Category: lifestyle

The Real Cost of Owning A Swimming Pool

The Real Cost of Owning A Swimming Pool

Swimming Pool maintenance is expensive

Now that you are working 65 hours a week in the hospital and making big bucks, you can now afford that giant in-ground swimming pool you’ve always wanted as a kid.  Can you really afford that pool? How much does it really cost to own a pool?

It’s not cheap.

Yes, it’s expensive even if you make $150,000 a year. Or $250,000.  The costs of owning a pool come from maintenance. Assuming your home already comes with a swimming pool, you still have to maintain it year round. On average, it costs approximately $3,000-$5,000 to maintain a swimming pool per year. Consider that cost, compare it to the cost of membership at a local pool, the number of times you go swimming per year, and the intrinsic happiness you gain from the convenience of having a pool in your back yard.

Why does it cost so much to maintain a pool of water? Let’s briefly go over the costs:

Heating

Heating a pool will likely cost you around $100 a month with traditional heating methods, likely more if you are keeping it heated during the cooler months. If you live in a sunny area, you can install a solar system where your water is pumped to your roof and heated passively through sunlight. These systems will cost you around $7-9k to install, and maybe an extra $50-$100 a year to run the pump.

Maintenance

You have to maintain your pool weekly during use. This includes adjusting chemical levels, cleaning it, maintaining the filters and pumps, and repairing anything that breaks. The pool guy might charge you $50 a week (or $100 if you’re in southern California) for a 12,500-18,000 tank. It takes about a 45-60 minutes of your time to thoroughly go through the motions.

DIY Tips on Pool Maintenance

Okay, you’re only worth $100/hr pretax as a doctor. Your fancy house came with a standard chlorine pool. The local pool maintenance company charges a monthly fee of $300 a month for maintenance on an annual contract. That is too fancy for your blood. What do you have a to do to maintain it?

Cleaning the pool requires multiple steps

Skimmers

You want your pool water to be clear and free of debris, bugs, and plant matter. Most pools have skimmers on the side walls that trap surface debris. You want to empty out the skimmer baskets weekly. If you have a dog that also gets into your pool, then you should consider installing a Scumsock, which traps animal fur. This reduces the likelihood that your pump filter doesn’t get clogged with animal fur.

Leaf Net and pool brushes

A net on a pole is used to remove larger leaves and debris in the pool. Walls of your pool need to be brushed weekly to remove mineral debris and bugs.

Automatic Pool Robot 

Sand and heavier debris on the bottom of the pool should be removed using a cleaning device that runs on the bottom. This isn’t the only solution. There are plenty of companies that make automated pool cleaning devices, and each on requires different maintenance.

Circulation Pump

All pools require a circulation pump with filter. You will need to run this pump 8-10 hours a day to remove waste from the pool, more if the pool undergoes heavy use. The pump helps remove organic waste (like sunblock, sweat, and human waste…yuck) from the water. These substances  competitively bind to the chlorine in the pool and prevents the chlorine from doing its job. The end result? Algae bloom. Keep your pump running and filter clean. These filters may have to be replaced every 3 months with heavy use.

Balance the chemical levels of the pool

Alkalinity (800-100ppm), pH (7.4-7.8), and chlorine levels (1-3ppm) need to be adjusted at least weekly. If you have too much chlorine (>10ppm), then you have to add a chlorine reducer. If you have a moderately high level of chlorine, add pool shock to oxidize the compounds in the water.

Salt Water Pools Still Require Maintenance

On average, it will take you about an hour a week to maintain a standard chlorine pool. At $100/hour pretax on your regular job, it is a sound financial decision to clean your pool yourself unless you are able to pick up extra shifts at work or more patients to operate on. If you want to save even more time with maintenance, you can consider a salt water pool.

To clarify, salt water in the pool does not equate to having a tub of sea water to swim in. The water in a salt water pool should not even taste salty if it is maintained properly. A salt water pool uses salt in a generator to produce chlorine. Remember, in high school Chemistry? NaCl is salt. The advantage of salt water pools is that you may not have to monitor the chemical balance as closely, but you still have to clean the debris, skimmer, and dead bugs. Instead of one hour a week, it will probably take you 15 minutes a week to clean a salt water pool.

