Which market is more competitive/saturated, SoCal or DFW?

[musicalfeet]

I’m writing this on behalf of my fiancé, who is an EM attending one year out of residency. He did his residency in SoCal and stayed on as faculty while I finished up med school and am now entering the match process in a completely different specialty. Now that it’s time to rank, I’ve fallen in love with two programs, UCLA and UTSW. He’s said he will follow me wherever I match, but I want to rank also based off of where he can find a job that he doesn’t absolutely despise. Unfortunately match this year isn’t until March 20...so he can’t officially start looking until then.

I’m just having trouble figuring out which of these locations would be better for him, since I’d be really happy at either of those places. I’ve been reading that the job market as tightened considerably, and his current job isn’t exactly great (low pay, high hours and not great environment). His current job is like $160 an hour on w2 with full time being 16 9 hour shifts a month. We’ve had a lot of talks about this but his answer is mostly “I don’t know I can’t predict this and I can’t start looking for jobs until you match”. Being that he did his residency at a southern California program (but 2-3 hours away from west LA), most of the alumni work somewhere around here, but we also have 2-3 alumni who are good friends that work in the DFW area. Just don’t know how much that actually helps.

I’m just scared of him not being able to get a job where I match, and having to be separated for all 4 years. Other possible locations are Phoenix, Sacramento, houston or Galveston.

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[GeneralVeers]

Stay away from CA. There is no logical reason to live there unless you have family ties.

 

[musicalfeet]

Unfortunately we both have family in CA and we're currently there now. Is CA really that bad? Isn't everywhere else sucking too for EM as the market is shrinking?

 

[BoardingDoc]

I’m writing this on behalf of my fiancé, who is an EM attending one year out of residency. He did his residency in SoCal and stayed on as faculty while I finished up med school and am now entering the match process in a completely different specialty. Now that it’s time to rank, I’ve fallen in love with two programs, UCLA and UTSW. He’s said he will follow me wherever I match, but I want to rank also based off of where he can find a job that he doesn’t absolutely despise. Unfortunately match this year isn’t until March 20...so he can’t officially start looking until then.

I’m just having trouble figuring out which of these locations would be better for him, since I’d be really happy at either of those places. I’ve been reading that the job market as tightened considerably, and his current job isn’t exactly great (low pay, high hours and not great environment). His current job is like $160 an hour on w2 with full time being 16 9 hour shifts a month. We’ve had a lot of talks about this but his answer is mostly “I don’t know I can’t predict this and I can’t start looking for jobs until you match”. Being that he did his residency at a southern California program (but 2-3 hours away from west LA), most of the alumni work somewhere around here, but we also have 2-3 alumni who are good friends that work in the DFW area. Just don’t know how much that actually helps.

I’m just scared of him not being able to get a job where I match, and having to be separated for all 4 years. Other possible locations are Phoenix, Sacramento, houston or Galveston.

I can't directly answer your question, but he shouldn't have a hard time doing better than what he currently getting. $160/hr, w2 or not is laughable.

 

[DeadCactus]

Pay is related to job satisfaction but not the defining feature. You're in one of the lowest paying regions of the country, he will likely find better pay wherever you match. From my brief look around the area, $160/hr + benefits is even low even for southern California. But again, there is much more than salary that goes into enjoying a job. A tight market means he is more likely to have to find a compromise between pay, commute time, and quality of work environment but it's unlikely he will be trapped in a job he despises or finding no job and you can end up in a job you despise in plenty of well paying, open markets.. I would argue that a happy wife and living in a city he enjoys will do more for career satisfaction than the specifics of the job market.

SDN will come take a steaming dump on anyone who thinks about living in California, Denver, or NYC and yet those cities are full of physicians who seem to enjoy their lives and careers there enough to stay even if reimbursement is significantly less than many other places.

 

[RuralEDDoc]

Stay away from CA. There is no logical reason to live there unless you have family ties.

I’ve read this sentiment often and It always struck me as odd. California reimburses among the top 10 states nationwide. Yes there are high state income taxes, but if you make 15% more than your neighbor, who cares if their taxes are 9% less? There’s a good to great malpractice environment. Nearly no uninsured patients (yes the newly insured are Medicaid but it’s not nothing). Cali sunshine. What am I missing?

 

[TheSingularity]

A couple things:

1) He can and absolutely SHOULD start looking for jobs before you match. Never hurts to start sending out feelers.

2) Classically in EM you get to choose two out of three of these: Pay, Location, Job Quality. Sounds like your fiance only has 1/3 right now (location). In my classically shyt on northeast USA locale, I believe I have 2.5/3 if not 3/3. 16 x 9 x 12 = 1728 hrs / yr is a LOT. Also, if you're going to make $160 / hr in EM, you had better live next to your own personal water slide or something, and the job had better be all rainbows.

Good jobs can likely be found in either state, he just needs to do the field work to find them. Good luck to both of you and congratulations on your match!

 

[alpinism]

Both markets are unfortunately very saturated and it will be difficult to find a full time job in either city.

