What do you need?

[alotofyarn]

I never imagined I'd move back close to my parents, but now that we have E, I'm not sure I want to be far away! I wanted a place where we could live in a good sized house, preferably a more suburban feel, and I needed to be able to get a job. I also didn't want to go too far north. We didn't end up where we thought we might, but we couldn't be happier.

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[SuzySunshine]

Really we've decided both for residency match, fellowship and our first job we decided we didn't really need anything more then our family of 2-4. For residency we moved from a beautiful foothill view cottage in CA to the frozen tundra of MN. We went from a short drive to Napa, silicon valley, all kinds of cultural stuff to a town of 100,000 that didn't have much but we loved it and it ended up being 7 of the happiest years of our lives. For fellowship we thought we could live anywhere for a year (ended up being 9 months) and we did. Then when it came time for the job we didn't care as long as it was a good job, and it ended up being a great job in the state we both grew up in.

[Cleave]

Really we've decided both for residency match, fellowship and our first job we decided we didn't really need anything more then our family of 2-4. For residency we moved from a beautiful foothill view cottage in CA to the frozen tundra of MN. We went from a short drive to Napa, silicon valley, all kinds of cultural stuff to a town of 100,000 that didn't have much but we loved it and it ended up being 7 of the happiest years of our lives. For fellowship we thought we could live anywhere for a year (ended up being 9 months) and we did. Then when it came time for the job we didn't care as long as it was a good job, and it ended up being a great job in the state we both grew up in.

SuzySunshine, that answer just makes me feel good about the world. Thanks for that.

[metroguy]

depends on family dynamics(kids?). i didn't want to move but in the end--the rank list was base on reputation.

[MAPPLEBUM]

Yea I told him to rank based on reputation and the programs he liked. He knew I wanted to live somewhere different, and...I might have threatened to leave him if he matched close to his hometown...but we also do have similar feelings about location. City large enough for diversity but not so big it's inconvenient.

Interesting, DH seems completely convinced that programs in dense metropolitan areas are not as good of programs because everyone wants to live there. I've never thought to question it...maybe he just says that because he hates big cities more than me.

[diggitydot]

We really just ranked based on the quality of the programs or job. We've landed in great places and have no regrets.

[SuzySunshine]

Interesting, DH seems completely convinced that programs in dense metropolitan areas are not as good of programs because everyone wants to live there. I've never thought to question it...maybe he just says that because he hates big cities more than me.

So I'm not sure I agree with this as a sweeping statement - DH got a great fellowship training in a densely populate metro area. BUT someone asked him the other day if he thought the "Mayo way" could be duplicated in big cities. They were talking about the expense of health care, the ability of people to shop around, etc. And he said no (he trained at Mayo and is now in a big metro area) - he said he sees specialties that are tied to each other (like neurology and neurosurgery and oncology) doing a better job of working together but the Mayo way works at Mayo in a large part because of WHERE its located and because its always been the same Mayo way since the day it was started/created.

The Mayo docs are paid differently, they are all paid a salary (usually lower then industry standards) BUT they are also given a pension, one of the few (if not the last) that still exists in medicine. If you work there for 3 years, doesn't matter if you're in your 30's or 70's (and its not just the docs) you will get a pension when you retire based off of your last 3 years of work's salary. So employees making less then the industry standard don't have to save as much for retirement and it costs a WHOLE lot less to live there then most places. They are not paid one iota on productivity and there aren't any contracts per se. Mayo could, and will, dump you for the slightest HIPAA violation, poor performance, etc.

Anyway, not sure where I'm going with this and sorry for the hijack but I thought it was an interesting conversation because we hear people talk about outcomes based medicine as a better gauge for healthcare and Mayo does that but its probably not sustainable, recreate-able in big cities.

[GreyhoundsRUs]

Interesting, DH seems completely convinced that programs in dense metropolitan areas are not as good of programs because everyone wants to live there. I've never thought to question it...maybe he just says that because he hates big cities more than me.

