Selecting a location for medical practice

“What would make us the happiest?” That’s the question plastic surgeon Jordan Frey, M.D., and his wife, Selenid Gonzalez-Frey, asked themselves when selecting a location for medical practice. After six years of residency plus a fellowship year at New York University in Manhattan, New York, the Freys thought they might be ready for a change.

They weighed the pros and cons of staying in New York City; moving across the country to San Antonio, Texas; or moving in-state to Rochester or Buffalo. Given their priorities, they eventually chose Buffalo. It’s where Frey grew up, and his family still lives there. Still, he says, “It was unexpected that we ended up back in Buffalo.” After all, they had started with a nationwide search.

Frey explains they were looking for “a place where I could practice in an environment that was close to family, low cost of living, minimal call responsibility and where I still had the opportunity to teach residents and medical students.” In Buffalo, they found a place they both love. “We’re very happy with our decision and the community we are currently in,” he says.

Loving where you live is essential for long-term happiness. Physicians who don’t usually end up moving. In fact, some recruiters estimate as many as 70 percent of physicians change jobs in the first two years of their careers. And in 2020, the Association of American Medical Colleges reported an annual health care industry turnover rate of 6 to 7 percent. That represents 50,000 or more physicians moving each year.

No one wants that. Relocating isn’t just disruptive to your career. It’s also incredibly stressful and can upset family life. So what’s the key to finding a place you love—and avoiding an unnecessary move? These tips from physicians and experts alike will help you figure it out.

1 Clarify what you want

Frey says he and his wife had to do the difficult work of defining their priorities. “So often in medical training, we’re used to being told where to go. And for training, we do. We open an envelope, and it tells us where to go,” he says. “Then we get to the end of the line, and we almost get a little agoraphobic. There are so many options, and we end up taking what’s most comfortable—not necessarily what’s best for us—because we don’t always take the time to think about what we actually want.”

Frey didn’t want to take the easy route and end up unhappy later. He and his wife agreed at the outset that each had veto power over any city or situation. “If one of us said, ‘No, that’s just not going to work for me,’ for whatever reason, then that was it,” he explains. Both of them had to be excited about any cities they considered. Buffalo came out the winner.

2 Think location, location, location

Most physicians prioritize location, according to Bob Bregant, Jr., FACHE, president of Steel Healthcare Solutions in Overland Park, Kansas, and a board member for the National Association of Physician Recruiters. “Location is always number one,” he says.

He explains that many physicians have reasons to stay put after residency. Maybe they’ve made friends there, maybe their spouse is from the area, or maybe they’ve simply put down roots. Others want to return to their home or their spouse’s. Their job searches focus almost exclusively on those locales.

But a third group consists of people without ties to a specific area. These physicians are open to more opportunities in a variety of places.

3 Start with regions, not cities

Frey may have been surprised to end up back home, but that wasn’t the case for James Griffith, M.D., a dermatologist with U.S. Dermatology Partners near Kansas City, Kansas. He wanted his kids to have an upbringing similar to his own.

“I was born and raised in the South, just outside of Nashville in Franklin, Tennessee,” he says. “For me, a big part of my childhood was being able to roam around, get to meet kids in the neighborhood and even learning the niceties of being a gentleman: holding doors for people, having little side conversations with random strangers.”

For Griffith, finding a similar community for his own children was high on his list. “It’s a culture that doesn’t exist everywhere,” he explains. “It really depends on the community that you’re in.”

That’s why Frey started his search by considering geographical regions, rather than zeroing in on cities as many of his peers did. “I think there are a lot more opportunities if you’re more open to looking beyond specific cities,” he says. Instead, he suggests, “Have a more general checklist of the features of the community you want to find. That way, you can get into a community you’ll love.”

4 Consider family ties

Just like Frey, Reyzan Shali, M.D., and her husband chose to move near family after her residency at Ascension Providence Hospital in Southfield, Michigan. Shali is an internal medicine and primary care physician with Tri-City Primary Care in Vista, California.

“My husband had close family members in the San Diego area, so that was our biggest initial attraction to the area,” she says. “Then, of course, as we lived in it, we loved it more and more and more.”

Family was important to Shali because she and her husband had one son at the time and hoped for another child. “We wanted to be in an area where we loved the community,” she explains. They were also looking for good schools and other families to connect with.

Knowing what they wanted in a community made it easier to find. The same is often true for workplaces.

5 Meet potential colleagues face-to-face

Early on in his search, Griffith made a point of scheduling a Zoom call with physicians in each practice to get a feel for the place. “I really like that face-to-face communication,” he says, explaining that body language is important.

The next step was an onsite visit to get a sense of the community and the work environment. While visiting, Griffith made sure to meet as many people as possible. While meeting other physicians, he tried to understand their routine. He asked what they liked to do outside of work and how long they had been with the organization.

Likewise, when Shali visited employers, she says, “I was looking for how I felt in the clinic, meaning the energy basically.” She paid close attention to the people she saw. Were they upbeat and smiling? Or did they walk around with hunched shoulders? She wanted an uplifting and positive environment. She looked for signs of positivity as she walked through each clinic.

6 Explore the area

When you’re getting to know an area, start with background research. Google the city to find out more. Learn what activities and events are available. After that, Griffith recommends spending time in the community and pretending you already live there. He and his wife did just that when visiting Kansas City. They enjoyed some local food, explored nearby parks and went to a Kansas City Royals baseball game. Their goal? Strike up some conversations and size up the area.

