in AZ and CA, but just couldn't justify short changing myself after spending so many years getting to this point.
Click to expand...

What do you mean shortchanging yourself?
 
southerndoc said:
Close to job application season? You're graduating in 2011 then? Seriously, you should already have applied by now and should have your contract signed by March if you want to start working in July. Most hospitals require 3 months to grant you privileges, while most hospitals require 6 months. Sign in March, work in September.
Click to expand...

Yeah, I've got 17 months and change to graduation. So I need to start specifically looking for areas that I want to focus on.
Texas is always up there, but I worry in a year and a half it might be saturated.
The Pacific Northwest has nice scenery.
Hawai'i is paradise.
Florida has sketchy malpractice environment, etc.
My one requirement is that the city has to have a decent airport (as in volume). Culture is nice as well.
 
I got lots o' pix, but just haven't uploaded them yet.

Being a doc in Hawai'i isn't great. However, being a doc is great. Living in Hawai'i is great. If you can make that work, it's doable. Remember that the best jobs aren't advertised, though. (Still, it helps to have a connection.)

And no "spider bites" here! When people DO get bitten, it's a centipede, and they bring it with them!
 
Zanegray said:
What do you mean shortchanging yourself?
Click to expand...

It seems that a dollar earned in TX goes further than it would in other areas. The reason being that there is no state income tax, the cost of living is good, housing prices are great, and cost of malpractice insurance is low (relatively speaking). Thus, by default, more cash left over after all monthly expenses are paid as compared to other areas. This is just the way I see it, doesn't mean it's right for everyone.
 
I wouldn't mind staying in Florida, but the malpractice here is horrible. There's no relief in the near future. You can't swing a dead cat in this state and not hit a "personal injury" attorney. Any type of tort reform has been blocked.
 
WilcoWorld said:
I looked all over the country and ended up in the southwest. I really love it here and am happy that I (and my wife) had the guts to move somewhere totally new. That freedom allowed me to look for and take what was the best job/location combination for us. It sounds like you are in the same boat, so I encourage you to search far & wide with an open mind.
Click to expand...

Congrats on getting married!
 
I'm in Central Florida, and although the malpractice situation can be painful, there are practices out there that offer Sovereign Immunity. (Like mine - we're affiliated with a big academic med center, but are a community practice.)

The hospital is in a smaller town (we're not a trauma center), but only 1-1.5 hours from 2 major metropolitan areas, both with international airports, which was also one of my requirements. I was able to buy some land, put down some roots, and not worry about big-city crime, while still being close enough to get good food and culture when needed. Some of my partners live in the cities, some live in the country.

Oh, and we're hiring... 😉
 
Any info/input on EM in Arizona would be much appreciated. thanks!
 
I live in Southern Oregon. I like it here. Oregon is about middle of the road as far as medico-legal climate. I am more here for the location then the job. I love the Pacific Northwest. I am from Texas and although not bad, it is not where I want to live. I trained on the East Coast and definately do not want to live anywhere there. The job here is fine, better than most I have worked but not the very best. I can live with it to live where I live. Proximity to the ocean and to mountains is a priority for me and my family. Good luck finding your future home.
 
I'm new to the forum, but I have to agree that Wisconsin is a pretty good practice environment, with a pretty good medico-legal environment and I think most jobs pay around $200-300K plus benefits. A large number of the hospitals are staffed by private groups, and there are not a lot of the huge corporate players like TeamHealth in the state. I've been in Wisconsin for 4 years now.
 
Midwest baby.
Was in mideast for 2.5 years, made decent cash, but practice environment not ideal.

here in Wisconsin (south central), past year I made 375k and I'm not partner yet. Will probably shoot 450k after partner buy in. Fantastic place to practice. legal environment favorable, and the followup is fantastic... I can get someone to see ortho/ent/neuro next day if I wish.

Best damn EM job in the country.

And I'm getting paid $290/hr to post this on SDN (at work now).
Q
 
DrQuinn said:
Midwest baby.
Was in mideast for 2.5 years, made decent cash, but practice environment not ideal.

here in Wisconsin (south central), past year I made 375k and I'm not partner yet. Will probably shoot 450k after partner buy in. Fantastic place to practice. legal environment favorable, and the followup is fantastic... I can get someone to see ortho/ent/neuro next day if I wish.

Best damn EM job in the country.

And I'm getting paid $290/hr to post this on SDN (at work now).
Q
Click to expand...

Wow, those numbers are nuts ...
 
Now that we've reached at least a moderate interest in the thread, I can start asking specifics.
Does anyone know anything about the medical climates of the following:
Boise
Portland (Oregon and Maine)
Houston
Tampa
Also, anywhere with reasonable access (less than an hour) to a beach. I'm not talking sand trucked to the river, I'm talking waves and sal****er.