You Will Need More Umbrella Insurance if You Own A Pool

We don’t like to talk about it, but you can get sued for owning a pool. If a neighborhood kid jumps the fence in your back yard, uses your pool, and drowns, you may be liable for his stupidity. Welcome to America. You probably should have umbrella insurance anyway, but you will pay more for having a pool. This will set you back a few extra hundred bucks a year.

Conclusion

Overall, having a pool is still a luxury, even for a high income family. It adds complexity to your life, but can be rewarding if you live in an area that allows you to swim year-round.  There are some regions in the country where it’s difficult not to find a house with a pool (read: Florida, southern California, and some parts of Texas), and perhaps those are the only places to seek one out.  Be aware that it is not cheap (time and money) to own a pool, whether you have pool help or decide to do it yourself.

Do you own a swimming pool? Has it been worth your investment? How often do you use it?

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Weighing the geographical arbitrage scale for doctors

Weighing the geographical arbitrage scale for doctors

Large cities with robust public transit and cultural hotspots are the ideal place for some of us.  Vast nature and open spaces will appeal to others.  Some of us can only imagine living in warm weather next to sandy beaches.  Fortunately all three of these locations need healthcare.  As physicians, we are likely to be able to find a job nearly anywhere we’d like.  Unfortunately some more coveted regions of the country come at a cost.  This cost can manifest in several aspects:

  • high cost of living
  • low wages
  • competitive market
  • extenuating commute times / traffic
  • natural disasters (read: southern California)

For those doctors graduating with an average debt in the six-figure range, the lifestyle of where we choose to work can strongly influence where we decide to settle.  How much of a range can we expect to see? Let’s take a look at a few cities:

Honolulu, Hawaii

Who doesn’t like beautiful beaches, tropical weather, and poke all year round? There are aspects of your life that you will have to compromise on if you decide to live there.

Median home price in Oahu in 2018: $810,000

Average physician salary in Hawaii in 2018: $241,000

Pros: Great climate, natural landscape, paradise in what people otherwise would vacation

Cons: bad traffic, high cost of living, rock fever

Toledo, Ohio

Unless you have family in this area, it is unlikely that any physician would consider moving there for career reasons (other than potentially high pay/opportunity).

Median home price: $68,000

Average physician salary in Ohio: $275,480

Pros: High salary/housing ratio, no traffic, low cost of living, proximity to a Great Lake

Cons: limited culture, relatively isolated area of the country, cold, snowy winters

If your main goal in choosing between Honolulu and Toledo is to get out of debt and build up your net worth as quickly as possible, then there is no comparison.  There is a good chance that in Toledo you will find a better paying job with less work, less demanding clientele, higher reimbursement schedules, and lower living costs on all accounts.  Yet, there are still people who will opt to practice medicine in Honolulu over Toledo…

According to a recent Doximity poll, the majority of the income-favorable metro areas aren’t in the coasts:

Data courtesy of Doximity

San Jose may actually be an outlier on the map, but the Bay Area poses challenges mentioned above that aren’t necessarily compensated by a marginally higher doctor salary.  What polls typically don’t reflect is the rigor of the daily grind.  For instance, one of my colleagues currently works in a six-physician group in the Bay Area.  His group has five offices and two surgical centers to commute among during the week.  He takes practice call every three weeks since the practice has a rule that the senior three doctors do not have to take call.  In addition, he takes shared call for five regional hospital every five weeks.  Practice building events include lectures at monthly seminars and trade shows.

Using the Geographical Arbitrage Scale in job selection

I define the Geographical Arbitrage Scale (GAS) to be graded with five variables, each with a maximum score of two points (decimal points are okay!).  These are common variables that physicians consider when taking a job:

  • Income — earning potential includes retirement options and benefits
  • Work/life balance — includes access to family and friends
  • Environment outside of work — weather and activities that you’d enjoy
  • Career satisfaction — opportunities to innovate or lack thereof, depending on physician preference
  • Cost of living — higher score means lower cost of living

The GAS comparison between Honolulu and Toledo might look like the following:

Use the scale when selecting a job 

Find out what situation you are in, and adjust your career goals accordingly:

If your GAS is too low, high tail it out of your job!

It would be interesting to see how long one could tolerate a low GAS score that might offer a very high income potential.  In a case like that, one could “rebalance” the GAS score after five years to achieve a happier medium.

What is your GAS score?

