Big City vs. Small Town. What is Right for You?

Big City vs. Small Town. What is Right for You?

At DaVita Source we receive quite a few inquiries from fellows and practicing nephrologists who are looking for a first time job or a career change. Each inquirer usually has a specific location in mind and more often than not, it is in a large metropolitan area or within easy reach of one. Popular cities include: New York City, Houston, DC, Dallas, Tampa, Atlanta, San Francisco, Los Angeles and Chicago. We understand why physicians want to be there – lots to do, cultural diversity, international airports, the list goes on. However, there are plenty of reasons one might not want to be in a big city and plenty of reasons why a more rural location can be very appealing. This is what we’d like to share with you in this post – some food for thought on Country Doc vs. City Doc.

First and foremost, big cities typically mean low salaries. High competition for available positions drive the starting salaries down making both the short and long term incentives considerably less than you might find in a small or mid-size market. Additionally, this increased competition drives the candidate criteria up and practices may be looking for niche characteristics like fluency in a specific foreign language or those who trained locally and already know the referring physicians. Other factors to consider are the challenges in building or growing a practice in a market where there are numerous options for patients and long-established referral relationships. Not to mention the cost of living like property tax, private schooling, commuting costs, paying for a parking space… Small fish in a big expensive pond. See where we are going with this?

Read on for just a few key considerations to keep in mind before totally ruling out that small town job opportunity.

1. There’s less competition in a small town.

In larger cities it is not uncommon for positions to be filled without any advertisements ever being posted. Major cities typically have fellowship programs and most hires come directly from those programs. There is usually intense competition among local fellowship programs and outsiders rarely get consideration without an insider contact. In a smaller city, and even a mid-sized one, there is less candidate competition and practices must try harder to attract applicants. There is also less competition for patients and referrals if you are the only nephrology practice within a 50 mile radius. It can be far easier to grow a practice and establish yourself and your professional reputation in a smaller town than to be the new anonymous face in a city of millions.

2. Salaries and incentives may be more generous.

Since a small town location may not be as exciting as a shiny big city, practices will use other means to attract the attention of quality candidates. Salaries can be 20-30% higher, if not more. Incentives may include student loan repayment, sign-on bonuses and relocation assistance. How is this possible? The practice may have higher revenues being the only group in a particular area, offering them more expendable income than a city practice with high overhead. In some communities, a local hospital may be willing to provide financial support as well because adding a new nephrologist to the community may also benefit their patients.

3. The cost of living is often a great deal lower.

Sure, living in sunny (sometimes smoky and sometimes rumbly) Los Angeles sounds like a good idea, until you look into purchasing a home for your family and realize you can’t purchase anything decent for under $1M in the area you wish to live. In most rural and mid-sized cities you can purchase a well-constructed, generously sized home usually for half the cost. In a small town, if you take into account the larger salary and the lower cost of living, you can really start doing things like paying off your medical school debt, traveling or saving for your kids’ college account. You can also save time. In LA it can take you 30 minutes to drive a few miles. The less time in your car, the more time seeing patients or relaxing with your family and friends. Schooling can also be a HUGE consideration. Usually public school options are of much greater quality in suburban and smaller towns than in the inner cities. Private school costs in any major city can be a major budget buster.

4. The sense of community and belonging.

Many small and mid-sized towns have a great sense of community and identity. You can get to know your neighbors, your kids’ teachers, and your patients on a more meaningful level. Living and working in a small town can provide a sense of safety for raising a family. Physicians tend to be held in high regard in smaller communities and neighbors look out for one another. Want to be a softball coach on the weekends or start up a chess club at the local library? Much easier to do in suburbia. There is a reason that many people raised in small towns never want to leave!

Another huge consideration when comparing City vs. Country is “how happy will my spouse and family be if I move them to XYZ?” Physicians often find that smaller cities actually mean more financial security and more freedom and sense of place for their families. City living definitely has advantages when it comes to international cuisine and cultural diversity, but many smaller towns may pleasantly surprise you. America is a great melting pot of cultures. There are beautiful, diverse and progressive smaller communities all over the country waiting for a new nephrologist to come home and put down their own roots. Something to think about.

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