On edit. Wow, it edits salt water if you leave it as one word. What fantastic software.
 
Last edited by a moderator:
Dr.McNinja said:
Now that we've reached at least a moderate interest in the thread, I can start asking specifics.
Does anyone know anything about the medical climates of the following:
Boise
Portland (Oregon and Maine)
Houston
Tampa
Also, anywhere with reasonable access (less than an hour) to a beach. I'm not talking sand trucked to the river, I'm talking waves and sal****er.

On edit. Wow, it edits salt water if you leave it as one word. What fantastic software.
Click to expand...

Someone has already commented on the medicolegal climate in Oregon. I will say that, because so many people who come here for residency want to stay after finishing their training, the Portland Metro area job climate is getting pretty crowded in EM (at least from what some recent grads have told me). Not that there aren't any jobs available, just that they don't go begging. Moving out of town a little bit (Salem, The Dalles, Corvallis, etc) makes things a little easier.

Also, the people I know who have moved to Boise (hospitalists and oncologists) love it. But I don't know anything about the EM job market or medicolegal climate there.

The salt water edit thing is hilarious.
 
DrQuinn said:
Midwest baby.
Was in mideast for 2.5 years, made decent cash, but practice environment not ideal.

here in Wisconsin (south central), past year I made 375k and I'm not partner yet. Will probably shoot 450k after partner buy in. Fantastic place to practice. legal environment favorable, and the followup is fantastic... I can get someone to see ortho/ent/neuro next day if I wish.

Best damn EM job in the country.

And I'm getting paid $290/hr to post this on SDN (at work now).
Q
Click to expand...

Holy Crapballs!, Thats good stuff! How many shifts do you do per month? I know where im going after residency!
 
dchristismi said:
I'm in Central Florida, and although the malpractice situation can be painful, there are practices out there that offer Sovereign Immunity. (Like mine - we're affiliated with a big academic med center, but are a community practice.)

The hospital is in a smaller town (we're not a trauma center), but only 1-1.5 hours from 2 major metropolitan areas, both with international airports, which was also one of my requirements. I was able to buy some land, put down some roots, and not worry about big-city crime, while still being close enough to get good food and culture when needed. Some of my partners live in the cities, some live in the country.

Oh, and we're hiring... 😉
Click to expand...

sounds nice....near enough to city, but far enough to not have the negatives.
 
New data on this subject (or just Texas). College football as we know it is being turned around.
I don't know if I can live with a Texas/Stanford rivalry in the new "Pac-16". But with Nebraska jumping ship Friday, I guess I can learn.
USC cheerleaders will not be wearing those sweaters in College Station, that I can guarantee.
 
Dr.McNinja said:
USC cheerleaders will not be wearing those sweaters in College Station, that I can guarantee.
Click to expand...

HAHA. 👍

I wonder if there is a tie btwn Pac-10 expansion and USC losing bowl eligibility. Think they are trying to scoop up TX in time to make up for that loss? I'm just not happy about all those PST kick offs. I need sleep 🙂
 
I second McNinja's request for data about the Tampa/St. Petersburg area and anywhere with a beach within a half-hour to 45 mins away. California is out, though - I'm not playing their licensure reindeer games.
 
Dr.McNinja said:
Now that we've reached at least a moderate interest in the thread, I can start asking specifics.
Does anyone know anything about the medical climates of the following:
Boise
Portland (Oregon and Maine)
Houston
Tampa
Also, anywhere with reasonable access (less than an hour) to a beach. I'm not talking sand trucked to the river, I'm talking waves and sal****er.

On edit. Wow, it edits salt water if you leave it as one word. What fantastic software.
Click to expand...

Ha! That edit is hilarious! It took me a second to get it though.
 
Thanks to Dr. McNinja for starting this thread last year. I am now in his position and wanted to get any additional input that might be available:

o how difficult is it to land a good job in Colorado?
o Oregon: still a wonderful place to be?
o really, for someone not from Wisconsin, how jarring a transition would it be? Because it sounds like a fab place to practice....

I've found that Austin seems difficult to land in. Still working it though.
 
EvoDevo said:
Thanks to Dr. McNinja for starting this thread last year. I am now in his position and wanted to get any additional input that might be available:

o how difficult is it to land a good job in Colorado?
o Oregon: still a wonderful place to be?
o really, for someone not from Wisconsin, how jarring a transition would it be? Because it sounds like a fab place to practice....

I've found that Austin seems difficult to land in. Still working it though.
Click to expand...

Re: Oregon. The most recent class at our institution had a lot more people leave the area than in the past...I have no idea if that was because of the job market or personal choice, just an observation. The people I know who have stayed here in Portland over the past couple of years have started off working 2-3 PT gigs for 6-18 months while waiting for something FT to open up.
 
