Working in a different city

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Dendritic Tree
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Working in a different city

Post by Dendritic Tree »

I am a physician working in a hospital setting, and I live in our dream city. We’re very happy with our life here. My wife is also a physician and is a partner in an outpatient practice that she loves, and thinks she’ll spend the rest of her career there.

My job is “good enough” to be happy staying here. It’s a great group of doctors and colleagues, but I don’t really get to fully utilize my subspecialty training, so I’m not 100% professionally satisfied. Certainly, I have found some fulfillment and I’m not disgruntled, but it’s not perfect. To make extra money and help pay off our mountain of student loans earlier, I’ve done some intermittent moonlighting at a hospital in a major city a little over 2 hours away. This moonlighting gig is in my subspecialty, so it’s actually kind of fun for me, despite taking me away from my family for up to a week at a time (only a few times per year).

The moonlighting gig has gone well enough over the past two years that they’re repeatedly, aggressively recruiting me to join them full time. At first I scoffed at the idea - it’s too far away, I don’t really like the city in question, and I’m happy enough with my current job. My wife has made it clear that she’s fully committed to her current practice, and we won’t be considering moving away from our dream city (again, we both love it here and hope to live out our lives and even retire here).

The job pitch at my moonlighting hospital is for 1 week on, 2 weeks off. It would be a massive 30% increase in salary. I would get to practice my favorite type of medicine using my full subspecialty training, which isn’t an option in my current hospital. But it would be in a totally different city, too far away to consider commuting every day, so I would have to have an apartment or condo there to stay in 1 week out of every 3. The hardest part is that I would be away from my wife and kids 1/3 of the time, but this is balanced somewhat by being totally 100% available 2/3 of the time, which would be kind of an improvement in some ways as I do a lot of nights and weekends in my current job.

Am I crazy for considering this? Does anyone else have experience having a job in a different city than their home?

Part of my hesitation is that I really do feel like my current group is family, and 2 out of the 7 of us just announced they were moving to a job in a different part of the country, so the 5 remaining of us are going to have quite a hard schedule until we can recruit to replace the 2 that are leaving (recruiting a doctor can take well over a year from start to finish sometimes). If I left too at the same time, the 4 remaining docs will be hopelessly overwhelmed, and I do feel that I owe it to them a little bit not to screw them over at the worst time. But I’m not sure how long the job offer at the hospital where I moonlight will be on the table, and they just called me with a more urgent request for me to consider them (I’ve turned them down several times in the past, saying I was still happy with my primary/current job). I’d have to give six months notice at my current job.

I’d love to hear your thoughts,
EddyB
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Re: Working in a different city

Post by EddyB »

How old are your kids?
ThankYouJack
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Re: Working in a different city

Post by ThankYouJack »

Sounds like a great situation either way. Could you negotiate even more of a pay bump with the new job?

I would take the new job, but rent an apartment. If it turns out to not be all that you hoped or too much time away, it sounds like your current group would take you back immediately.
sport
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Re: Working in a different city

Post by sport »

Could you relocate half-way between the 2 cities? An hour commute is not impossible.
HomeStretch
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Re: Working in a different city

Post by HomeStretch »

ThankYouJack wrote: Wed Oct 09, 2019 10:00 pm Sounds like a great situation either way. Could you negotiate even more of a pay bump with the new job?

I would take the new job, but rent an apartment. If it turns out to not be all that you hoped or too much time away, it sounds like your current group would take you back immediately.
+1. Many people travel for work so to be away M-F one week out of three is feasible if it works for you/spouse.

If your notice to current practice would be shorter than you like, you could help them out by working one day per week on your off weeks for a couple months.
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Watty
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Re: Working in a different city

Post by Watty »

Dendritic Tree wrote: Wed Oct 09, 2019 9:47 pm The job pitch at my moonlighting hospital is for 1 week on, 2 weeks off.
I may be reading a lot in between the lines of your post but it sounds like you would like to get more professional fulfillment from your job but you would not be working almost 35 weeks out of the year which does not sound very professionally fulfilling.

There are lots of things you could do with all that free time but if you are mainly looking for professional fulfillment that might not be ideal.

If they could work with the schedule you might want to do something like still work half time at your current job.

