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  • Avatar FIREshrink 
    Participant
    Status: Physician
    Posts: 984
    Joined: 01/11/2017

    Like I said, commute. That’s arbitrage.

    We lived in a town of 35k, county of 100k for eight years. Only an hour to a major airport so not rural, but far enough away that the population was very insular. My wife hated living there. I liked the people, how easy it was to get around. Restaurant scene was dire. Hospital was fantastic people.

    But our main reason for moving was the schools. They just weren’t good enough. Not enough options, not enough families with the same goals and aspirations as us, not enough rigor, too many drugs, too many dysfunctional families. So we moved thirty five minutes away to the “big city.” Wife much happier. I spend a lot of time driving but have to admit our lifestyle is much better. I feel like a carpetbagger but for your kids you’ll do anything.

    So eight years of local, now eight years of commuting. If you can engineer a reverse commute under thirty minutes you’ll be fine. 30-45 minutes is more of a commitment. More than forty-five and I’d think twice. 38 minutes for me and no traffic is fine, just the length of many podcasts.

    #189173 Reply
    Liked by Vagabond MD
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 189
    Joined: 01/02/2018

    Sounds like you’ll end up paying for your kids to go to a private school with a long commute in the rural area. I’d pick the suburb.

    #189190 Reply
    Avatar Panscan 
    Participant
    Status: Resident
    Posts: 1008
    Joined: 03/18/2017

    I don’t understand what people mean when they say “we didn’t identify with the area, it’s just not who we were.” I didn’t know pieces of land had political or social views. Not sure how you just broadly categorize the views of an area. There are numerous people with a multitude of beliefs in any given area, especially in anywhere where there is going to be a prestigious. fellowship.

    It’s funny to me how it’s usually coastal people trashing the Midwest and calling it crappy and making generalizations about the views in the Midwest. If you don’t like an area thats fine but it’s pretty naive to ascribe a certain belief to a whole region. Ive also never understood why the coastal people have this incessant need to trash the Midwest. I have no desire to trash the coastal areas, I can see why people want to live there. It’s their choice, I have no problem with it.

    #189197 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3422
    Joined: 01/21/2016

    Like I said, commute. That’s arbitrage.

    We lived in a town of 35k, county of 100k for eight years. Only an hour to a major airport so not rural, but far enough away that the population was very insular. My wife hated living there. I liked the people, how easy it was to get around. Restaurant scene was dire. Hospital was fantastic people.

    But our main reason for moving was the schools. They just weren’t good enough. Not enough options, not enough families with the same goals and aspirations as us, not enough rigor, too many drugs, too many dysfunctional families. So we moved thirty five minutes away to the “big city.” Wife much happier. I spend a lot of time driving but have to admit our lifestyle is much better. I feel like a carpetbagger but for your kids you’ll do anything.

    So eight years of local, now eight years of commuting. If you can engineer a reverse commute under thirty minutes you’ll be fine. 30-45 minutes is more of a commitment. More than forty-five and I’d think twice. 38 minutes for me and no traffic is fine, just the length of many podcasts.

    Click to expand…

    This is one major reason why small towns in rural areas have trouble attracting docs. Yeah, the money is good, and the cost of living is low, but many docs come from urban/suburban backgrounds and med schools tend to be located in big cities or college towns with good restaurants, parents focused on educating their children, a decent amount of diversity, sports/cultural opportunities, etc. At some point, we are all exposed to these attributes and come to expect them.

    My wife and I have talked about taking the next phase of our lives into a smaller mountain or lake town. I have realized that there are two specifics that we require, within 30-45 minutes:

    1. A synagogue – we are Jewish and while not especially observant (I worship at a synagogue a couple times per year), it is a marker for an area that accepts Jews and, more generally, some level of diversity.

    2. A Whole Foods (or similar) – we spend more time at Whole Foods than at the synagogue 😉 . We certainly do not do all of our food shopping there, perhaps twice a month, but it is again a marker for an area that can support healthy and higher end food options and likely other higher end dining (beyond fast food and chain casual).

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #189198 Reply
    Liked by Hank, Anne, Moomoo
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3422
    Joined: 01/21/2016

    I don’t understand what people mean when they say “we didn’t identify with the area, it’s just not who we were.” I didn’t know pieces of land had political or social views. Not sure how you just broadly categorize the views of an area. There are numerous people with a multitude of beliefs in any given area, especially in anywhere where there is going to be a prestigious. fellowship.

    It’s funny to me how it’s usually coastal people trashing the Midwest and calling it crappy and making generalizations about the views in the Midwest. If you don’t like an area thats fine but it’s pretty naive to ascribe a certain belief to a whole region. Ive also never understood why the coastal people have this incessant need to trash the Midwest. I have no desire to trash the coastal areas, I can see why people want to live there. It’s their choice, I have no problem with it.

