[Editor’s Note: Deadline alert! August 31 is the final day you can apply for the WCI Medical School Scholarship, which will give away more than $70,000 to professional students in the US. For all the details of this year’s scholarship (or to find out how you can donate and/or become a volunteer judge), all the information is here. As one former scholarship winner said, “You have impacted my journey in a way that will never be forgotten.” Make sure to apply by August 31 for an opportunity to set yourself up for the start of your financial journey!]
By Dr. Francis Bayes, WCI Columnist
I could not ignore personal finance when I created my residency rank list last year. As I explained in my column about whether MD/PhD was a good financial decision, the opportunity cost of sacrificing clinical time—thereby earning lower income—is the biggest challenge in academic medicine. Meanwhile, my wife’s only requirement was that I match to a program in a city with good Asian food, so most of my programs were on either coast (I invest in my marriage first!). Similar to many memes, the three most important factors for my rank list were family, fit, and finance (in order of importance), but I could not have all three with most of the programs to which I applied.
I had a running rank list throughout the interview season, and the list was divided into three tiers, mostly based on fit. I would have been content to match to the top program of my second tier, whereas I would have been disappointed to match below the last program of my second tier. I started the season with a handful of programs in the first tier, but by the end, I narrowed it down to two programs that I will call Program EC and Program WC.
My most challenging decision was at the top of my rank list. I would have ranked Program EC, which is located in an East Coast high-cost-of-living area (HCOLA), as my first choice without reservations if finance was not a factor. But Program WC—where I would have liked to train even in a vacuum—is located in the West Coast HCOLA that includes my wife’s hometown and is closer to my parents in East Asia. Because family and fit are specific to individuals, I share in this column a list of generalizable financial factors that influenced the top of my rank list.
(I reveal how I weighed the factors at the end.)
#1 Future Opportunities
Based on my mentors’ advice and my impression, both programs would prepare me to become a good psychiatrist and scientist. My mentors advised that Program EC would open more doors—including at Program WC’s institution—than Program WC would. But I have heard from different residents that Program WC was more likely to continue supporting me after residency with or without external funding (e.g., flexible arrangement for clinical time).
I wrote about how I can take advantage of Economic Outpatient Care by seeking once-in-a-lifetime opportunities instead of financial comfort. Regardless of fit, Program EC’s institution is one of the few that attract ambitious physicians and scientists from everywhere, in everything, all at once. This was an opportunity for me to walk the walk.
Verdict: Program EC
More information here:
#2 Average Attending Physician Income
Medicine is one of the few professions in which physician income is higher in LCOLAs than in HCOLAs. According to the US Bureau of Labor Statistics (Table 1), neither California nor Washington state are in the top-five of best-paying states. But San Jose, San Francisco, and Seattle are in the top-five of best-paying cities for psychiatrists (Indianapolis and Kansas City round out the list).
In contrast to West Coast HCOLAs, East Coast HCOLAs such as Boston, New York City, and Washington DC have a mean wage that is 60%-70% of their West Coast counterparts. One possible reason for the difference is that Boston, NYC, and DC are in the top-five of metropolitan areas with the highest employment (i.e., number of psychiatrists). Interestingly, the correlation between the concentration of psychiatrists and the mean wage is weak (< |0.20|), in part because California, Connecticut, and New Jersey pay psychiatrists very well.
Verdict: Program WC
#3 Childcare and Travel Costs
The WCI forum thread on childcare costs was enlightening. My wife’s work is now fully remote, yet she would have to travel for work occasionally. If she switches jobs in the future, not as many jobs may be fully remote. As someone who studied the role of fathers in child development, I will do everything in my power to care for our future child(ren). But despite our best efforts and work flexibility, we would need to pay for backup childcare at some point.
Spending at least $10,000-$20,000 per year, which seems like a conservative estimate in an HCOLA, might be the “cost of doing…
Read More: How Personal Finance Influenced My Residency Rank List