Dear Anita,

I agree with all of your post.  And here’s the thing, why sign up for IFS. At this point in our life, after all we have been through – why sign up for them.  It is a good question, isn’t it?

There is the concept of a different type of lifestyle in SD – but that works only if you are financially not worried, and not worried about steady work flow – it is not like we are going there for entertainment or retirement.

But, there are other potential benefits of the scenario – and IF my husband can get busy quite quickly that “worry” won’t be there.  Lots to consider…

Dear Anita,]

You are absolutely correct about the calculated risk part.  I also agree about the fear aspect and seeing this current job in a different light.  But here’s the thing, that perhaps I did not mention.  His department (subspecialty) is currently in the growth phase.  Some older surgeons retired and they have hired new ones (such as my husband and one 2 years prior who is his colleague and now friend – nice person and i’ve met his wife a few months back).  They are re-building it many ways, which takes a lot of time esp when it comes to large nyc hospitals (as you can imagine).  In the past few months, they have hired a new physician’s assistant, and other staff members.  These changes have already started to help my husband somewhat.  When he spoke to th chairman to give his notice, he did mention certain aspects of the job that were difficult such as the need for more staff such as PA, and the rigorous call schedule.  The chairman noted that they would be hiring more PAs and hopefully another surgeon in the next year, to reduce the burden on my husband and his colleague.

That being said, these things do not change the: patient population, and the overall daily struggles that go with an inner city setting type hospital.  Yet, he believes that once he gets things like his own PA, a new secretary, etc – some of the daily nitty gritty annoyances will be reduced.

I can see that.

BUT (huge but) the overall demographic remains the same.  I will say though, sometimes with the right set up (staff, and subspecialty organization) even the most difficult hospital positions can be become okay since there is a reliable daily/regular flow.  it takes away th need to “hustle” per say.

It all depends on the person, and what they are looking for.

you are right, will he/can he survive the move.

I think in so many ways – why throw such a huge stressor (and yes it is a stressor) onto him at this point in our lives.  What he craves is more peace…what we crave is more peace.  But I see the calculated risk, and the long term potential for more peace perhaps in SD…

Oh my!

Dear Anita,

Good morning. Freezing cold morning over here! I hope you enjoyed your walk yesterday, and beware of the ice! I don’t want you having any falls like last year!!!

To your last point yesterday evening, the changes do seem abrupt – of course.  Here my husband is worried about this SD job, and all of a sudden seeing his current job in a new light.  It is a combination of fear for the other option, as well as perspective.

There is the concept of medicine being difficult everywhere at this moment (Your husband stated it perfectly months ago – when you spoke to him, he mentioned many points – medicine is ruled by administrators and insurance companies that just care about the bottom line, money — therefore doctors are treated like metric items to be pushed around often).  So knowing this, and learning to accept it is key.  Yes, it isn’t ideal – but it is the state of affairs at present.  10-20 years ago was different.  This is the case in all of the US, east coast or west coast.

The only difference being that many things in the east coast can be more grueling simply because of the “hustle” and the aggressive nature, and often a difficult patient population.

That isn’t to say the West is any better.  As you mentioned if he is in sunny SD in a nice building with great colleagues – what if he has 1 patient that day – the stress of that far supercedes a clinic full of inner city patients in nyc!

So there we have that.

My husband is pleased with his chairman’s response to him, and his openness.  He has noticed recently that things are changing, and that he will have to be much more patient in this sort of setting (as in, IF I am going to work here I just have to know change happens slowly – and with that, know that at the end of the day it is a predictable/stable job that you come to daily).

So here’s something more, interesting timing.  Yesterday I had a phone call with a physician in SD.  I connected with him through our network somehow (long story) he works at one of the local hospitals and is pretty entrenched in the community.  He was one of the leaders at this hospital over the last year.

Anyway, he mentioned how the SD orthopedic community is “cut-throat” as in there is the perfect storm of “too many great physicians, and too little volume” which makes it difficult for many.

He also mentioned that he knows the group that my husband would be joining, and the other surgeon.  (the one I mentioned that may be approaching retiring/going on his own).  Let’s call him Dr. T.

Well, he stated that he knows Dr. T quite well, and he is a great honest person.  He feels that Dr. T was thinking the over head (costs you have to pay when you’re in the private “eat what you kill” model) were getting too high.  And so he may be branching out on his own (he is in his 50s and already has experience out there for years by now).