It also was not clear just how many days a week you would be working or what hours you would be working. If it is only five days a week then you might only be away for four nights the week you are working since you might still be home by 7:30 PM or so on Friday night. On Mondays you could get up early to make the 2 hour drive or do something like leave at 9:00 PM Sunday evening after the kids have gone to bed.
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Re: Working in a different city

Post by random_walker_77 »

Is the "1 week on" a full 7 day week? You mention a hospital -- how many hours would you be cramming into that "1 week", between regular hours, and call?

On one hand, lots of people work sales jobs where they're away 25-50% of the time, and still working full time on the weeks when they're in their home city. So being away for 33% of the time isn't crazy, especially since the other 2/3 of the time, your time is your own. But will it work for you and your family? What's your spouse think of this? (Not just what they say, but what they're really hoping for). How old are your kids, and how would this affect your relationship with your kids?

Also, all jobs grow old after a time. You're having fun now w/ the moonlighting, but will you still be happy w/ being away for 33% of the time after a couple years of this? A lot of people get out of jobs involving travel simply because it gets old. But they also don't get the "2 weeks off" for each week working.

How important is the money angle -- if they offered a 50% increase rather than a 33% increase, would that materially change how you'd view this? If you're on the fence, and this is important to you, why not negotiate hard to see if you can turn this into a 50% increase. Worst case, you stay where you are and continue moonlighting for fun.

To what extent is this a business problem? Is there a possibility of creating a market for this subspeciality work where you live? (i.e. instead of traveling to the city to do this for an employer, is it feasible to build a practice that offers this service where you live? Is there enough of a population and/or can you draw enough patients to your city to make that work?)
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Re: Working in a different city

Post by Dendritic Tree »

To answer a few questions:

Moving halfway between the two cities is not an option. Not only do we love where we live (and my wife and kids won’t move), but the new position would require me to live no more than 15 minutes away from the new hospital, because I would need to be immediately available to go into the hospital at night.

The hours would be 7am - 7pm, 7 days a week. Usually that 7pm goes a little bit later, possibly 8 or 9pm depending on how sick the patients are and how many new admissions there are. I would also take call from “home” at night and be required to be able to go into work at a moment’s notice at night for emergencies, which happens a few times per week. We’ll call the workweek 90 hours of actual in-hospital work, plus many more hours of returning pages from home, pretty standard for what I do.

My kids are 3 and 5 (about to turn 6), and one of the main sources of joy in my life. To answer the question of whether I could be away from them 33% of the time... I don’t know, that’s kind of my main hold-up right now. I feel like I would miss a lot of important stuff. Then again, I already miss a fair amount because I work at least 5 overnight shifts a month in the hospital currently, at least 2 or maybe 3 weekends every month, and a handful of 24 hour shifts on occasion. Being completely “home” for 2 weeks at a time might actually give me more time with them.

Negotiating the salary is of course something I’ll do. My current salary is quite average. The new salary would be well above average for my field. I doubt I could push it much higher but I would try.

As for what I would do during the 2 weeks off... what a happy problem to figure out. I currently also do some moonlighting from home for a telemedicine company. I would probably do more of that while the kids are in school, pushing my total comp up even higher. My wife has recently become more of a Boglehead and is drooling at the prospect of killing off our massive student loans even faster and saving up for a house with this new salary.

As for creating this subspecialty where I live... I’ve actually been trying to do that since arriving in my current job over 3 years ago. I am hospital-employed and my subspecialty inherently requires a special physical unit that the hospital so far hasn’t felt they needed, and then hire a bunch of people (including more physicians like myself) to staff it. They keep saying it’s in their future plans but I’m becoming less convinced they mean it. By the nature of the subspecialty I couldn’t just make a private practice... it requires a large hospital with a specialized physical unit.

From a purely financial standpoint, the new job is a big win because of the new salary and possible extra moonlighting telemedicine income from home on top of that when I’m “off”. I’m hesitant to be away from my family for a week at a time. At least when I’m super busy or stressed in my current job, I get to see them intermittently which helps keep me happy and sane. But like I said I may actually get more quality time with them during that regular 2 weeks off. I also hate the idea of stabbing my current group in the back right at the worst time, just after 2 other physicians have quit (and we’re all just taking on their workload until we can hit 2 docs to replace them, which is expected to take at least a year to find the right people and then get them credentialed and licensed - that last part always takes a solid 6 months).
Last edited by Dendritic Tree on Thu Oct 10, 2019 6:14 am, edited 1 time in total.
ARoseByAnyOtherName
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Re: Working in a different city

Post by ARoseByAnyOtherName »