    Click to expand…

    Yeah, it’s costal elitism. I think it’s always been there, but the current red/blue political environment has made it more pronounced.

    On a couple recent vacations, I have mixed with folks from New York and California, and they have viewed me, living in a 2.5M+ population center in the Midwest, as an oddity, asking me questions as if I lived in a third world country.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #189200 Reply
    Liked by NaOH, FIREshrink
    Avatar SValleyMD 
    Participant
    Status: Physician
    Posts: 450
    Joined: 05/12/2016

    “There are numerous people with a multitude of beliefs in any given area”

    Yes in the “Midwest” that is the case. You can obviously find pockets. But what some including myself are trying to state in the thread as a warning for others is that’s not nearly the case at all in many rural areas (which is pretty obvious). It’s more of a warning post for those chasing the $$ of the challenges they’ll likely encounter.

    Last week my 3rd grader asked if I wanted to buy a raffle ticket to their school fundraiser.. When I asked what the prize was, she said “um, I think a gun”.. I laughed.. “No sweatheart, you’re elementary school isn’t raffling off a gun.” She then pulls out the flyer and the top prize is a picture and description of a 9 mm Glock. Now I own guns and my FIL owns a gun range so I’m not some anti gun bleeding liberal but obviously I felt that’s kind of a bad look to be giving 1st graders flyers for a gun raffle in a school sanctioned event. Well, my wife brings it up at the PTA meeting and everyone scoffs and laughs at her..  We just laughed afterwards because it was just weird to us.

    So, I promise you that in some of these regions that already have a low population/selection to start with that you’ll find very, very, very little in common w/ nearly everyone. So that can be a challenge for your kids and spouse to find friends (and for the record, I wouldn’t want my kids going to the Menlo school for the same reason)

    Now, most docs here don’t care. It selects for either two types: 1) a doc who sees the $$ and comes here to work really, really hard to maximize that or  2) a doc on the end of the rope where he (our shes here are great) burned bridges everywhere else and this is his last shot.

    In nearly every case I see, the docs that leave (and many do) almost to the man leave because their spouse just never fit in. And that’s not a knock on MAGA America or some elitist docs from NYC. It’s just the reality and obviously why the $$ is often dangled to get you to bite.

    #189232 Reply
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6063
    Joined: 01/12/2016

    I don’t understand what people mean when they say “we didn’t identify with the area, it’s just not who we were.” I didn’t know pieces of land had political or social views. Not sure how you just broadly categorize the views of an area. There are numerous people with a multitude of beliefs in any given area, especially in anywhere where there is going to be a prestigious. fellowship.

    It’s funny to me how it’s usually coastal people trashing the Midwest and calling it crappy and making generalizations about the views in the Midwest. If you don’t like an area thats fine but it’s pretty naive to ascribe a certain belief to a whole region. Ive also never understood why the coastal people have this incessant need to trash the Midwest. I have no desire to trash the coastal areas, I can see why people want to live there. It’s their choice, I have no problem with it.

    Click to expand…

    Yeah, it’s costal elitism. I think it’s always been there, but the current red/blue political environment has made it more pronounced.

    On a couple recent vacations, I have mixed with folks from New York and California, and they have viewed me, living in a 2.5M+ population center in the Midwest, as an oddity, asking me questions as if I lived in a third world country.

    Click to expand…

    I think most cities are the same. Odd that NY and CA people have acted that way. On the other hand, it would not be true to say that areas arent completely different and sometimes very at odds with your values. I dont think this has anything to do with coastal vs. midwest, but is really urban/rural.

    So I did come from west coast to tx, and from LA to a town of about 60k and the differences were stark. Politics in your face all the time whereas in LA most people I never saw caring at all, which is pretty typical LA about anything (did you know we had a team in the Super Bowl?). People constantly asking about church/family/etc…to the point you tried to avoid people or getting cornered, etc…Hoping this town was a little extreme, and being a resident and a bunch of my staff being the offenders it definitely made it feel less reasonable. Some of these places can be pretty homogeneous and that extends to activities, beliefs, and politics.

    The same is true even in places like CA, get out of the cities and into the smaller forgotten towns and you might be shocked. Of course more likely to keep it to themselves, but its there.

    Most of the time if I can mind my business and you do the same I dont think it matters. Moving back to new midwest small town area myself so its not like its enough to deter me from an opportunity but it can exist.