The only way to know for sure which is the better option would be to contact groups in both cities and see if anyone is hiring. I'd highly suggest doing this as soon as possible since graduating residents are currently looking for jobs and signing contracts. If you waits till March the few jobs available will likely be gone already. While its not ideal another potential option would be to just travel for work. Both cities have easy access to airports and it would be a quick flight to nearby cities with plenty of good high paying jobs.

 

[deleted109597]

Also, if he hasn't started working on his Texas license, he should. Waiting until you match means he will be working in SoCal for a few months to a year after you move.

 

[emergentmd]

What am I missing here? Where is the problem? Why can't he start looking?

Spend a day and call every CMG/SDG/Hospital in the area. Call the hospital, ask for the medical director, and call him/her. I am QUITE sure you are he will find 5+ openings in the DFW area. ITS a BIG city with MANY suburbs and hospitals. Texas is getting tight but there are openings. Get Texas License NOW. Takes upwards of 6 months to get.

When you match in March, he should have a few offers and if you match in DFW, he picks one.

Do the same in Socal.

I don't see the problem? Actually the only problem I see is the $160/hr.

 

[deleted109597]

Not disagreeing with looking. Just needs to start the license is all.

Also, there's the part where the match might go beyond 1 or 2.

 

[Rekt]

Not disagreeing with looking. Just needs to start the license is all.

Also, there's the part where the match might go beyond 1 or 2.

Yeah you're ranking two "competitive" programs as your 1 and 2. Just like everyone else. Be open to the rest of your list. Might even be a blessing for his job search.

 

[musicalfeet]

Yeah you're ranking two "competitive" programs as your 1 and 2. Just like everyone else. Be open to the rest of your list. Might even be a blessing for his job search.

I’m a relatively competitive/strong applicant for my specialty so I feel the odds are quite good I would get 1 or 2. He would actually ideally want me to land at #3 and I’d be happy there too but that program is just of a slightly lower caliber which is why I decided to put it there. Honestly I highly doubt I would drop beyond 3,maybe 4 at the lowest.

I just don’t want to match at my #1 and then feel partly responsible for him not being happy at where we are or him not being able to get a job. Especially since either of those are relatively interchangeable for me.

 

[deleted109597]

I just don’t want to match at my #1 and then feel partly responsible for him not being happy at where we are or him not being able to get a job. Especially since either of those are relatively interchangeable for me.

So don't feel that way. I realize it's tough, but you have to match to do residency. If you have an honest conversation with him about where he will be happy, and you're willing to do that, then do that. Otherwise, do what's best for you. I am fairly certain he will get a job somewhere. And not every job in EM is great, so he may not be happy regardless of where he goes. But that's not your fault.

 

[deleted497653]

Until you’re married, you’re not married. Other than that... you may not end up where you rank 1,2 so don’t count the chickens too early.

 

[deleted941485]

Texas' physician population hits 10-year high

Texas' physician population has been increasing at a record pace for the past decade, according to new data from the Texas Medical Association.

www.beckershospitalreview.com

 

[VA Hopeful Dr]

Texas' physician population hits 10-year high

Texas' physician population has been increasing at a record pace for the past decade, according to new data from the Texas Medical Association.

www.beckershospitalreview.com

So as of now Texas has 190 doctors per 100,000 people.

The lowest of the top 10 states with the highest number of physicians is 293 back in 2016 (New Jersey, if you care). In fact that 109 is still in the lowest grouping from 2016: Top 10 States With The Highest Physician to Total Population Ratios

 

[deleted941485]

So as of now Texas has 190 doctors per 100,000 people.

The lowest of the top 10 states with the highest number of physicians is 293 back in 2016 (New Jersey, if you care). In fact that 109 is still in the lowest grouping from 2016: Top 10 States With The Highest Physician to Total Population Ratios

The point is the geographic premium you get to moving there coupled with the fact that living costs in those cities are rising makes it not all that desirable.

Yes The population of TX is growing as they get transplants from other states but honestly in a few years it won’t be much better than practicing in NJ or NY in a few years

 

[VA Hopeful Dr]

The point is the geographic premium you get to moving there coupled with the fact that living costs in those cities are rising makes it not all that desirable.

Yes The population of TX is growing as they get transplants from other states but honestly in a few years it won’t be much better than practicing in NJ or NY in a few years

To get close to NY you'd have to double the number of physicians without increasing the overall population. I guess that could happen, but I kinda doubt it.

 

[The Knife & Gun Club]

The point is the geographic premium you get to moving there coupled with the fact that living costs in those cities are rising makes it not all that desirable.

Yes The population of TX is growing as they get transplants from other states but honestly in a few years it won’t be much better than practicing in NJ or NY in a few years

I don’t agree. Yea the COL has gone up a bit in Houston and Dallas and Austin, but as a whole, it’s still nowhere near the northeast.

Look at how much it costs to get a decent house in Long Island or parts of New Jersey. Factor in the crippling taxes, Med mal, and just general inflation of every day goods. COL in even the most saturated parts of Texas would need to increase exponentially to rival the NE.