Doctors working in tech cities are losing the rat race

Doctors working in tech cities are losing the rat race

Populous cities are populous, well, because people want to there.  Whether the appeal comes from greater career opportunities or simply being closer to family, these places have continuously grown over the last few decades.  The growth is seemingly self-sustaining—certain industries and businesses exist because there is a population that desires these services.  In return, these businesses require workers, so they attract people to the region.   Add nice weather to mix, and these desirable places could even be called Utopia.

Utopia might be a bit of an exaggeration, but isn’t it nice to be the first to experience innovations in our daily lives, whether it be a food delivery service, personal assistant service, or simply a new Broadway musical?  Who actually wants to experience the bubble tea craze two decades after it began?

Sounds great, but there are two sides to the coin.  Yes, these are certainly amenities but there is also a lot of compromise in order to enjoy these perks.  The reality is that if you aren’t retired or living completely on passive income, you still have to go through the daily grind.   That grind in a major city is likely much worse than you realize if you haven’t lived the part.  

Take, for instance, New York City.  It might even be considered the best city in the world.  Most visitors to NYC tend to rave about the energy, the food, and the sights.  These visitors aren’t going to know that it’s not cheap finding good housing (apartment brokers take a cut for finding you a rental), the subway schedules are only a rough approximation, and the vast variety of food options will eventually consume your budget (unless you eat at 99c pizza for all your meals).  

Being a physician in a large city

It is true that a greater population ought to support a greater number of physicians.  In reality that is absolutely true.  However, there are inherent issues with being a physician in these areas.

Despite a greater demand in more populous areas, our profession is still beholden to insurance companies and managed care organizations that dictate reimbursement and certain practice patterns.  There is often a cost of living adjustment (COL) in the reimbursement, but the numbers don’t add up.  For instance, an insurer might pay a physician $165 for a Level 4 visit in Columbus, OH and $180 for the same visit in Sunnyvale, CA.  Your medical assistant in Columbus earns $18.50 an hour, but in Sunnyvale he commands $29/hr.  Oh, and by the way, a $350,000 home in Columbus will cost $2 million in Sunnyvale.  
There are also many immeasurable factors thrown in the mix, like commute time, actual cost of living differences, and other like-minded physicians who are competing for the same subset of patients.

The numbers simply don’t add up.  That $250,000 salary in Columbus will get you quite a bit further than the $300,000 salary in Sunnyvale, AND it’s a whole lot easier to get.  If you’re unlucky, you might only earn $180,000 a year for the first six years of your practice while in Sunnyvale too.

Engineer salaries exposed!

Continuing along the lines of big-city bashing, most physicians practicing full-time are going to have income in the six-figure range.  There are plenty of occupations whose compensation is equal or greater than what a physician can earn in these populated cities.  Engineering and tech jobs are the ones that come to mind when you’re looking at areas like the Bay Area, Seattle, Austin, Los Angeles, and NYC.  
Highly competent software engineers at successful companies can command base salaries in the $150,000 range.  Year-end productivity bonuses could add another 30%, and stock options can double the base salary.  You might be looking at a total annual compensation package of $350,000 for a 25 year-old!
What is interesting is that the growth potential and tax benefits of stock options could potentially amplify the compensation package substantially for the software engineer.  Anyone who’s compensated strictly on a salary and bonus will not realize these perks.

Gotta keep up in the rat race

You might also like: How much money do doctors make?
Whenever there are a large number of people in the same income range living in an area, the housing  and service market will adjust to cater to these groups. Those who are on the fringe of the group will be financially stretched.  Many physicians in these area are actually the ones that are financially stretched.  

There is still light at the end of the tunnel
It’s also important to be aware that people aren’t actually leaving the large cities en mass.  There are still plenty of doctors in these areas, many of whom are likely doing quite well financially.  We all have  to realize that if physicians aren’t able to afford living in HCOL area, then who is?

Just remember that life isn’t a huge race.  We face decisions daily, and ultimately make compromises to get ourselves and our families in the best possible situation available.  Physicians living in HCOL areas can and actually do retire, but there is no doubt that they face unique lifestyle challenges that their counterparts living elsewhere do not.

Are you stuck in a rat race?

Financial serenity in the midst of turmoil

Financial serenity in the midst of turmoil

As of March 2020, the COVID-19 pandemic is still ramping up in the United States.  Testing measures are slowly ramping up, so we’ll be expecting more of a jump in affected individuals over the next few weeks.  It’s important for all of us to do our part and limit the rate of transmission so our healthcare facilities do not become overwhelmed.

