Where to practice medicine

Deciding where to practice medicine is exciting. But it can also be fraught with uncertainty.

Some physicians are laser-focused on moving to a specific area or returning to familiar surroundings. For others, the decision is a rollercoaster ride—fluctuating daily as their search zigzags all over the map.

Whether you want to return home or spread your wings, surprises aren’t welcome during a relocation. And you want to end up somewhere you love. That’s why it’s important to define your career goals and your personal preferences. That way, you’ll find a place you and your loved ones will all be happy.

Part 1: Launching your career

Professional opportunities are a major factor in choosing where to live. What’s at stake with this choice varies greatly from one physician to the next.

Your colleague may be thrilled to work for a prestigious trauma center in the heart of a major city, while you may be drawn to serving families in an underserved rural area. No one direction is better than another. The best answer is finding what feels right to you.

Where are the best opportunities for you?

One perk of going into medicine is that doctors are needed everywhere—from the frozen banks of Alaska to coastal resort towns in Florida. Even so, understanding supply and demand can help you identify which areas may offer more opportunities.

Because of the ongoing physician shortage in the United States, demand for physicians is expected to remain high—even more so in some states than in others.

According to a 2020 report, California, Florida and Texas are predicted to have the greatest physician shortages over the next decade. And Mississippi, New Mexico and Louisiana are predicted to have the largest shortage ratio (measured by the number of physicians per 100,000 residents), while Massachusetts, Vermont and New York are predicted to have the smallest. By 2030, 34 states—most of which are in the South and West—will be experiencing a significant lack of physicians.

Going where the opportunities are is always a good idea, but there are other factors to consider, such as the type and size of practice where you’d prefer to work. All states offer a variety of practice types: urban or suburban hospitals, rural clinics, large and small practice groups, independent practices and academic centers.

Knowing what you’re interested in will help you target states with a high demand for doctors—and an ample supply of the type of job you want.

You should consider also where the demand is highest for your specialty. Each state’s needs vary depending on the age of their residents, seasonal population fluctuations, common ailments and injuries in the region, etc. Most specialties are almost always needed, but some are more in demand in certain areas than others.

Do you need to be in the office?

Traditionally, living near your employer has been the norm, but recent changes have given doctors newfound flexibility. Telehealth visits and remote patient monitoring were on the rise even before the COVID-19 pandemic.

In the American Medical Association’s February 2019 survey, 28 percent of physician respondents said they were using some type of virtual platform, up from 14 percent in 2016. Once the pandemic hit, this figure jumped to 60-90 percent.

Like many others, Russell C. Libby, M.D., founder and president of Virginia Pediatric Group, embraced telehealth when the pandemic shuttered offices across the nation. He set up a workspace at his cabin in the Rocky Mountains, where he says he continued working and seeing patients as often as he made himself available.

“Patients love telemedicine,” says Libby, who predicts that continuing to offer virtual medicine will help practices remain competitive. “The platform for a televisit is convenient for both doctor and patient. There are fewer no-shows and more reliable follow-ups. It keeps patients more involved in their care, something important when we think about value-based care.”

And virtual medicine doesn’t just benefit patients. It also increases physician quality of life. “To be able to get up in the morning, review my schedule and be prepared for the day without travel or office clutter is wonderful,” says Libby.

As you think about where to live, consider if and how virtual medicine fits. After all, if this is an option, it can greatly expand your location choices.

What’s your financial situation?

Affordability will always be a major factor in choosing where to live. You may not yet know your future salary, but you should have a ballpark idea based on your specialty and experience.

Start with this figure and add in the other pieces of your own puzzle, such as student debt, financial obligations or recurring expenses like daycare or transportation. This should give you a rough idea of your financial comfort zone.

According to Medscape, the 10 highest-paying states for physicians are Kentucky, Tennessee, Florida, Alabama, Utah, Ohio, Oklahoma, Indiana, North Carolina and Georgia. But salary alone isn’t a complete picture.

The typical cost of living varies widely from place to place. A high salary may be quickly depleted in a city with steep rent and transportation costs, while a lower salary may go farther in a more affordable rural area. Consult a cost-of-living calculator to compare the different regions you are considering.

A real estate agent can save you time and research by helping you understand how far your money will go in a certain area. They have valuable insider knowledge about their communities—and how where you live will affect your budget. Seek out agents with experience in any of the areas you’re considering. They’ll be happy to send you information, set up a call or even provide a video tour of some homes in your price range.

Did you dig beyond the surface?

A job change is a busy season, and it can be hard to find time to research and think things through. But this is time well spent. Slow down and thoroughly investigate every area you’re considering. After all, a place may look great initially but seem very different once you dig deeper—or vice versa.

“It’s a common mistake to not do enough research but just jump into an unknown environment,” says Vonne Jones, M.D, an OB/GYN in Houston, Texas.

Thankfully, it’s easier than ever to gather information about an unfamiliar location. Scour the internet for regional forums and social media pages. Check in with alumni groups or medical associations. And explore local resources, such as a chamber of commerce, real estate agents or community centers. You can also chat with trusted colleagues. Until you ask, you never know who might know someone else in the area.

