My decision to move from New Orleans (Nola for those in the know) to California (Cali) was not an easy one. We loved living in Nola and my job was pretty good. We had a good social network. Things were pretty good. Therefore, to come to a decision about whether to move my wife and I started a SWOT list.
If you are not familiar with a SWOT it is a document where you place Strengths, Weaknesses, Opportunities, and Threats (SWOT). It’s a good way of getting all of your thoughts in one place and hopefully making an informed decision. My old boss (from the job I left) recommended I write down my reasons for leaving so that a few years from now I can look back and see if it was the right decision.
I think taking time to reflect prior to any major life decision such as a job switch, a move to another part of the country, or deciding to retire early deep is key. The SWOT allows you to do this and forces you to write down your reasons.
A year goes by quick
Well it has been a year since I have made the SWOT and almost a year since I moved (June 2016). I thought it would be a good reason to revisit, while introducing the concept of a SWOT to anyone unfamiliar with it.
Below is our original SWOT regarding our move and in italics how I believe it has turned out. The new California based job versus the old Nola based job. We also assessed things like schools, city versus suburban life, etc. Today I analyze if our decisions ended up positive, negative, neutral, or to be determined. Take a look and let me know your thoughts.
- The new Cali based job is not an RVU based model. This has been a great switch. While there was no pressure in my old job to order tests, it was always in my subconscious. The need to see people to produce revenue. Now there is no pressure to order tests or see people in clinic when a phone call will suffice. This improves the efficiency for both the clinic and patients, while decreasing physician burnout. Assessment: Positive.
- Moving to Cali will lead to increased overall revenue in the form of a higher salary, lower cost of health care/insurance, higher 401K match, ownership in the practice, and a defined retirement plan (a.k.a: a pension). These were all big reasons to move to Cali. I joined the Firm! (https://www.youtube.com/watch?v=JzH1Z17c4yc) So how has it worked out. Higher pay- check! Lower health care costs- Check, I think we have spent $50 all year compared to $13K last year. Higher 401K match- Check! I finally worked long enough to start earning the match and it is already paying dividends (get it….because I invested them in stocks).Ownership in the practice- Not check yet. I am 2 years away from partnership and will have to dish out some $$$ to buy the shares, but from what I can tell it will be worth it. A pension. Check! 10 years to vest and who knows if it will be here when I turn 65 years old, but I like the possibility of it. The financial decision to move has truly held up by leaps and bounds despite the higher taxes in Cali. Assessment: Positive.
- There are bonuses paid in both programs but likely higher in the Nola. While the bonuses may be higher in Nola, I would always choose to have a higher salary. A salary is hard to reduce, so if it keeps going up then your overall financial situation is likely to improve. A bonus can vary year to year and while it is counted in your total compensation, is not guaranteed. Give me a raise above a bonus any day. I did miss out on a large bonus in 2016 with the Nola job, but I still think the move was worth it. Assessment: Positive.
- My maximum income is likely to be a $100K more in Cali. It may take 7 years to reach the max income, but thinking long term this is a benefit. The long term gain by being in Cali is huge. The short term gain was less beneficial. I will need to stay here at least 10 years to see all of the benefits (pension, pay raises, appreciation in shares, etc.), and this is my goal for now. Who knows, maybe I will be here for 20 + years. It is a bit scary to commit to one place for so long, but at some point in life it is doable and I am at that place. Assessment: Positive, but with a long term commitment.
- The group is all young with our oldest physician being 44 years old. The hospital in general consists of young physicians. I have really enjoyed working with a young group. My last group was much older and the older guys were a valuable resource coming out of fellowship. Now, as I am comfortable practicing, having a young group with young children is great. Due to our age proximity and similar life stages we have a lot in common and are quick to take care of each other in a bind. Plus, we are more adaptable and practice medicine in a more evidence based approach then some of my former older colleagues. That being said, I have great friends at my old job and miss them dearly. Assessment: Neutral.
- Hiking and Outdoors activities. Definitely a positive, but we gave up the culture that Nola has to offer along with all of the festivals. We love festivals so this was a big loss for us. Still the ability to drive 40 minutes to the ocean, 3 hours to ski, and 5 minutes to hike is priceless. Assessment: Positive.
- Proximity to some family (driving in Cali vs flying in Nola) This is a mixed bag. We are closer to my wife’s family, but further from mine. Her parents drive up weekly to help, so that is a positive. A free break from child rearing! Assessment: Neutral.
- Increased vacation time in Cali. Can’t argue with this point. Assessment: Positive.
- Experience a new part of the country and explore the northern west coast. Anyone who knows me, knows that I like to travel. I always jump on a chance to live somewhere new. While it is often said that the West Coast is the best coast, I am not yet sold. There are things I love out here like the weather and the outdoors, but a lot of things that I am still adjusting to. So for this point I will leave it at undetermined. Check with me in 20 years, and we may or may not be here anymore. Assessment: Positive.
- Good public schools. More options in Cali then Nola ever had, but with the increasing Charter school system in that city, it may be a wash. For now our son is at home. I will be able to reassess this in 4-7 years when he is actually at school. Assessment: Neutral.
- Land for my dog to run. My dog has a lot more space, but is not running that much. When we made the decision to move we had two dogs. Unfortunately, the bigger dog was re-homed. He now has a nice yard and older kids to play with. Assessment: Neutral.
- Land for fruit trees (already planted!). Done and thumbs up! I can’t wait for the fruits of my labor… Assessment: Positive.