Obviously the stock market and economy is taking a nosedive.  Some people might even say that it’s a bottomless pit.  Will it be the worst in history? Does that even matter?  The healthcare sector will always need doctors, but this doesn’t mean that our incomes won’t take a beating.  Many of us still have loans, mortgages, and bills to pay.  The 10% drop in our investments will hopefully recover by the time we retire, but the red down arrows on our statements still hurts.  However, now is the time for us to reassess our financial plan and ensure that we are making appropriate choices.

Focus on what you can control
Remember, I’s and O’s—that’s all there is to it. Renal function, net worth…it’s one of the same.  You can control how much you spend.  This is where having a recurring monthly lawn bill of $1000 (yes, that is more common than you think), cellphone and internet bill of $600, and $150 per dog grooming bill is going to start hurting you.  Sure, it is doable if you have multiple income streams from your rental properties, but what if your tenants start to default on rent? What if your plastic surgery aesthetic center drops its volume by 90%?

Find peace in world of turmoil.

This is where ultra-savers butt heads with the ultra-earners.  There are people who would prefer to clip coupons rather than find ways to increase income to get rich.  Guess what? You could do both.  Sometimes there are no coupons in the weekly mail, but there is someone waiting to give you their money.  When no one is waiting to give you their money, clipping coupons is the only option.
Now is a good time to assess what our expenses are and decide how modifying them would impact our daily lives or our financial future.  I dislike nitpicking on details that might not make a long-term difference, but many of us are also working in the front lines are also at greatest risk of developing illness from our jobs.  If we are sick and can’t do our jobs we will not have an income.  It would behoove us to reduce our recurring costs in the short-term if that will provide a sturdier financial buffer.

Stick to your financial plan
When a large percentage of your investments go to pot, it’s normal to want to change the plan.  However, selling your stocks at the bottom of the market or selling your real estate in a buyer’s market is the easiest way to lose the long game.  There is no reason to sell low unless you are cash-strapped and have no other way to pay your bills.  The more level-headed approach when there is global financial downturn is to review your financial plan.  Now is the time to rebalance your portfolio if the change exceeds your thresholds.  If you don’t have a financial plan, now is the best time to create one!  If your tenants are asking for deferred payments, figure out what is reasonable in order to make the situation work.  You don’t want them to default, but you also don’t want to go bankrupt being a nice guy. 

Now is also the time to negotiate with your creditors too, especially if you are a small business owner.  If you own your medical practice, now is the time to see what your landlord can do for you in times of financial crisis.  As a doctor, you are likely going to be the most reliable tenant the landlord will have.  They should do whatever they can in order to help you out.  Likewise, now is the time to see what loans you can defer, what vendors you can postpone payments (electronic health record, maintenance…etc). 

Ride the wave

The winner is always the last person standing.  Remember that these economic troughs will eventually become a peak.  The game plan is to outlast the trough.  

Stay safe everyone!

Financial checklist for the holidays – MD edition

Financial checklist for the holidays – MD edition

Happy holidays everyone!  December is typically a time of gathering, relaxation, and gifting.  Aside from the festivities that we participate in this time of year, it is also important to remember that health is the best possible wealth we can possess.  Those of us working in the hospitals have seen the tragedies that can roll into the emergency room, and we are all grateful for those healthcare workers who are on duty when most of the world is at home with their families.  

In keeping with financial angle of this website, here are a few housekeeping items to make note of before we ring in a new year:

Keep receipts of your donations

The amount of bookkeeping needed for non-cash donations like clothing and furniture depends on how much you are giving away.  In general, you should ask for receipts on everything you donate in order to show that the receiving party qualifies as a non-profit or equivalent entity.  Amounts greater than $500 require more substantial proof of donation, like detailed photos, where the items are from, and estimated worth.  Non-cash donations totaling $5000 or more will likely require official appraisal values.

Everyone deserves to have a good time this season!

Cash or cash-equivalent donations can be deducted in full on your tax return, provided that the amount doesn’t exceed a certain percentage of your gross income. 

It’s better to keep good bookkeeping up front—as we all know our memory fades with time!