I would also disagree with this. Because everyone wants to live there, there are more applicants, and programs can be more choosy...

There are good and bad programs in both rural and metropolitan areas - independent of the actual area!



Wife of a PGY-4 Orthopod

[SoonerTexan]

I'd say maybe the job pickings aren't as good (because everyone wants to live there), but definitely not the programs. If everyone wants to live there, that should = better faculty right?

[Cleave]

We really just ranked based on the quality of the programs or job. We've landed in great places and have no regrets.

Totally makes sense to me. I just found the whole exercise of thinking about what I really needed, what he really needed and what our family really needed to be fascinating and valuable - and the match forced that conversation in a different way than I'd ever experienced.

[spotty_dog]

I cant do really crazy heat, though. Dallas is my limit. No Arizona, no Florida, and I'm not thrilled about Houston. It really means a lot of to me!

Never say never. This Alaska girl cried when I learned we were moving to Arizona. You manage.

[SoonerTexan]

I'm sure I'd manage. Just like I do in the summers here! So I guess it isn't really crazy heat, but the length of it. I hate hate hate the summers here

[WolfpackWife]

We've had this conversation a lot even by this point, and I've concluded the following things:

I want to be close to family (ideally back in NC) for residency. I need to be back in NC permanently (please don't remind me to not get my hopes up, I'm just being honest) where we'll raise a family. That said, I have come to terms with the fact that I would be okay with DH ranking places based on how good their programs are and how good of a position they could put him in for fellowships/attending spots. If he matched somewhere that would be a great move for him in the long run, I would do 3 years (IM) where he needed to go. The end goal for us is home - even if it's not until attendinghood/The Job.

Other than that, ideally for residency I have surprised myself by being oddly okay with certain locations. For example, when considering the options I would much rather spend 3 years in Nashville (which I do consider east coast still, kinda) or Dallas or Denver rather than stay here in VA even though here we're only 3 hours from home. If I had to choose between here and one of those places - I'd definitely choose them because it is a finite amount of time. However, I do want to try to keep us within driving distance of home and family and 5ish hours away (driving) just about puts me at my breaking point. I hate driving. I don't want to be rural, I don't want to be super far north (after this week I'm thinking DC is my limit but I know I have to be flexible on that). I don't think I could hack it in NYC even if it was for 3 years, and even though hypothetically I think it would be such an amazing place to live. Honestly just the prospect of having to sell or store so much of our furniture to fit us into a 500sq ft NYC apartment stresses me out enough.

We're so early in the game, what I think/want/need doesn't really matter yet. I know what I *want* but I'm also loosening the reigns on what I *am willing* to do and be okay with. Some days I look at residency as an awesome opportunity to live in a different/cool place - there's an end date to residency and I appreciate that. Some days I freak out at the thought of possibly moving even further away and I almost can't handle it. This whole journey is such a mind fuck.

One DEFINITE: absolutely NO Florida. No Florida, ever.

ETA again: maybe a second definite - no midwest. I very honestly do not think I could survive winters there.

[alison]

Our needs have changed over the years. One thing that stays constant is my need to be in a big city in a walkable neighborhood. We just moved from a denser neighborhood to a single-family one, and I struggle with having to get in the car and drive everywhere. Even if it's just 5 minutes to the grocery store by car, I feel disconnected from people. When you walk to stuff every day, you see the same people, and I really felt like living exactly where I took care of my daily errands was huge. Oh well.

I also like living close to the ocean, but that's not a need, as long as my city is big enough to get me to Hawaii within a reasonable amount of time.

I've softened up a bit over the years, I think.

[Deebs]

We went for best training opportunity. EM is typically a three year program, so we knew we could be anywhere for three years if it would open up more opportunities over a lifetime. It helped that we had no kids yet, and I worked in healthcare, so I could probably find a job anywhere DH ended up.