So we spoke about this, and why would my husband want to join a practice, where the current surgeon in his specialty is trying to phase out, perhaps because high costs! Moreover, if the climate is that cut-throat and perhaps difficult to get patients – well that says something.

He recommended we speak to Dr. T again and be more direct.  And say to him, “will you be leaving” and what his thoughts were on the overhead.  Be direct.

I agree this is a great idea.  Dr. T mentioned that his dad had a stroke recently and he is not doing well, so he is going to spend more time away from the practice, and that my husband could have the volume of patients he would be unable to see.  But what is the real story..

It isn’t a good idea to join a practice without knowing the full story of course.  My husband will be talking to Dr. T this week.

All in all, more and more fingers are pointing to NYC – aren’t they…

• This reply was modified 5 years ago by Cali Chica.

Dear Anita,

Yes ice accidents are a concern – be very very careful and take it easy!

I am not worried about Dr. T lying, its more of – what are you doing? Are you in or out?

Sure, his dad may have had the stroke – but Dr. T what is your long term plan?

Regardless that overhead is high, been high – we see the numbers – but Dr. T has been able to make a decent living we have seen all the financials.  Issue is the time now is different perhaps for a new guy like my husband.  And as the doctor yesterday said, it is a cut throat environment.

I think my husband in many ways feels like he is “grieving” the concept of not moving to CA.  He knows deep in his heart it is not the best decision.  But the allure is there, the lifestyle is there, and getting out of the northeast does have an appeal.

Dear Anita,

yes NYC. Known to be the greatest city in the world. Not in the middle of nowhere. The land of opportunity and the city that never sleeps – with beauty and energy in its own right.

yes, how easy to under appreciate this when looking for something different.

my husband feels that I may resent us staying in nyc. I have always wanted to live out there. The weather the culture. The focus on outdoors – the ability to spend your time doing these nature oriented activities. Ever since I first visited there I knew I wanted to. I guess I caught the California bug. After my husband and I met San Diego became a special place for us. he too felt he could see himself out there many times in his life – and especially after meeting me.

but hey- we are in Central Park, with abundant beauty around us at least half the week. The proximity to doing things is like no other. I mean you know – you used to live here downtown I recall.

I feel sad deep down inside today. Or confused.  Or maybe not sad – stressed. It is hard to differentiate sometimes since I’m so used to feeling distressed. I think you know what I mean.  I feel in a way I am mourning the concept of a fresh start or moving somewhere new – somewhere I do love. Maybe – not sure. My innate feelings I don’t always trust, distress is much more complicated for those of us who have been through so much. It isn’t just happy sad mad. It’s deep complicated and tangled.

Dear Anita,

I think so. Also the concept of viewing nyc as dark and aggressive and California as light and free. An over simplification of course. Of course!

especially when real life and work are involved – not so light and free at all.

maybe realizing this and seeing that my husbands opportunity out there is in fact, the opposite of light and freeing – is what I am grasping now. And seeing to it that CA may ever be an option. Yes all of the individuals at the practice were nice and calm and a breath of fresh air versus CA. But If there is a surgeon leaving (dr. T) because Costs in that practice are too high. Well that sounds unstable and not light and freeing at all.
how do I feel about that?
I feel that the illusion and allure of CA is magical perhaps – but not for physicians. Not for many. Perhaps for those who are retired or independently wealthy. Or perhaps for those who feel it’s the only option for them and are willing to “put up” with the market. Maybe.

people may say the same about us in nyc, the crazy rents and parking!

oh who knows. I just know I definitely feel unsettled that’s for sure. Which is warranted

Dear Anita,

I read what you wrote twice, especially the part about the beach.  You know what visual came to me?

NYC…

lights during xmas time

central park with fresh snow, central park with lavendar bloom

quiet streets in upper east side

graffiti in lower east side

quiet on the river

insanity on the subway

—-everything and anything for any age – can never tire of it, and when you feel too tired of it, there is respite – upstate, the beach, my in laws beautiful home.

there is magic here – there is magic here! i just have been overlooking it with CA in my eyes of recent.

I know I love nyc, and nyc is me, it is my husband – it is us and our story and our energy – we should not try to push ourselves away from it no longer..

Anita,

Do YOU love NYC?