Are you on an unrealistic quest for perfection?

You might already be picturing the perfect job in your head. Visualizing it might have helped you get through medical school. That’s no small thing. Even so, don’t make the common mistake of focusing too narrowly on your predefined vision. California-based surgeon Dagny Zhu, M.D., says doing so can come at the expense of professional growth.

“You may waste time looking for the perfect match and lose out on other valuable opportunities,” she explains, noting that your first job doesn’t have to last forever. Experts estimate roughly half of new physicians will leave their first job in under three years.

That’s why Zhu gives this advice to younger physicians: “Take what is best at the moment, build your confidence and skill set, and get established. Then move on when the opportunity arises.”

Is your idea of the perfect match limiting your options? It may be time to take a fresh look at that vision, decide what’s still important to you and what you may need to reevaluate. “Let go of some of your checkboxes, some of the smaller things. Don’t be afraid to take risks,” Zhu suggests. Try sorting your priorities into must-haves and nice-to-haves. As you do, you may discover some of the priorities you’ve been clinging to for years have shifted.

Part 2: Nurturing your non-professional side

You’re probably thrilled to start practicing on your own, but as you enter the next phase of your life, remember that you’re more than just your job.

Your hobbies, personal tastes and interests may have been placed on hold while your education and career took priority, but these things are important to your long-term happiness—as are your family’s interests. And no matter what stage of life you’re in, their input is important for your next career move.

What are your family commitments?

For Zhu and her husband, family ties helped to steer their direction. “My husband and I met while we were attending school in Boston but were both from Southern California. Fortunately, we had a common objective to return to that area to be able to care for our parents and to raise our children around family,” she recalls.

Once they’d identified their target location, Zhu looked for jobs with best growth potential. “We were focusing on long-term opportunities because we both planned to stay in that area,” she explains.

Thinking about your loved ones and how your move will affect them is critical. If a partner will be moving with you, listen to their thoughts and give equal weight to their commitments, career aspirations, educational needs or other priorities.

“You want to be on the same page with your spouse or loved one,” says Jones, recalling the story of a colleague who kept up a long-distance relationship while one partner was in New York and the other in Los Angeles. They eventually settled together in New York, but the time before this move was difficult. “If you can’t agree, try to compromise,” she suggests. “If it’s a training program or fellowship, you might both agree to do this now and then do what your significant other needs after.”

Issues rarely resolve themselves, so resist the temptation to plow ahead despite a difference in opinion. It’s best to clear up any disagreement before decisions are cast in stone. Remain open-minded and keep working together until you reach a solution you’re both happy with.

Even family members outside your immediate household might influence where you choose to live. If you and your spouse are close to extended family, it’s best to discuss how far away you’re willing to live and how you’ll stay in touch. Consider travel time, nearby airports or train stations, and whether or not you’ll be able to set up a spare bedroom in your new home.

It may feel like you’re balancing a large list of priorities once you’ve taken all of this into account, but it’s data worth collecting. You’ll be happier and more able to focus if you and your loved ones are satisfied with the move.

Where are you when you aren’t working?

Have you ever vacationed somewhere and daydreamed about staying there permanently? This may be telling. Think about the places you’ve loved visiting, then consider what about these destinations appealed to you.

“Yes, you’ll be busy with work, but you need enjoyment. It’s important to establish a work/life balance. We’re not taught that in medical school, but you need to make sure you don’t get bogged down with work and burn out,” says Jones.

Recreational outlets can help protect you from burnout, so take a good look at what will make you and your family happy. Then give those factors plenty of weight in your search. For example, Zhu and her husband wanted to live near lots of dining opportunities. “We’re both foodies,” she says. “We wanted to live where we could easily get in and out of areas with a variety of restaurants.”

Consider what else makes you feel comfortable and at home. Issues you might not consider at first can majorly impact your happiness, so study up on the area: education levels, crime rate, demographics, political leanings, economic factors and more. And don’t forget about the weather. Spending years in a climate you find unappealing can be emotionally draining.

You likely put a lot of thought into defining your dream job. Give the same time and consideration to identifying the ideal area and community for you and your family.

What might change in your personal life?

Unforeseen events can send your life in a new direction at any time, but other changes are at least possible to anticipate.

Consider which of the following you might expect to face in the next three to five years: getting married (or divorced), caring for extended family, having kids, repaying debt, etc. Determine how these factors affect where you’ll want to live. For example, if you have small children you’ll send to public school in a few years, you’ll want to choose a town with a good school system.

It’s also wise to prepare for the unexpected. This means different things to different people. Maybe you prefer an area with ample job opportunities in case you want to make a change later. Maybe you want to live within a day’s drive of your extended family. Consider what safety nets are important to you and prioritize them as you make your decision.

Choosing where to live isn’t a small decision. And even after spending hours in self-reflection, making lists, compiling spreadsheets and having long conversations with your loved ones, there are no guarantees. Even so, don’t despair.

Every experience is just another opportunity to grow, and many physicians bounce around a bit before putting down roots. The next decade is projected to have strong employment prospects for physicians, so now’s a good time to explore and experiment. Eventually, you’ll land somewhere you and your family are excited to call home.