Get ready to fund your Roth IRA in the new year

Most doctors should be able to front load their Roth IRAs in January.  Remember that the longer that you are invested in the market, the more likely (historically) you will come out ahead.

Fund your 529 account

If you intend to fund a child’s 529 account, do it before the end of the year if you want to have a tax deduction.  If your state doesn’t offer a tax deduction or if you’re using another state’s 529 custodian, then contributions based on tax year will not matter.

Self-employed can finalize 401k contributions

Most self-employed physicians simply contribute up to the maximum 401k limits, but many doctors have full-time employment jobs along with contract or locums work.  Income earned from these ancillary income sources may not necessarily allow for maximum contributions up to the IRS limits. 

That’s it! We hope that all of our readers have a safe and joyous holiday season!

What other financial housekeeping tasks do you complete before the year’s end? 

Photo courtesy of Flickr.

Why every doctor needs to think about early retirement

Why every doctor needs to think about early retirement

While there’s no strict definition on what constitutes “early retirement” (FIRE, or financially independent, retiring early), those in the non-medical field who can enter the workforce in their early twenties can potentially build enough savings to retire with less than ten years of “working”.  Obviously this calculation is dependent upon many assumptions on savings rate and expenses, but since the term came into use I don’t recall anyone publicly announcing that their early retirement experiment actually failed. Only time will tell perhaps.

Doctors, by nature of their protracted education duration, are typically a decade behind in earnings compared to their peers in other professions.  Many doctors are also burdened by educational debt, which averaged around $200,000 for graduates in 2018.  Fortunately our profession can still overcome these financial disadvantages and still sustain a relatively good living in the long run [for now].  If doctors can’t “retire by 30”, then is it possible for them to retire in a similar amount of time once they obtain “real jobs”?

Doctors can definitely opt to retire “early”.
The rate at which we can build our nest egg is directly proportional to the amount that we can save.  Non-doctors with six-figure salaries can FIRE within a decade of work.  Doctors, if maintaining a comparable standard of living other “FIREee’s”, can potentially retire early within their first fifteen years of medical practice even if they have to pay off a six-figure educational debt.  There are definitely doctors and other high-earning individuals who have opted to retire before the expected age to hang up their hats, but that is not the norm. 

Why?

That’d be bucking the trend.  Most of the time it’s not practical to give up on a stable profession that pays well. Why would you want to spend your twenties studying and working off your tail to become a doctor and then quit?   The other problem involves lifestyle creep.  As we all know, it’s easy growing into your income.  Sometimes it’s no fault of our [mostly] own, but rather the environment where we live.  It’s normal that people would opt to live in more affluent neighborhood to raise their children.  These areas not only have more expensive homes but also have higher association fees and requirements to keep your front lawn green and manicured.  I have a friend whose lawn bill costs $800 a month!  I know doctors who maintain a professional clothing budget of $250 a month.  Most of these doctors opted to live in the neighborhoods attached to the most desirable school systems yet still send their kids to private secondary schools.  These recurring expenses certainly make it difficult to scale back without having to relocate.

You might also like: Is a degree from a prestigious medical school advantageous for doctors?

The evolving medical landscape
Those of us in medicine know that regulatory changes (for the worse), reimbursement cutbacks, and increasing physician responsibilities can turn the most visionary of doctors into cynics.  The worst part about being in the healthcare industry is that it is constantly an uphill battle for doctors.  

You might also like: Can the health system afford to give doctors raises?

With a fixed or diminishing amount of funds in our existing healthcare system, most of us are aware that it is only a matter of time that new unfavorable rules to doctors are passed.  Not a day goes by in the hospital that I don’t see some doctor griping about some change that puts doctors at a disadvantage:

  • Anesthesiologists losing a hospital contract to another group predominantly staffed by midlevels.
  • Nocturnist shifts that pay the same as a daytime Hospitalist shift.
  • No more bottled sodas in the doctor’s lounge.
  • Revised RVU bonus compensation schedule that is unachievable.
  • Emergency room doctors getting fired and replaced by midlevels due to lower costs at the expense of training.

As most things in life you can complain about anything and everything, but most of the gripes we hear are well-warranted.  I’ve met too many doctors who are simply stuck in their jobs because it helps them pay the bills.  

If you grow your own oranges, you will be less susceptible to fluctuations in the produce market!