Dendritic Tree wrote: Wed Oct 09, 2019 9:47 pm Part of my hesitation is that I really do feel like my current group is family, and 2 out of the 7 of us just announced they were moving to a job in a different part of the country, so the 5 remaining of us are going to have quite a hard schedule until we can recruit to replace the 2 that are leaving (recruiting a doctor can take well over a year from start to finish sometimes). If I left too at the same time, the 4 remaining docs will be hopelessly overwhelmed, and I do feel that I owe it to them a little bit not to screw them over at the worst time.
I wouldn’t factor your current work situation in to your decision at all. Obviously the 2 who left had no qualms about doing what’s best for themselves, why should you hold yourself back?

It may be hard for them but they will survive. People (including doctors) leave jobs all the time.

Is the 6 month notice something you are contractually bound to? And will that be acceptable to the new hospital if you take the new job?
Ready3Retire
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Re: Working in a different city

Post by Ready3Retire »

Could you do a 6 month trial of 1 week on 2 weeks off at new job, and at the same time have your current employer agree to you doing 2 weeks on 1 week off? After 6 months, you will know how the 1 of every 3 weeks away is working, as well as how you like the new position. You'll also be exhausted I'm sure.. :wink:
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Re: Working in a different city

Post by Dendritic Tree »

ARoseByAnyOtherName wrote: Thu Oct 10, 2019 6:12 am
Dendritic Tree wrote: Wed Oct 09, 2019 9:47 pm Part of my hesitation is that I really do feel like my current group is family, and 2 out of the 7 of us just announced they were moving to a job in a different part of the country, so the 5 remaining of us are going to have quite a hard schedule until we can recruit to replace the 2 that are leaving (recruiting a doctor can take well over a year from start to finish sometimes). If I left too at the same time, the 4 remaining docs will be hopelessly overwhelmed, and I do feel that I owe it to them a little bit not to screw them over at the worst time.
I wouldn’t factor your current work situation in to your decision at all. Obviously the 2 who left had no qualms about doing what’s best for themselves, why should you hold yourself back?

It may be hard for them but they will survive. People (including doctors) leave jobs all the time.

Is the 6 month notice something you are contractually bound to? And will that be acceptable to the new hospital if you take the new job?
Yes, I’m contractually obligated to give 6 months notice. I imagine my new job would be ok with that as long as I’ve signed with them. They can probably hold out for 6 months, and like I said before, starting a new hospital job always involves many months of paperwork and vetting prior to actually starting work, though I imagine this process might be easier for me in this case since I’m already credentialed to admit patients there as a moonlighted, so they already have much of my documentation on file.

Part of the qualm with leaving my current group would be that, after ditching them, I would still be living in the same medium-sized city with them and we’ve all become pretty socially entwined. Some of our kids go to school together, for example. So I would still be party to hear about their suffering with a drastically understaffed group.
Last edited by Dendritic Tree on Thu Oct 10, 2019 6:19 am, edited 1 time in total.
livesoft
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Re: Working in a different city

Post by livesoft »

Why don't you get "the other city" folks to move to "your current city"? Or you could start the business yourself in your own city. They could bankroll your new business.
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Dendritic Tree
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Re: Working in a different city

Post by Dendritic Tree »

livesoft wrote: Thu Oct 10, 2019 6:17 am Why don't you get "the other city" folks to move to "your current city"? Or you could start the business yourself in your own city. They could bankroll your new business.
Unfortunately the nature of my specialty is such that you really can’t just “start your own group”. You really have to have a dedicated ICU of a certain type in a large hospital with certain support staff hired by the hospital as well.
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Re: Working in a different city

Post by Carson »

Would your 2 weeks off actually be *off* or is there a chance of work creeping into that time as well (eg, on call or consultations?)

Do you have a spouse/childcare network setup so that there are no gaps in coverage? It might be okay right now when the kids are in the same (assume daycare) but it gets logistically sticky to manage kids schedules as things like after-school clubs, sports, etc... are added. I solo parent (DH works 24 hour shifts) and it is difficult to be in two places at once, and I have to rely on friends to help. It can even be hard to find someone to hire to help the solo parent because few people are willing to work for just 3 hours or so each day.
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Re: Working in a different city

Post by RickBoglehead »

I get the part about being "family", and not wanting to stab your "family" in the back.

Question - didn't the other 2 that left in fact do just that?