     

    #189234 Reply
    Liked by Kamban, Anne
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1104
    Joined: 11/07/2017

    I don’t understand what people mean when they say “we didn’t identify with the area, it’s just not who we were.” I didn’t know pieces of land had political or social views. Not sure how you just broadly categorize the views of an area. There are numerous people with a multitude of beliefs in any given area, especially in anywhere where there is going to be a prestigious. fellowship.

    It’s funny to me how it’s usually coastal people trashing the Midwest and calling it crappy and making generalizations about the views in the Midwest. If you don’t like an area thats fine but it’s pretty naive to ascribe a certain belief to a whole region. Ive also never understood why the coastal people have this incessant need to trash the Midwest. I have no desire to trash the coastal areas, I can see why people want to live there. It’s their choice, I have no problem with it.

    Click to expand…

    Yeah, it’s costal elitism. I think it’s always been there, but the current red/blue political environment has made it more pronounced.

    On a couple recent vacations, I have mixed with folks from New York and California, and they have viewed me, living in a 2.5M+ population center in the Midwest, as an oddity, asking me questions as if I lived in a third world country.

    Click to expand…

    I don’t think it’s coastal elitism.  More like provincialism.  Trust me, I can show you plenty of places on both the west and east coasts where rednecks abound.  (I come from a long lineage of rednecks on one side…sorry if anyone takes offense to me saying that).  The same is in other countries–rednecks are rednecks everywhere.  Or, as my in-laws said when they came to this country and saw the behavior that they thought was unique to the rural folk in their country “todos pueblos son los mismo”  (in addition to being the word for small town, pueblo is also a term that has the same connotation as redneck where they are from)

    Some people in New York or other big cities suffer from provincialism too.  They rarely leave the city and think nothing compares to it and thus are narrow-minded, just in a different way.  They’ll be in the middle of the Oregon rainforest and all they can do is complain that you can’t get a decent bagel around here.

    My husband has an accent but his English is perfect.  He has no problem in cities or towns but whenever we go to a rural area in the U.S. suddenly nobody can understand him and talk to him like he’s a deaf 4 year old.  We’ll be at a diner and he’ll say “I’ll have the oatmeal with a side of 3 scrambled eggs” and they’ll look at me to translate and then talk extra slow to him.  He has a good sense of humor about it–sometimes he’ll just start talking German or French if it gets too absurd, but it really is annoying.  We couldn’t live with that on a daily basis.

    Not all rural areas are created equal.  I think Jackson WY and Aspen CO would both qualify as rural based on one of the previous definitions someone laid out here, and I could be persuaded to move to either if you twisted my arm enough.

    #189252 Reply
    Avatar Doc Spouse 
    Moderator
    Status: Small Business Owner, Spouse
    Posts: 203
    Joined: 10/20/2017

    I’ve talked a bit about this before, but I think it depends on what you’re looking for, and it’s important to do a few moments of self-reflection to figure out what that is.

    If it’s important for you to live in a place where everyone thinks like you, acts like you, and speaks like you… then you definitely need to look for places where you know that’s going to be the case.  That random rural spot that you’ve never heard of?  Yeah, there’s something that’s going to be very different than what you’re used to.  Some of it may be stuff you don’t like, or agree with.  If you can’t handle that, then it’s better for your long-term happiness that you pick somewhere else.

    People are tribal.  We aren’t that evolved from our evolutionary roots, no matter how much we try to tell ourselves differently.  Most of us find comfort in the familiar.  If your familiar is a place where everybody has the same color skin as you, same accents as you, same beliefs, and same food tastes as you, then you’ll find comfort in other places that share these traits.  On the other hand, if your familiar is a place where everyone has different color skin, different accents, different beliefs, and different food tastes, then you’ll find comfort in similar places, and the places where that isn’t the case will give you a sense of discomfort.

    Caps for this next part – JUST BECAUSE YOU LIKE ONE OVER THE OTHER DOES NOT MAKE YOU A BETTER OR WORSE HUMAN BEING THAN SOMEONE WHO FEELS DIFFERENTLY.

    Coastal elitism, and the rural hatred for city-slickers, is all part of the same character flaw as far as I’m concerned.  At its root, it’s tribalism. It’s the same issue that gives us racism, class warfare, and hyper-politics.  We like to belong to a tribe and some of us like it entirely too much.

    Looping this back around to your question OP:

    Do some self-reflection and know what’s important to you.  Push that out 10 years and try to figure out if there’s things (like schools for FireSHRINK, or a Synagogue for Vegabond MD) that you don’t necessarily need right now, but may in the future.