Break the cycle
The strongest negotiating chip one can have is the ability to walk away from the deal if the other party doesn’t agree to favorable terms.  The only real way to do that is if your livelihood doesn’t depend on the job itself.  The same analogy goes for several of my colleagues in academic medicine—some of them with independent family wealth opted to take a significantly lower paying university-based job in order to practice medicine without dealing with the insurance hassles (epilogue: they still deal with insurance hassles).

So aiming to reach early financial independence even though you have no intention of quitting medicine early may serve as a buffer to any changes in medicine that are out of your control.  If your working conditions end up become intolerable, you have more freedom to walk away.  Most doctors won’t have to use their exit strategies but having one might be the most foolproof option not to lock yourself into golden handcuffs.

Does your financial strategy involve aiming to reach financial independence early?

The hate associated with being a Californian doctor

The hate associated with being a Californian doctor

Geographical arbitrage is a huge component to being able to build wealth in a timely manner.  For doctors, the formula for rapid wealth accumulation calls for geographical arbitrage even more strongly as our salaries do not have wide ranges across the country.  A doctor in Texas will probably command a similar salary in Arizona (maybe slightly less).  A doctor in the midwest might earn more, spend less, and work less than her equivalent in California.  By this token, who would want ever want to live in the Sunshine state?


There was a recent post on the White Coat Investor website enumerating all of the financial disadvantages of being a doctor in California.  Sadly for those in California, those reasons are backed by fact—on average, you’re going to probably going to work pretty hard as a physician in California, spend $1 million on a starter home, and commute a few hours a week. By the way, gas is around $4 a gallon.

The fuel to the fire

Those of us living in California are probably aware of many other factors that make living in the area financially tough. Some of them that come to mind include:

  • Private practice physicians can’t establish as an LLC. This basically means that you have to pay a little more and deal with more logistics to get a corporation established.
  • Payor mix is skewed. There are practices that thrive on taking care of MediCal patients.  Actually, in-office visits pay horribly but if you patient needs surgery you can actually get decent reimbursement.
  • High concentration of doctors.  California has over 50,000 physicians. Many of these doctors are clumped in the larger cities so competition is tough. Many plastic surgeons in California operate on Fridays and Saturdays in order to capture the appropriate demographic. Think longer hours.
  • Potentially malignant physician employers.  Those doctors who have potential to join private practices will face employers who will burn and churn you. Full-time jobs at part-time salaries. You name it, and it exists. 
  • Inter-office commuting.  One of my friends covers 4 offices for his practice and operates at 3 different hospitals.  By the way, he can’t expense it, because he is a W2 employee. 
The “special” gas, by the way, has an octane rating of 89.

California is not all bad

There are almost 40 million people living in California.  It’s got to be not all bad.  Many of the reasons that people use to justify living this fair state are emotionally charged, but there is still good reason that they are valid. Let’s take a look at some of them:

  • Ethnic diversity.  There is more benefit than face value of having diversity.  Part of this argument sounds snobby, but this is how some doctors justify working 6 days a week trying to pay off a $1.4 million home that they don’t really even like.  This is more than moving to Detroit to take a highly competitive Hospitalist job because it has a sizable Middle Eastern population and good Halal options.  Most doctors I know have eaten tasty dim sum rolled around a cart, but probably have no idea that the real stuff can only be found in more diverse cities like Los Angeles, New York, or San Francisco.  Does this matter to everyone? For some people it clearly matters a lot.
  • Proximity to family.  We all know that this is important, but sometimes it’s non-negotiable.  
  • Values and attitude.  We all know that type of laid-back attitude, culture, and general vibe in California. Sometimes all that you need to know that the world is going to be okay is that jogging path down by the pier, the Iranian supermarket where you can get 6 tangerines for $1, or the sunny weather when you go hiking.  Likewise, those die-hard New Yorkers wouldn’t trade their lifestyle for anything else. 

Getting hit financially

The average physician in California will likely take longer to build up her bank account.  Some two physician households in California will only generate an earning power comparable to a single physician family in the Midwest.  The biggest question is whether that is going to be okay with you.  If you want to be financially independent by age 40 it might be tough.  Most doctors, however, will still be able to manage a respectable living with judicious financial choices–if doctor’s can’t afford to live in California, then who can?  Let’s stop the hate on the Californian doctor!

Californians and New Yorkers, I want some love! Why do you choose to live in the cities that you are in?