In life, family comes first. That's the wife and kids. You need to do what's best for you and your family, and work comes second. If you can improve your quality of life in all aspects by taking this new job, then you should. Being away from home for 7 days, and then back home for 14 days sounds fine.

In your 30% increase in money, have you factored in the apartment you'll need, utilities, the added food expense (cooking for one), etc.? Also any local city income taxes?
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Re: Working in a different city

Post by ARoseByAnyOtherName »

Dendritic Tree wrote: Thu Oct 10, 2019 6:16 am
ARoseByAnyOtherName wrote: Thu Oct 10, 2019 6:12 am
Dendritic Tree wrote: Wed Oct 09, 2019 9:47 pm Part of my hesitation is that I really do feel like my current group is family, and 2 out of the 7 of us just announced they were moving to a job in a different part of the country, so the 5 remaining of us are going to have quite a hard schedule until we can recruit to replace the 2 that are leaving (recruiting a doctor can take well over a year from start to finish sometimes). If I left too at the same time, the 4 remaining docs will be hopelessly overwhelmed, and I do feel that I owe it to them a little bit not to screw them over at the worst time.
I wouldn’t factor your current work situation in to your decision at all. Obviously the 2 who left had no qualms about doing what’s best for themselves, why should you hold yourself back?

It may be hard for them but they will survive. People (including doctors) leave jobs all the time.

Is the 6 month notice something you are contractually bound to? And will that be acceptable to the new hospital if you take the new job?
Yes, I’m contractually obligated to give 6 months notice. I imagine my new job would be ok with that as long as I’ve signed with them. They can probably hold out for 6 months, and like I said before, starting a new hospital job always involves many months of paperwork and vetting prior to actually starting work, though I imagine this process might be easier for me in this case since I’m already credentialed to admit patients there as a moonlighted, so they already have much of my documentation on file.

Part of the qualm with leaving my current group would be that, after ditching them, I would still be living in the same medium-sized city with them and we’ve all become pretty socially entwined. Some of our kids go to school together, for example. So I would still be party to hear about their suffering with a drastically understaffed group.
I actually think this is a positive and not a negative in your situation. If you decide on the new job you'll need to frame your departure in a positive way, of course, and yes you'll need to listen to your friends complain a bit. But on the upside you maintain your ties to them.

If you take the new job, and after a few months realize it's not working out, maintaining ties makes it more likely that you could go back to your old job - especially if it takes them a while to hire 3 replacements. Or, by maintaining ties it might be easier to find a new job though them.
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Re: Working in a different city

Post by csm »

While nowhere near the same situation as your schedule, I used to work 50-60 hours a week at a M-F schedule. When I changed that to working M-F one week and then M-Th the following week, with a 3-day weekend every two weeks, it made an enormous difference. So although I worked a similar total number of hours, just having an extra full day off every two weeks helped me regenerate both physical and mental energy.

So I would think that the tough one-week on, even though away from the family, followed by two weeks off at home, would be ideal. It also sounds like you have a plan for the downtime with the telemedicine work.

For your housing situation, you may wish to looking into a deal with a mid-range hotel chain with suites (e.g. Homewood Suites, Residence Inn, Staybridge Suites) for the week you are in the other city. Talk directly to a manager and try to work a deal (tell them you don't need daily housekeeping, for example). With the hours you described you would be working, would you really want your own apartment that you pay for 100% while only using one week out of three? If you compare costs all-in to fewer than 20 weeks a year in a moderate-priced hotel, you might be ahead.
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Re: Working in a different city

Post by Keenobserver »

Here is what I got from your post.
1. You love where you currently live.
2. Your wife has a successful business there ( she lives the city too) and kids are unwilling to move. Oh, tour wife sees herself living there for the foreseeable future.
3. You consider your current coworkers to be family.
I can' t imagine why you would want to change that. No job is perfect and the new job you seek will also become rotuine soon enough. Yes, you will make more money, but if its money you are after then you can do 1 week away and continue to work at current job during time off from new gig. However, I doubt that you are chasing the $$ alone. I would continue moonlighting and look for other moonlighting opportunities to stay sharp. Stay put and count your blessings.
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Re: Working in a different city

Post by Jack FFR1846 »

1) What does your wife think about making this change?