- Less education leave in Cali by 1 week but a $1,000 higher educational budget. This is offset by the fact that I can go to Hawaii pretty easily for some continuing medical education conferences. Assessment: Neutral.
- Due to the low/free cost of health care, in Cali we will not need a Flexible Spending Account. $2500 a year saved. $2500 saved is $2500 saved. Assessment: Positive.
- I work more weekends, about 9 weekends of call versus 5 in Nola. Call is one of my least favorite parts of work (as I imagine it is for 99% of physicians out there). This remains a down side. I am also the only Cardiologist when I am on call. I have no interventional or electrophysiology back up like I did at my old job. This has helped me become a better physician but also develop a stress ulcer! Assessment: Negative.
- I am committing 10 years minimum to be vested in the pension. I have not lived in the same place for 10 years since I left for college. In fact in the last 10 years I have lived in 5 cities all over the world. Assessment: Negative, though could end up being a positive.
- No side income allowed using my medical expertise. No role as a speaker for drug companies, which can be quite lucrative. I made almost $30k from this alone in 2016. I would prefer not to do them and instead make income practicing medicine. Still this is a cut in salary. For now this is okay. In the future, if any opportunities arise to use my medical expertise, I may have to reconsider my current job. There is a loss of income, but the time gained back from not giving these talks is invaluable. Assessment: Neutral.
- Give up academics, titles such as associate professor, and research opportunities. This does not bother me so much. Being content is part of my new life mantra. Plus I have still published 5 papers since coming to the Cali job. Assessment: Positive.
- Will I be bored in private practice? So far I am not bored. 10 months in and I go to work and then come home. Part of my lack of boredom is likely this blog. It takes up more time then I would have imagined. Assessment: Neutral.
- Will it be the right fit for us to move to Cali? Who will we meet and become friends with? The friends have been great. The town is nice too. We miss things and friends from Nola. Assessment: Undetermined.
- The pain of moving across country? It was painful. We lost about $24K on our Nola home sale after commissions and it sitting empty for 2 months. I was able to drive across country with my dog though. Check it off the bucket list. Assessment: Neutral.
- Will there be room to do non-MD stuff? There is room if I am interested. I can try my hand at administrative tasks. I have started this blog. Assessment: Neutral.
Difficult airport to travel in and out of. We drive an hour for direct flights to any of our preferred destinations. This is my biggest complaint. It takes us 1.5 to 2 hours to get to a decent airport depending on traffic. If our flight is early in the morning we get a hotel at the airport because it is such a pain to drive in the morning. Since we travel almost every month if not every other month, this has sucked. Not to mention when my family visits it is tough for them. We have a local airport, but it is not useful for getting anywhere passed Las Vegas. Assessment: Negative.
- No live music near us. True and we miss it. Assessment: Negative.
- No zoo or easy children’s activities (there is a children’s discovery zone). I have found the children’s museum to be awesome. Who needs a zoo when you can go hiking. Plus if we drive into San Francisco there is a world of activities for kids. Assessment: Neutral.
- Maybe increased room for growth in company. I still have not decided what route I will go. Will I want to do administrative stuff going forward or just practice medicine? Do more research? Assessment: Neutral.
- Networking and applying myself to a company. Could I do that at my current employer in Nola as the city grows? While both of the above are true, for now they are not my objective. Assessment: Neutral.
- Increased opportunity to work in the Bay Area? Advisorships, etc? True, but I am limited by my contract and conflicts of interest. If I retire early, then I can consider these other opportunities. Assessment: Neutral.
- I gave up academic background and associate professorship. Assessment: Neutral.
- Proximity to family- is it too much? So far we have not been too close. It is still an hour drive to see any of my in-laws and they have been helpful when they visit. Assessment: Neutral.
- I have a conflict of interest clause that prevents me from doing advisory roles go through them. I do retain rights to patents, books, etc. written on my own time. This is painful, but more so in theory than practice. Assessment: Negative.
- Increased cost of living- 800K for equivalent house here for 600K. I was wrong. The cost of a house was double my old home. The view is amazing though. That is why buying a house is tough. Assessment: Negative.
We are doing pretty well with the move. Reflecting back on the year, it seems that our SWOT demonstrated 9 positive, 6 negative, 15 neutral, and 1 undetermined events/ideas. I am happy with that and think we made the right choice.
Strengths– 8 positives and 5 neutrals
It’s good none of the strengths ended up being negatives. With 8 positives and 5 neutrals I think we were fairly accurate in our reasoning for moving here.
Weaknesses– 1 positive, 4 negative, 5 neutrals, and 1 undetermined
I think we determined the weaknesses accurately with 4 remaining negatives and 5 neutrals. To me, the fact that 5 weaknesses are neutral now is pretty good. Surprisingly, 1 item became a positive as I was able to continue publishing some research papers. I suspect this will die down over the next few years, but still pretty cool to see how that turned out. Whether Cali will be the right long-term fit has yet to be seen, but I like it more every day.
Opportunities– 3 neutral.
Not bad. It’s surprising none of them became positives, but maybe in the future.
Threats- 2 negative, 2 neutrals.
Again I am glad they were not all negatives. Neutral is a win on the threat front.
SWOT at those tough decisions
Making this SWOT and reflecting back on is a great way to confirm that our decision is a good one. For any big decision, like early retirement, a move, or a new job, I would recommend making a SWOT. It forces you to reflect on both the positives and negatives. Importantly, it forces you to write them down. Then 1 or 5 years later, whether or not you took the leap, you can look back and see how your thoughts worked out.
For me, California has been the right decision but who knows where we will be in 5 years.