One often-overlooked aspect of taking a job in another jurisdiction is the licensing factor, both state and federal. No matter how enthralled they may have been with you at the interview, many employers are unable to put you on the payroll until you successfully navigate the dreaded maze of license applications. If you decide to practice in the same state in which you treated patients as a fellow, that is one aggravating, time-consuming hurdle that you will be spared simply by virtue of remaining local. But should you choose to broaden your geographic horizons, be prepared to once again fill out and await approval of those forms necessary to allow you to treat the ill and prescribe medication.
On top of all of this, newer medical professionals also may find themselves facing an interim period, between graduation and employment, without the health insurance we so often take for granted. As anyone who has ever utilized the COBRA continued health insurance may confirm, it is not cheap. While I initially was going to gamble on my health for those 60 days between graduation and employment (perhaps not a fully rational decision), once the start date of my employment was delayed due to licensing issues, we decided to bite the bullet and obtain independent health insurance at a cost not attractive, but less oppressive than COBRA.
As those with school-age children can empathize, our choice of new community was not accidental, but largely dictated by the quality of school systems. Does anybody tell you to ever apply for a job in an area with good schools? Has that topic ever surfaced in a career advisory meeting? It was never addressed with me. After moving for the third time in two years, I consider school system quality a paramount and necessary component of the job search. We looked and were fortunate to find an exceptionally good school in Texas and, after conducting the necessary but time-consuming research, are now again located within a well-regarded school system.
During two or three years of training, medical fellows are bombarded by offers to meet with financial advisors. One nice piece of advice that I recall from those meetings was not to buy a house if you are uncertain whether you will spend more than five years in that location. Heeding that advice, I rented a beautiful house that my family and I share with the above-mentioned carpenter-ant family. With all of the customary turmoil that accompanies moving to a new job, in a new area, I cannot even imagine in my darkest dreams simultaneously dealing with the added headaches of house hunting, applying for a mortgage, finding temporary shelter during the search, etc. When first getting acquainted with the new job and new area, renting seems far easier and practical, particularly while I remain in pre-paycheck limbo.