Huh. That's gotta be a bit frustrating. OTOH, Portland seems like a pretty good place to live.
 
Dr.McNinja said:
Now that we've reached at least a moderate interest in the thread, I can start asking specifics.
Does anyone know anything about the medical climates of the following:
Boise
Portland (Oregon and Maine)
Houston
Tampa
Also, anywhere with reasonable access (less than an hour) to a beach. I'm not talking sand trucked to the river, I'm talking waves and sal****er.

On edit. Wow, it edits salt water if you leave it as one word. What fantastic software.
Click to expand...

Boise and Portland OR very tight, like Denver, Salt Lake, Reno, Flagstaff etc. When I was looking for a new job a couple years ago the group in Boise wanted me to work at 3 different hospitals involving 1-3 hour commutes. I never did find a group in Portland or Denver hiring that year, and only 1 in Reno and 2 in Salt Lake.

There's lots of jobs open with access to beaches in Southeast Virginia.
 
ActiveDutyMD said:
Boise and Portland OR very tight, like Denver, Salt Lake, Reno, Flagstaff etc. When I was looking for a new job a couple years ago the group in Boise wanted me to work at 3 different hospitals involving 1-3 hour commutes. I never did find a group in Portland or Denver hiring that year, and only 1 in Reno and 2 in Salt Lake.

There's lots of jobs open with access to beaches in Southeast Virginia.
Click to expand...


I am also very interested in Colorado jobs. I still have a few more years before I will be job-hunting, but it would be nice to get an idea of what to expect.
I'm not that interested in Denver, though. More like either the Colorado Springs or Fort Collins areas. Anyone have any insight on Colorado EM job opportunities outside of Denver?
 
ShanFan said:
I am also very interested in Colorado jobs. I still have a few more years before I will be job-hunting, but it would be nice to get an idea of what to expect.
I'm not that interested in Denver, though. More like either the Colorado Springs or Fort Collins areas. Anyone have any insight on Colorado EM job opportunities outside of Denver?
Click to expand...

Within the last month I heard from someone working in the Ft. Collins area that EP's seeking employment generally have to work part time & wait for full time to open up, so it sounds like a pretty tight market.
 
Dr.McNinja said:
Now that we've reached at least a moderate interest in the thread, I can start asking specifics.
Does anyone know anything about the medical climates of the following:
Boise
Click to expand...

Can't really speak to the medical climate, but just having been down that road recently and settling on another state EM jobs in Idaho seem to be harder to come by than a snowball in hades.
 
WilcoWorld said:
Within the last month I heard from someone working in the Ft. Collins area that EP's seeking employment generally have to work part time & wait for full time to open up, so it sounds like a pretty tight market.
Click to expand...

I interviewed in Fort Collins a few months ago. So did 18+ people in a 3 day time span for a "maybe someone will retire sometime in the next few years, currently no openings" job. Not knowing that going into the interview, I was annoyed that they wasted my time. I felt like a contestant on Survivor. Seriously... I needed something a little more firm than "we'll give you a few shifts and see if we like you" or "if something opens up." Not worth the money in this scenerio to get a CO license.

FYI- There are two main hospitals in Fort Collins and they are both staffed by the same EM group.
 
Old_Mil said:
Can't really speak to the medical climate, but just having been down that road recently and settling on another state EM jobs in Idaho seem to be harder to come by than a snowball in hades.
Click to expand...

I too recently looked in Boise Idaho for a job. They put a post in one of the EM newspapers and got a huge response. I called about 4 times over a period of 6 weeks and never got a response. I got an apologetic response from a secretary who said that they were overwhelmed with applicants and never dreamed they would have so much interest.

I get the impression that the wealthy in America are fleeing those armpit inner-cities that have recently become nightmarish. The suburban areas are continuing to grow and ER's in those areas are having no problem with their payor mixes. Many other ER's are having worsened problems with their payor mixes and hospital systems are (appropriately) petrified about government tampering with the medical system. Even hospitals that are in the black are tightening their belts in anticipation.

Moral of the story: If you want to live in one of those "paradises" like Fort Collines, be patient, or consider going rural in a spot that is a reasonable commute to where you wouldn't mind living.
 
what's Florida like in terms of Miami-Ft. Lauderdale area in terms of pay, affordability, and terms of fear of those malpractice lawyers (or is it mostly that mal insurance is bad?)? going to be applying soon, and for some reason my wife and I really like the idea of leaving the NY metro area that we've been in our whole lives for Sunny Humid Pastures.
 
Jarabacoa said:
I too recently looked in Boise Idaho for a job. They put a post in one of the EM newspapers and got a huge response. I called about 4 times over a period of 6 weeks and never got a response. I got an apologetic response from a secretary who said that they were overwhelmed with applicants and never dreamed they would have so much interest.

