Physicians practicing in Manhattan, Kansas, have a different set of day-to-day experiences than those practicing in Manhattan, New York - but each environment is perfectly suited for different types of people.
As you begin evaluating your next career move, what type of community will be your best fit?
Do you need a major metropolitan area for your specialty? Would seeing a wider variety of cases in small-town America be your best move? Or is a suburban practice your perfect fit?
There is no one-size-fits-all answer for everyone. Depending on your own experiences, career goals, outside interests, personal connections and employment offers, you can zero in on the type and size of place that will make you happiest. Because isn’t that what life after residency is all about - finding a place to call home?
For many residents, the search for a place to live and work often starts back where they grew up, whether that was a small town of 500 people, suburbia or a bustling metropolis.
"Where physicians grew up often drives where residents want to practice," observes Linda Gommesen, faspr, a physician recruiter with Metro Health Hospital in Wyoming, Mich. Those raised in a big city often want to end up close to a big city, she has found, while residents who grew up in the suburbs or smaller towns may want a similar upbringing for their own children.
But not always.
John Martin, Jr., M.D., grew up in a small town in the Berkshires of Massachusetts and attended Williams College - also in a small community - for undergrad. Med school at Harvard kept him in New England but introduced him to the pace and atmosphere of a larger city. He loved it.
After four years in Boston, Martin headed to Philadelphia for residency and then applied for a very competitive fellowship in oculoplastic surgery. Only about 20 programs were available at the time, and Miami and Los Angeles were Martin’s top picks.
He accepted the position in Miami and headed south for a 15-month fellowship - but he didn’t expect to stay. At the time, his attitude was, "I can do a year anywhere," and Miami sounded pretty nice for a short assignment. "The availability of outdoor activities anytime was particularly appealing," he says.
Though he enjoyed Miami, he considered a number of opportunities for oculoplastic surgery positions after completing his fellowship. He landed back in New England in Westport, Connecticut, a suburb of New York City. He was close to home and close to a major city, which he thought would yield plenty of plastic surgery patients.
In fact, being so close to New York actually hampered the growth of his practice. "People went in to New York City for surgeries; more plastic surgeries were done there," he found, than in Connecticut, which made attracting clients more challenging. After two years, an opportunity surfaced to return to Miami and Martin accepted. "Westport wasn’t urban living, and I decided I wanted that," he says.
Having experiences in different types of working environments helped Martin recognize the type of place that would make him happy. He needed a larger city where plastic surgery was accepted, even expected, and where he could also enjoy outdoor activities year-round. Miami turned out to be the perfect locale.
Marcela Dominguez, M.D., would have been comfortable in a big city or suburb but knew that a small town wasn’t in her future. Not that a smaller community wasn’t appealing, but Dominguez recognized that she hadn’t had the broad surgical training needed to serve the needs of a smaller community. "People in other programs get training in removing gallbladders," for example, which she hadn’t had as a family practice resident. For that reason, she wanted to join a practice that specialized in serving moms and healthy babies, which she thought she would be much more likely to find in an urban or suburban setting.
Dominguez grew up in the suburbs of southern California and knew from an early age that she wanted to be a physician. She went to high school in San Diego and did her undergraduate work at UCLA in kinesiology. She then intentionally took a year off after college to do something she knew she wouldn’t have the opportunity to do once she proceeded with her medical training and taught fourth grade at an underserved bilingual elementary school.
Med school at the University of California at San Diego came next, followed by residency at Long Beach Memorial. Knowing that she wanted to perform obstetrical care in private practice, she pursued further OB training during residency and became the chief OB resident at Long Beach, taking advanced OB electives at several busy urban hospitals.
During the early years of her medical career, Dominguez began heading to a more holistic approach in treating her patients, moving away from a complete reliance on conventional medicine. During her senior year in residency, she visited several private practices that were available for sale and realized it would be best if she joined a group practice first before going into private practice.
So, after residency, she joined a group practice and stayed there for seven years. She called the move "a confidence-builder." "I wanted to join an established practice first, to confirm that my medical skills were sufficient before I transitioned into opening my own private practice." Working within an established practice gave Dominguez access to experienced doctors who shared "practical pearls" that continue to help her. "I recommend joining a group practice first, for experience," she says.