“People are usually a bit more open to having conversations when you’re in the park or at a game,” he says. “You’d be standing there, and the next thing you know, commentary starts. You begin talking, and you get an opportunity to learn about random strangers. If you do this enough, you can get a feeling about the type of community you’re coming into.”

At the ballgame, he says, “We met tons of amazing people that were so friendly, and it really made us feel welcome and part of the community.”

Those kinds of conversations can be hard to have when you’re only in town for a day or a few hours. Griffith recommends spending a weekend or at least a couple days if you’re seriously considering a particular area. The more time you spend embedded in a town, the more you’ll know if it’s a good fit. In most cases, you’ll get a gut feeling for a place and be able to tell if you’ll be happy there.

7 Turn to the experts

Mark Siwiec is a real estate agent and associate broker with Keller Williams Realty. He helps 10 to 15 physicians a year relocate to Rochester, New York, for Rochester Regional Health, a major health care system. Many of them fall in love with the community and end up staying to raise their families.

How does Siwiec find homes, neighborhoods and communities his physicians will grow to love? He starts with a phone conversation with the physician and/or their spouse. He tries to find out who they are, what their family is like and what activities they’re interested in.

“If they have kids, [the housing decision] is all about the school district,” Siwiec says. He sets up phone conversations for the parents with local school districts, superintendents or teachers. That way, each family can assess how the various school options fit their children. Many also do research online before visiting.

“But then, there are other considerations,” he adds. If their kids are involved in a particular pastime, parents may choose location accordingly. Once they’ve taken care of the kids, Siwiec says, “Frankly and honestly, everything else falls into place.”

When he’s selling physicians on the area, Siwiec often shows them area landmarks. He might take them to the Wegmans flagship grocery store, health clubs, museums, golf clubs, theatres or art galleries.

Once a physician is familiar with school districts and neighborhoods, Siwiec has a third conversation about other considerations. “If you’re an OB, you don’t want to be 45 minutes from the hospital,” he explains. “You probably need to be within 20 minutes of the hospital.” A dermatologist or pediatrician may not have the same restrictions.

There may also be family activities to take into account. “For Rochester Regional Health, one of the things that I hear often is that they have a lot of people who really enjoy boating, and they want to be near or right on the lake,” Siwiec explains. Others want easy access to ski slopes. These preferences inform the housing hunt.

He adds that many physicians rely heavily on input from colleagues. But this isn’t always the best idea. Each person has their own preferences and opinions. “Everyone’s trying to be very helpful, of course, but you’re going to get six different answers based on the six different towns that the six different doctors are talking about,” Siwiec explains. Their advice usually has little to do with the needs of the physician checking the area out.

Instead, Siwiec recommends talking with experienced real estate agents who can give less biased input. You can often get recommendations from an employer’s human resource department. Or you can ask fellow physicians who they’ve worked with in the past.

8 Make sure you’ll have support

Choosing a community is important. But so is choosing the right work environment. It’s important to ask questions about the practice itself and make sure it’s a good fit. For example, you might want to know some basic details, such as the number of available rooms, the number of assistants on staff, the patient volume, any expected growth or the types of office visits and procedures you’ll be expected to perform.

Griffith says it’s equally important to find out how a practice supports its staff. He asked questions like “Does the practice have enough employees to provide cross cover when a staff member is out?” and “Who responds to patients calling with questions about their medication regimen or an upcoming procedure?”

He also asked about turnover and retention. He wanted to know why the position was available and how long other employees had stayed with the company. Griffith says, “These questions may provide a clue as to how things will be when staff members are out sick and whether people are burning out from a lack of support.”

9 Consider your finances

Another important factor? The money. Bregant says physicians who want to maximize income may be willing to overwork and compromise on location. There’s nothing wrong with that approach, but it may make it more difficult to find a place you love.

Frey says physicians sometimes make inaccurate assumptions about their earnings. This can lead to trouble later. “As doctors, we don’t think about the financial aspects of our career a lot or the right way,” he explains.

At the end of seven years of training, Frey felt burned out with $500,000 in debt and no savings or investments. Yes, he was about to become a high-earning attending, but his situation at the start was stressful.

To reduce that stress, Frey began creating a financial plan. He wanted to build a solid financial future without so much debt hanging over him. He also wanted to own a home and enjoy a life beyond his job.

“I think doctors get this false sense of security because we have a high income that we think will automatically translate to high wealth or an ability to live the life we want the way we want [and] retire when we want, etc.,” he says. “That’s not the case.” If you get used to a certain lifestyle, you’ll have to maintain or increase your income to continue affording it. This can create unnecessary pressure to maximize earnings.

The solution is to crunch the numbers. Once you understand your student loan payments and other debts, you can decide what salary you need to cover those expenses. And you should consider job offers that will help with student loan repayment. After all, it’s hard to enjoy any location or job if you’re burdened with crushing debt.

10 Don’t settle for less

Most physicians used to stay in one place for most of their careers, but that has changed dramatically since the early 2000s. Bregant says, “We started to see a high degree of physicians not tied down [by a practice buy-in or equity].” He explains that these physicians would get through their employment contracts and take time to reflect on their careers. Many realized they weren’t happy. “That’s when they started to make a change,” he continues.

The good news is that no matter where you are, you can always reevaluate. Whether you’re just starting out, mid-career or looking toward retirement, it’s worth it to make the changes that will make you happier.

Because physicians make such a huge investment in their careers, changing jobs isn’t as easy as in other professions. That’s why it’s so important to set yourself up for success from the start. Think about what your ideal life looks like. Consider where you want to live, how you want to work, what kind of schedule you want and what you want to do when you aren’t working. If you can picture that, you can forge a path to a life you love.