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I have been made a fantastic financial offer, but the location is not where I want to live. What do I do?

I have been made a fantastic financial offer, but the location is not where I want to live. What do I do?

I have been made a fantastic financial offer, but the location is not where I want to live. What do I do?


This is a tough one.  What is important to you as a physician and as an individual or part of a family?

Is it money? If so, realize, a general rule of thumb is that rural jobs pay more.  Also, jobs in some metro areas pay more than other areas.

Why?  A couple of reasons.  One is the simple law of supply and demand. If the insurance companies want to provide medical care for the patients, they have less room to negotiate the rates paid to the physicians for the services if there are fewer physicians available to provide the services.  It’s not usually a good option for an insurance company to provide insurance to patients without providing doctors on a panel for the patients to see. 

In larger metro areas, the insurance companies are in control.   More physicians are available for the insurance companies to negotiate rates and it puts pressure on the physicians who want to live in the areas to accept the lower reimbursement rates.  In addition, there are complications regarding hospital negotiations with the insurance companies, and the expectation that the physicians providing services to the hospitals would accept the rates the insurance company is willing to reimburse the physicians.

Typically, a physician in a major metro area will earn the same amount of money as another physician in the same specialty with the same volume doing the same procedures if that physician is in a solo practice with an equal amount of overhead expense. Why? Because the insurance companies have fixed reimbursements, and they do not magically pay one physician more than another if there are plenty of other physicians in an equal specialty in the same geographic area willing to accept their reimbursements.

What is the variable here? The variable is the ownership and management of the practice.  How expensive is the office overhead?  Is the practice utilizing Advanced Practice Providers to leverage the time and income of the practice?  How much profit is going to the partners or the corporation that owns the practice?  Does the practice have a premium location with premium rent and facilities?  The latest and greatest equipment?  How about a referral network? Would you have a built-in patient base from a long waiting list of new patients, or from a retiring physician or are you expected to build your own patient base?

How competitive is your specialty for your area? What are you expected to do to build your patient referral network? Will the practice be sending out marketing material to introduce you to patients and other physicians in the area, or are you expected to make dinner invitations and join local PTA and religious organizations to introduce yourself to the members of the communities?

If you are expected to join a practice with a low existing patient volume and a big guaranteed paycheck, how much time do you have to build your practice before your employment does not make sense financially?  Ask.

If you are open to going to a more rural area there are other factors to weigh that may help balance your decision.  Will the increased compensation make up for the lack of immediate proximity to a professional baseball game, or live theater.  Are there inexpensive weekend flights to the city of your choice, or is it a short drive?

If you have been offered a position an hour or two away from the “city”, the amount of money you will earn should exceed the cost of an occasional weekend in a hotel with your partner enjoining the city. If the amount of compensation is not significant enough to provide the opportunities to enjoy what you want, plus some, why would you consider it?  If the compensation and the hassle of buying a weekend or two away occasionally are more than enough to make up the difference, why wouldn’t you take the job, at least for a set period of time?

Okay, okay.  It’s not all about the money.  It’s about family, kids, schools, your day-to-day environment.  After years of recruiting physicians, here’s what I can tell you with no uncertainty; only you know what is the most valuable to you, and most of the time there are reasonable solutions that will meet your needs and your family or partners needs and they may not be perfect, but in the end, it works.  Don’t sweat it.  No matter what, taking a job, moving to an area, or changing careers all together is just a journey to something better, and usually a learning experience.

My old business Partner, Kenny Hayman used to say, “when one door closes, another door opens.”  To this day it remains one of my favorite clichés.