Confidence built, in 2006 she went into private practice in the suburb of Mission Viejo, California, forming Complete Care Family Medicine.
In 2013, Dominguez switched to a hybrid concierge practice as a solution to a fast-growing practice. She gets regular referrals and is able to provide more personalized care to a more manageable number of patients. "[Patients] get better accessibility" to their physician, she explains.
Dominguez’s decision process included looking for a position that would first give her experience and then later allow her to work and raise a family within five minutes of the beach. Her practice is in a large enough suburb to keep her busy, and it’s not far from the beach and her family’s home.
Dominguez grew up in the suburbs, trained in a larger city, then settled in a community similar to the size she experienced as a child. But Sucharu "Chris" Prakash, M.D., a medical oncologist with Texas Oncology, PA, in Paris, Texas - population 25,000 - followed a different path.
Prakash grew up in a big city in India, went to medical school in India, and then did his residency and a fellowship at Wayne State University in Detroit. He married a Texan who was a big-city girl, but the couple decided a smaller community was more their speed, even though they had never lived in one. Prakash’s wife wanted to be closer to family in Texas, so they moved to Paris after his fellowship. He now says, "We wouldn’t consider moving."
It’s all about finding the right combination of factors that are important to you. For Prakash and his family, small-town life offered many advantages. On the personal side, outdoor activities dominate and traffic is minimal. "It’s a better quality of life," he says.
On the professional side, smaller towns like Paris are good for generalists, he says. "You see a wider range of patients - a broader spectrum of diseases here" than in larger city hospitals and practices where care is "super-specialized." The medical community is very close-knit, and there is more interaction among doctors; "everyone knows everyone." The close proximity builds a bond within the community that is good for doctors. "There is a sense of brotherhood," he says, which would be less likely to occur within a major metropolitan area with millions of residents.
Overall, Prakash says Paris is "slower paced" than Detroit, and that’s a good thing. He sees 20 to 25 patients a day (fairly typical for oncology, he says), and that pace allows him to give each patient more personal attention. Because of the small-town atmosphere and geography, physicians and their patients frequently run into each other outside the office, and those casual connections help build a personal bond.
But life for an oncologist in Paris, Texas, is different than life in Chicago or Dallas.
Each type of community has its own pluses and minuses, depending on what you’re after.
The main differences Prakash sees between large cities, suburbs and smaller towns are the level of specialization and the time available for outside interests.
The larger the community, the more medical specialization there is because the larger population requires it. The pace of life and practice also tends to be faster in general at larger practices and hospitals, which can affect the time you have available for personal interests and pursuits.
Small towns are best for generalists interested in a slower pace, observes Prakash. Patients in need of a specialist are more likely to travel to a major city for specialized care because there simply isn’t enough demand in a town of a few thousand people. That means that patients in need of a generalist receive more personal attention from a physician who knows them personally.
Deciding where to move after residency is about much more than simply choosing a place to live and work - it’s about figuring out what drives your happiness, says Metro Health Hospital’s Gommesen. Deciding what is most important to you up front will lead you to a community that makes you happy to be there.
Some of the questions to ask yourself as you evaluate all the places you could live include:
Asking these questions of yourself, says Gommesen, will help you zero in on job opportunities that are a good fit for you. Recruiters will provide information about the job and the community at-large, but "we rely on you to know what you want in a location," explains Gommesen. And before you accept a position, ask yourself if you can see yourself there, she says. Even if a particular situation meets all your criteria on paper, if you can’t imagine living and working there, don’t take the job.
Most new physicians stay in their first job two to five years, says Gommesen. "They see it as a stepping stone, but it doesn’t have to be that way," she says. If you ask yourself the above questions before beginning the interview process, you’ll save yourself time and will be more likely to land in a location where you’ll be happy long-term, she says.
Listening to what other physicians tell you is important input, but it shouldn’t be the deciding factor. If you’ve made up your mind where you want to live, your challenge is simply finding an open position.
And don’t rule out the possibility of opening your own practice in the near future, even in a smaller market. "Everyone always says the market is oversaturated," says Martin, no matter which town or city you may be headed to. "But there’s always room for one more. It may be slow going at first but you’ll survive…Stick with it if it’s where you really want to be," he says. Because being where you’ll be happy is the most important consideration of all.