I get the impression that the wealthy in America are fleeing those armpit inner-cities that have recently become nightmarish. The suburban areas are continuing to grow and ER's in those areas are having no problem with their payor mixes. Many other ER's are having worsened problems with their payor mixes and hospital systems are (appropriately) petrified about government tampering with the medical system. Even hospitals that are in the black are tightening their belts in anticipation.

Moral of the story: If you want to live in one of those "paradises" like Fort Collines, be patient, or consider going rural in a spot that is a reasonable commute to where you wouldn't mind living.
Click to expand...


So I take it that the widespread rumor that "EM docs are needed everywhere so you will be able to settle wherever you want" is a bunch of bull then?

It's good to learn this.

Anyone know anything about the Colorado Springs area?
 
ShanFan said:
So I take it that the widespread rumor that "EM docs are needed everywhere so you will be able to settle wherever you want" is a bunch of bull then?

It's good to learn this.

Anyone know anything about the Colorado Springs area?
Click to expand...

Generally speaking, it is true that EM docs are needed pretty much everywhere (with a few caveats).

According to the EMRA Advocacy Handbook that I received in the mail just a couple days ago:
Hawaii is the only state with enough board certified EM docs to fully staff it's ER's at 104%.
Texas and Florida have the largest shortages in absolute numbers. This makes all of the advertisements you see for jobs and locum tenens at these places make sense.

Estimates are that there are about 450 EP's leaving the field yearly and 1350 new EP's graduating...and after accounting for expected levels of attrition will take approximately 30 years to fill all Emergency Departments with board certified , residency trained EP's. Other recent studies indicate that under current training methods, the supply will never meet demand.

Nearly 40% of doc's staffing ED's right now are neither EM trained or boarded.
33% of rural docs are EM boarded, 72% of urban docs are...but most of these aren't EM trained.

Don't want to go rural? Apparently, no one else does either: 5% of recent EM grads are going to rural areas compared to 15% 20 years ago.
 
NEATOMD said:
Hawaii is the only state with enough board certified EM docs to fully staff it's ER's at 104%.
Click to expand...

Hawai'i Medical Association stats support this (so I wonder if that is from where EMRA got the number), but I just don't see it. Everywhere is hiring, and there are still non-EM-boarded docs working - all over.
 
I thought I would chip in some additional info regarding the midwest (outside of Chicago).

Wisconsin is seeing some ridiculous salaries and sign on bonuses. This scares me a little because I don't understand how they're able to do it. Another resident in my class just signed a deal like the one mentioned above in WI.

Iowa has some nice deals as well. I know 3 guys that just signed deals for 350k a year plus benefits, plus 50k loan repayment, plus 30k signon bonus, plus $2500 a month stipend until he starts (at least one even got it retroactive for his whole residency).

Indiana is mediocre. There are some nice deals that pop up every once in a while, but I haven't seen anything crazy outside of ads in throw aways.

Missouri has some nice contracts over in the Springfield, Branson, Joplin (before the tornado), and up near KC I've heard. I don't remember all of the specifics, but they definitely got my attention.

Illinois, in general...sucks. I don't know if it is the ridiculous malpractice in the state or what. Seems like the further north you go the better deal you can get. I got an ad for a job in Rockford claiming 350k your first year plus 90k per year benefits. Peoria, Champaign, and Springfield are looking like about 300k per year with some decent benefits available.

That's about as much as I know from my interviews and searching. Good luck guys!
 
Apollyon said:
Hawai'i Medical Association stats support this (so I wonder if that is from where EMRA got the number), but I just don't see it. Everywhere is hiring, and there are still non-EM-boarded docs working - all over.
Click to expand...

Not sure. I do know that a friend who graduated last year had zero trouble finding a very nice job there so I would assume that your real life perception is probably more accurate.
 
Same. I have a friend who works on Oahu for a group and he had 2 offers out there before he picked one.

Regarding Boise I have a friend who just started there. I think there is more demand for that job than availability but I think they are hiring this year and I had a friend with an offer from there 2 years ago but turned it down. Apparently they have 2 (or 3) sites and they are pretty spread out.
 
So I finished my job search awhile ago, and have settled into Texas. It is hot here, and humid. I haven't started working yet, which made the move a little easier.
I will echo what many have said.

I signed up for a couple recruiting websites, which meant that I literally got dozens of emails daily, and my poor coordinator got phoned frequently (I put that number as the contact). There are a ton of jobs listed out there, however many of the open ones are run by large groups and thus poison to many. I have yet to figure out how to "find" the really good ones, but I bet it has more to do with making contacts and working than just stumbling into it.
What is funny is that my wife was able to join a group that puts here in the top 3rd %ile for pediatrician pay that wasn't listing a job, simply because one of the guys I talked to in my city cold called them on my behalf.
 
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