You could commute. I've done a 3 hour one way commute for work for a week at a time. I had the option of the company paying for a hotel (I was there for training) but wanted to be home with the family at night. Even if it was just to walk in and see the kids asleep. I'll also admit that I love driving, so would probably not have a problem commuting 4 or 5...or more hours (have done that for customer visits) each way. (Hopkinton, MA to Buffalo, NY)

How about this....get an apartment in the new place city and stay there when the nights get too long. Come home for a night in the middle of the week. If you have any schedule power, make Wednesday an early morning, early night day and plan to get home. That splits the work week.
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Re: Working in a different city

Post by forgeblast »

This is where a pro/con list comes into play. List everything and then have your wife do a pro/con list and then see what overlaps. The things she see's as a pro might be a con and vise versa.
I teach, so having a long time with my kiddo has been priceless.
I think you will find that during the school year it may not seem like it but when your off in the summer with them it will be worth it!
Now, how will this work with current daycare, etc will they still charge you even when your home with them etc....thats something to consider.
we had to pay (during the school year not summer) even on days that we had off but they were open. It only happened a few times but it could add up.
Good Luck!
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Watty
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Re: Working in a different city

Post by Watty »

Dendritic Tree wrote: Thu Oct 10, 2019 6:01 am My kids are 3 and 5 (about to turn 6), and one of the main sources of joy in my life.
One thing to consider is that it sounds like the job would require away from home during some holidays.

Even if you have to work some holidays in your current job at least you would still be around.

That would he hard with young kids.
Dendritic Tree wrote: Wed Oct 09, 2019 9:47 pm It would be a massive 30% increase in salary.
It would be good to do a dummy tax return to see what the after tax impact would be. In addition to being in a high tax bracket you may also run into things like Medicare IRMAA surcharges.

You might not be getting as much as it sounds like.
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Re: Working in a different city

Post by Dendritic Tree »

Answering a few more questions:

1. How does my wife feel about it? She's surprisingly open about it and encouraged me to reconsider after I initially shut it down. Her reason is that she wants me to feel professionally satisfied and do what I really want to do.
2. It sounds like you have a good thing going there, why would you seek a different job? Well, I do have a good thing going, but I spent several additional years of fellowship training in this one field I really enjoy, and I'm not using that training currently, nor getting paid for it. I'm doing a more generalized version of my subspecialty - it's sort of the penalty I'm paying for getting to live and work in my dream city. My training is adjacent to what I do, but not fully, and sometimes I get annoyed when I have to do some of the more general work that I was hoping to avoid when I made the decision years ago to focus on my subspecialty.
3. Why don't you split your time between the two, or commute back mid-week? Again, the proposed job in question requires that I be immediately available to come into the hospital at all hours, within a 15 minute notice. I really would have to live in the city in question when I'm working there. And even if I didn't, it would basically entail getting home to my family around 10:30pm and leaving to get back to the job no later than 4:30am. My wife and kids would be asleep the whole time.
4. Didn't your two partners that just left dump a lot of extra work on the group? Why would you hesitate to do the same if it's what's right for you? Ok, it's true, anybody can leave at any time. I happen to know these two that are leaving pretty well (they are still serving out their required 6-month notice for another ... 5.5 months) and I know it was a tortured decision, but needed to be done so they and their kids could be closer to family. They are physically moving away, but I would be staying in town even if I quit and took the new job. I know it really shouldn't be a factor in my decision, but the timing for me to take a new job seems poor. I was considering the new job and then my partners (they're married to each other) announced they were leaving and it suddenly made my decision much harder for some reason.
5. Haven't you considered the cost of having a place in the big city, and increased taxes on your higher income? Yes, of course. Money isn't the main reason I'm considering this - I'm doing it so I can practice as the type of doctor I trained to be and do the type of medicine I love best, which isn't currently an option in my dream city where I live. However, the big (~$100k!) increase in salary sure doesn't make it less attractive.
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FlyAF
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Re: Working in a different city

Post by FlyAF »

We don't have kids, but my spouse works M-F in a city 1500 miles away, commuting via air 3 weeks out of the month (home on weekends). Make no mistake about it, the time away from your family will suck for your entire family and yourself. While an extra 100k sounds like a lot, after taxes and expenses, it's really not IMO. Who will be paying for the apartment/utilities in the other city? In our case, spouse has a furnished apartment on campus paid for by the company. All travel expenses are paid (often times commuting via the corporate jet), private car service to/from airport, laundry/dry cleaning, maid service, as well as all meals/cooking/food shopping taken care of, etc.....Spouse is able to solely focus on work and nothing else while there. While the 2 situations are not identical, we wouldn't even consider for a minute doing this sort of thing for an extra 100k gross.
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Re: Working in a different city