    As MPMD said, crime statistics are hard to gauge a place by.  I wouldn’t automatically rule it out because of that.  Same goes with poverty rates.  Most rural places will have higher poverty rates than cities and surburban areas.  Salaries are usually lower (physicians’ pay not withstanding) in rural areas, but COL is usually lower, too.  Most rural communities are also pretty close.  Everybody knows everyone from church, kids school (since there may only be one school), etc.  That can be a disconcerting shift (as Zaphod pointed out) if you come from a place where people may not know their neighbor, let alone someone from a street down.

    In person visits are handy for this kind of thing.  You’ll get a better idea and feel for what it’s actually like there.

    #189271 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 2843
    Joined: 09/18/2018
    “we didn’t identify with the area, it’s just not who we were.”

    Click to expand…

    Whoaaa! Different does not mean better.  At a minimum population density has a huge impact as much as the total population.  When you mix in the regional differences it gets even more complicated. Pace and how life is lived is just “different”. Not to pit regions, a large state university to a small university is just different. Small town Tennessee, Wyoming vs Illinois or Texas are different. It can be small things. If the major community spirit thing is the high school football and you don’t like football you probably won’t care for small towns in Texas! No offense to high school football in other states.

    #189297 Reply
    Liked by Zaphod
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 1963
    Joined: 01/15/2017

    Yeah, it’s costal elitism. I think it’s always been there, but the current red/blue political environment has made it more pronounced.

    On a couple recent vacations, I have mixed with folks from New York and California, and they have viewed me, living in a 2.5M+ population center in the Midwest, as an oddity, asking me questions as if I lived in a third world country.

    Click to expand…

    Being in Sunny San Diego – you’ll be surprised on how many transplants are here.

    #189395 Reply
    Liked by Hank
    CM CM 
    Participant
    Status: Physician
    Posts: 1143
    Joined: 01/14/2017

    I just want to take this opportunity to renew my long-standing objection to calling working in an LCOL area, “geographic arbitrage”.  If you are living and working in the same place it is not arbitrage in any actual sense of the word.

    Lots of non-medical financial bloggers talk about geographic arbitrage, but they generally use the term correctly.  Normally they are describing people that work remotely for a American company from a LCOL area (that is normally overseas).  In this case, they are being paid an American salary while living an inexpensive life in Asia (for example).  So there is an actual arbitrage of sorts taking place.

    That’s not what is going on when a doc decides to both live and practice in a LCOL area.

    Anyway, I realize I’m fighting a losing battle here, so carry on.

     

     

    Click to expand…

    I feel your pain — every time someone says, “It begs the question,” when that someone means, “It raises the question.”

    https://en.wikipedia.org/wiki/Begging_the_question

    Begging the question is an informal fallacy that occurs when an argument’s premises assume the truth of the conclusion, instead of supporting it. It is a type of circular reasoning: an argument that requires that the desired conclusion be true. This often occurs in an indirect way such that the fallacy’s presence is hidden, or at least not easily apparent.

    The phrase begging the question originated in the 16th century as a mistranslation of the Latin petitio principii, which actually translates to “assuming the initial point”.[1] In modern vernacular usage, “begging the question” is often[2] used to mean “raising the question” or “dodging the question“.[1] In contexts that demand strict adherence to a technical definition of the term, many consider these usages incorrect.[3]

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #189398 Reply
    CM CM 
    Participant
    Status: Physician
    Posts: 1143
    Joined: 01/14/2017
    Earnest refinancing bonus

    Moving back to new midwest small town area myself so its not like its enough to deter me from an opportunity but it can exist.

    Click to expand…

    ..

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #189400 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1104
    Joined: 11/07/2017

    Yeah, it’s costal elitism. I think it’s always been there, but the current red/blue political environment has made it more pronounced.

    On a couple recent vacations, I have mixed with folks from New York and California, and they have viewed me, living in a 2.5M+ population center in the Midwest, as an oddity, asking me questions as if I lived in a third world country.

    Click to expand…

    Being in Sunny San Diego – you’ll be surprised on how many transplants are here.

    Click to expand…

    When I lived in San Diego, I met multiple people (who were forced to be there by the military, poor souls) who would grumble about how much they disliked San Diego and couldn’t wait until they could move back to Nebraska or whatever.  And the housing allowance there was plenty generous, so it wasn’t just the high rent cost.

    I guess people just like what they like.

    (btw, I’ve heard great things about Omaha and hope to visit someday–my favorite vegan cookbook author has a restaurant there–so this isn’t a knock against Nebraska!)

    #189402 Reply
    CM CM 
    Participant
    Status: Physician
    Posts: 1143
    Joined: 01/14/2017

    Now, most docs here don’t care. It selects for either two types: 1) a doc who sees the $$ and comes here to work really, really hard to maximize that or  2) a doc on the end of the rope where he (our shes here are great) burned bridges everywhere else and this is his last shot.

    Click to expand…

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #189404 Reply

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