 

[deleted941485]

Nah

To get close to NY you'd have to double the number of physicians without increasing the overall population. I guess that could happen, but I kinda doubt it.

We’ll in the case of TX the rate of paying patients coming into the state is prob

I don’t agree. Yea the COL has gone up a bit in Houston and Dallas and Austin, but as a whole, it’s still nowhere near the northeast.

Look at how much it costs to get a decent house in Long Island or parts of New Jersey. Factor in the crippling taxes, Med mal, and just general inflation of every day goods. COL in even the most saturated parts of Texas would need to increase exponentially to rival the NE.

As someone who looked around the suburbs of places like Austin and DFW when I was starting out. The property taxes were just as bad if not worse.

Yes I get it Texas is a big state and that drags the avg COL down. But anywhere in that state that’s worth living in is probably comparable to the northeast.

The gold rush is over. Time to move on. Anybody piling on now is just wasting their time.

 

[VA Hopeful Dr]

Nah


We’ll in the case of TX the rate of paying patients coming into the state is prob


As someone who looked around the suburbs of places like Austin and DFW when I was starting out. The property taxes were just as bad if not worse.

Yes I get it Texas is a big state and that drags the avg COL down. But anywhere in that state that’s worth living in is probably comparable to the northeast.

The gold rush is over. Time to move on. Anybody piling on now is just wasting their time.

Umm, what?

2020 Cost of Living Calculator: compare Dallas, Texas to New York, New York

Best Places to Live | Compare cost of living, crime, cities, schools and more.

www.bestplaces.net

 

[deleted941485]

Umm, what?

2020 Cost of Living Calculator: compare Dallas, Texas to New York, New York

Best Places to Live | Compare cost of living, crime, cities, schools and more.

www.bestplaces.net

Houston Is Now Less Affordable Than New York City

A new report finds that, when transportation costs are factored in, Texas’s biggest metros aren’t the bargain they often claim to be.

www.google.com

 

[VA Hopeful Dr]

Houston Is Now Less Affordable Than New York City

A new report finds that, when transportation costs are factored in, Texas’s biggest metros aren’t the bargain they often claim to be.

www.google.com

So first, your link leaves out everything else that factors into COL which is more expensive in NY.

Second, why is the median housing cost so very different between your link and mine?

 

[deleted941485]

So first, your link leaves out everything else that factors into COL which is more expensive in NY.

Second, why is the median housing cost so very different between your link and mine?

Hey getting to work everyday is kind of a big deal. If it’s costs an arm and a leg

 

[VA Hopeful Dr]

Hey getting to work everyday is kind of a big deal. If it’s costs an arm and a leg

What does that have to do with what I posted?

 

[deleted941485]

What does that have to do with what I posted?

I’m not sure why they are so different. I’m not going on an expedition to try to find out. But seriously the party in Texas for physicians is probably ending. Houston is huge but there are only so many desirable places to live. Docs are flooding the market and salaries are going down. COL in metros in Texas will continue to rise transportation costs factored in or not it’s just the beginning.

 

[VA Hopeful Dr]

I’m not sure why they are so different. I’m not going on an expedition to try to find out. But seriously the party in Texas for physicians is probably ending. Houston is huge but there are only so many desirable places to live. Docs are flooding the market and salaries are going down. COL in metros in Texas will continue to rise transportation costs factored in or not it’s just the beginning.

That all seems true

 

[bravotwozero]

Hey getting to work everyday is kind of a big deal. If it’s costs an arm and a leg

I live in houston and I bike to work....

 

[deleted941485]

I live in houston and I bike to work....

Great...Do your colleagues that live in the suburbs bike to work as well?

 

[bravotwozero]

Great...Do your colleagues that live in the suburbs bike to work as well?

First of all, I live in suburban Houston. Secondly, some of my colleagues do, actually. For the ones that don't, they very easily can bike if they want to. If they choose not to, that's on them. The point is that It's very easy to live close to your workplace here, so whatever information you've posted about transportation costs in texas is complete BS, by the way. Gas is cheap here, so is car insurance. I just paid less than two dollars for a gallon of gasoline, and I pay $150 per month for full collision and liability insurance, plus rental car coverage, for both mine and my wife's vehicle. Uber and Lyft have both been very affordable whenever i've needed to use them. And if people are willing to move their fat, jiggly behinds more, they can very easily bike to work and bring their commuting 'transportation costs' to near zero.

 

[Preston Ganey Jr]

DFW isn't as full as you might think. Look west to Arlington, east to Rockwall (Baylor LakePoint, etc), South Dallas, or at some of the smaller or microhospitals in the area (Texas Health Resources, Baylor Emerus, Medical City). $200+/hr IC is pretty standard, and I'm hearing 250-300/hr from friends who work at higher acuity shops. No state income tax and good med mal protection.

I got two of my gigs by walking into the ED and asking for the medical director. Another by cold calling and asking for the Med director. Texoma Medical Center in Sherman/Denison is another great spot, if more of a drive. 7.6M people in DFW - plenty of room, if you don't mind living in the burbs, which have great schools.