Post by 1789 »

I dont want to give a bad recommendation on finance stuff but if i believe if we (as a family ) are on the right track for family goals, i wouldn't spend 33% of my time away from my kids. I can correct it saying not even 3%, but thats just me.
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Re: Working in a different city

Post by goodenyou »

Surgical specialty surgeon here. Raised 3 kids, coached their hockey teams traveling all over creation with them and was there for all their important events. Wife NP-Dermatology. Don't live in our dream city, but had a dream raising our family together for 22 years. Wouldn't be away from my family. Can't get the years back.
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greg24
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Re: Working in a different city

Post by greg24 »

Did you go through extensive training in order to enter a highly-compensated field so that you'd be away from your family 1/3 of the time?

I would never do it. But it is a personal question.
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gr7070
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Re: Working in a different city

Post by gr7070 »

I'd do a very detailed look at just how much time you spend away from the kids while they're *at home* or could be at home vs. that same analysis with the new job.

Probably estimate the same as if they were in grade school, too.

While the times will certainly be different with the new job the number of hours missed don't sound like it will be drastically different. If that's the case I'd take the new job.

I'm a huge proponent of making some, potentially significant, sacrifices in my career and my finances for the betterment of my family and especially my child. My wife stayed at home for 7 years plus 2 years half-time. I always worked less (usually much less) than 50 hours per week in private sector and have taken a 30% pay cut in current government position in part for family.

With that said it sounds like the new job may not be a detriment and you may find the dedicated time to family those two weeks is a net positive for all.

And you can *always* change should things not work out.

Lastly children of *dedicated* parents turn out just fine! That includes dedicated parents with demanding careers who accommodate for family in alternative ways. It includes dedicated military parents that move often or get deployed. Etc. There's lots of was to make family work. Dedication to the kids and spouse are the key. Yes that certainly requires time, but doesn't have to be conventionally applied - even though I've chosen and prefer a conventional approach to family and time
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Re: Working in a different city

Post by mrspock »

FWIW I know some folks in Silicon Valley who fly in for work Sunday night and work M-TH or M-F (on their on dime no less), then get back on the plane to head “home”. They maintain a crash pad in the valley to sleep (studio or 1 Bdrm).

So it’s not under heard of, albeit a very tiny minority from my experience. Usually these folks, by my eye could retire tomorrow, but are squeezing out a bit more from their lucrative careers here. A phased withdrawal from the Valley if you like. The final steps being working remote... then they just resign/retire :) .
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Dendritic Tree
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Re: Working in a different city

Post by Dendritic Tree »

Thanks for the feedback, everyone. I am going to a major international conference next week where I will see colleagues from all over the country including several former mentors. I’m going to take some time to test the waters and think through my options a bit more before I continue down either pathway.
Xrayman69
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Re: Working in a different city

Post by Xrayman69 »

Grass greener on the other side no matter what side you stand.

Very few “perfect” jobs.

“You can have anything you want” but “ you can’t have everything you want”. Paraphrase of Ray Dalios to his kids.

You must make choices and sacrifices.
Hillview
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Re: Working in a different city

Post by Hillview »

a 100k increase seems like a lot but what would it cost to rent a place in other city or take a hotel room plus food and utilities (if you rent)? I feel like after taxes that might be a consideration that the 100k might not be an increase to you HH income.

From a lifestyle point of view as someone who travels for work (as does my husband) being home and available most of the time is very appealing so the opportunity sounds very good. I would just be thoughtful about the money.
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celia
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Re: Working in a different city

Post by celia »

Instead of doing the moonlighting job every third week, have you considered doing it every fourth or fifth week instead?

You would get more time doing your specialty while also helping your current employer with the manpower shortage.
Lexi
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Re: Working in a different city

Post by Lexi »

When both members of a couple have ambitious, intense professions it is very difficult to find situations where each has a fully challenging job in the same location, especially when a short commute is required. Even if they manage to get that situation, eventually one will need to move on to a new position. The only way I have seen such couples pull it off is by living in a large city with numerous potential employers in their fields.
If you both love your current city and want to stay there, i think you should give serious thought to how important practicing your subspecialty is to you. If it is really important, the new offer sounds as good as you will find.
Is this a subspecialty that really belongs only in a Center of Excellence?
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