Job decision

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  • Avatar folkher0 
    Status: Physician
    Posts: 7
    Joined: 12/22/2016

    I am entertaining a job offer and thought this community might be able to help me. I am four years out of fellowship in a surgical subspecialty.  I am still at my first job. We live in a low cost of living area, my salary is around 300 with excellent benefits.  I’m married with 2 children, ages 1 and 4. I am currently the sole income earner. I drive to work, it takes 20 minutes.  Lots of nights and weekends. Unpredictable. I would describe my job satisfaction right now to be moderate.  Could be better, could be worse. We save around 30% of our gross income each year.

    I am being offered a job in a high cost of living area (think Boston, NY, San Fransisco, etc).  I know and love the people in the practice I would be joining. Its a great professional opportunity, my partner is excited to move, and my kids are not yet in school, so the time is right.  The offer is in the mid 400 range, similar benefits.

    Given the family situation, we will probably live away from the city and/or look into private schools, This may require a 40+ minute commute. Housing costs will increase 4-5 fold (currently rent for $1700 a month).

    I’m a little worried that the salary is too low to pull this off. I really don’t have a great sense for typical salary for my specialty in this market: everyone I know in town is the same practice I would join, and I’m not about to ask them.

    So my choice:

    a. Sit tight. you’re doing fine, don’t rock the boat.

    b. Take the job, you’ll regret it if you pass it up.

    c. negotiate for a higher salary? (what would that salary be)

    d. Some other option…


    #238615 Reply
    CordMcNally CordMcNally 
    Status: Physician
    Posts: 3058
    Joined: 01/03/2017

    Both of those salaries seem low for a surgical subspecialist to me but I’m also not a surgical subspecialist. You really need to obtain good data to compare. With the information given, the best financial situation would be to stay where you’re at but it also looks like you’re underpaid where you’re at.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #238635 Reply
    Liked by EndoRobert, Kamban
    childay childay 
    Status: Physician
    Posts: 1087
    Joined: 01/09/2016

    Yes curious as to the subspecialty.

    Housing costs alone would be an $80k increase in expenses.  Not to mention the commuting, private schools, and all the other increased expenses in HCOL.

    That said, helpful to know the financials but probably not a strictly financial decision

    #238641 Reply
    Liked by Kamban
    Status: Physician
    Posts: 2608
    Joined: 05/01/2017

    One thing I would not discount is that commute.

    20 min to me is about the upper limit before it starts to suck.

    40+ is probably the lower bounds of truly annoying and life-affecting.

    If your #s are correct you’re potentially adding 3 hours a week in your car…

    #238660 Reply
    Avatar mjohnson 
    Status: Physician
    Posts: 64
    Joined: 05/05/2019

    If starting salary is mid 400’s will it go up once you have been there awhile if you make partner, etc?  Also 300 sounds low for a surgical specialty, I would consider asking for more depending on your job situation (employed vs straight private practice).  It would also depend for me if the bad hours on weekends and nights would be the same, increased or reduced at the new job, especially with a longer commute.  I commuted ~ 45 min each way for 2 years of my life in a bigger city, I didn’t enjoy it at all.  It doesn’t sound too bad, but then you have a terrible day and the traffic is horrible.  I swallowed hard at the increase at living expenses, but doable.


    That all being said, sounds like you both are interested in a new adventure.

    #238665 Reply
    Avatar folkher0 
    Status: Physician
    Posts: 7
    Joined: 12/22/2016

    Thanks for the replies so far.  If it helps, I am in academics, and a hospital employee. Field is abdominal transplant/HPB.

    #238668 Reply
    Liked by childay
    Avatar jhwkr542 
    Status: Physician
    Posts: 1338
    Joined: 02/15/2016
    Splash Refinancing Bonus

    The transplant surgeons at my training institution seemed to be making $1MM+ but also doing q3 call.

    Agree, this is less of a financial decision and more of a, “would you be happier here?” decision.

    #238670 Reply
    Avatar Kamban 
    Status: Physician
    Posts: 2577
    Joined: 08/01/2016

    Never heard of a transplant surgeon 4 years out of fellowship making only 300K. That is grossly underpaid, even in LCOL.

    You need to ask for 500K+. I routinely get offers in that range and I am only a medical sub specialist. Look for jobs in LCOL or MCOL that pay $500K+.

    And I did drive 40min+ from NJ to NY and back for 5 years in my residency / fellowship and would never do that again, ever.

    #238683 Reply
    childay childay 
    Status: Physician
    Posts: 1087
    Joined: 01/09/2016
    And I did drive 40min+ from NJ to NY and back for 5 years in my residency / fellowship and would never do that again, ever.

    Click to expand…

    Likewise but different town.  Commuting for long in heavy traffic is terrible and extremely frustrating.

    #238685 Reply
    Liked by Zaphod, Anne, Kamban
    Avatar Anne 
    Status: Physician
    Posts: 1240
    Joined: 11/07/2017

    300k for transplant surgeon?!? I just felt Thomas Starzl roll over in his grave. That is ridiculous.

    Thank you for what you do.

    I agree this is not just a financial decision. You didn’t mention student loans, or how this change might affect career trajectory.

    #238686 Reply
    Avatar Peds 
    Status: Physician
    Posts: 4695
    Joined: 01/08/2016

    Negotiate like crazy

    #238687 Reply
    Zaphod Zaphod 
    Status: Physician, Small Business Owner
    Posts: 6339
    Joined: 01/12/2016

    If you’re going to a practice with people you know and love, and income is going to increase significantly, again, shocked at the level of pay and call/wkends/etc…I’d say go for it. Moderate fulfillment and that pay seems ridiculous.

    Maybe forgo the private school unless absolutely necessary and totally agree about the commute, think about that again. Mid 400s isnt bad (and huge from where you’re at) especially if you’ve got bonus/wRVU type incentives that basically make it a floor with a lot more potential.

    FWIW I recently went to practice with friends/former coresidents and while its employed and there are system/admin type issues as with everywhere, the actual practice part is awesome. Cannot discount working with and enjoying those people and frankly being able to trust them more than your average coworker.

    I’d do it if I were you (and me since i did it), you’ll probably be very happy.

    #238699 Reply
    Avatar EM->CCM MD 
    Status: Physician
    Posts: 82
    Joined: 07/23/2017

    Negotiate your salary. If they want you, they’ll pay you.

    #238707 Reply
    Avatar folkher0 
    Status: Physician
    Posts: 7
    Joined: 12/22/2016

    Thanks again for all the responses. It’s fun to see how people outside the field think we get paid. FWIW, I’m not flying totally in the dark here, our society has a compensation survey that was last released in 2017. It suggests that my current salary is a little low, but not embarrassing. Probably balanced by he low COL.

    FWIW, I’m not a big spender. still drive my old car, rent a house. My priority is on saving money and getting things squared away for my family.

    Transplant is a small field, with few job openings. We tend to be employees of academic hospitals. We are not generally private, though a few are. All this drives salary down.

    The thing is that in places with unusually high cost of living the survey doesn’t give much guidance.

    Appreciate everyone’s thoughts. It’s been very useful.

    #238708 Reply
    Avatar dentoid 
    Status: Dentist
    Posts: 86
    Joined: 02/08/2016

    Why is your compensation so low? How is it in the fly over areas? This is more of a personal decision as once you add in a commute and several kids to private schools + taxes, I’d assume it’s near a wash.

    #238711 Reply

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