Major Commute for Better Wages?

May 1, 2008

I live near LAX and want to commute somewhere to do pain medicine four days a week, hopefully to a state income tax-free area where the reimbursement is good. Where would that be? Possibly a godforsaken place no physician wants to live, to cut down on the competition? California’s a tax tough place; practice expenses are rough as well. Any advice would be appreciated.

Question: I live near LAX and want to commute somewhere to do pain medicine four days a week, hopefully to a state income tax-free area where the reimbursement is good. Where would that be? Possibly a godforsaken place no physician wants to live, to cut down on the competition? California’s a tax tough place; practice expenses are rough as well. Any advice would be appreciated.

Answer: You want to stay in southern California and commute to a tax-free spot? Really your only choice is Nevada, which is a bit of a commute four days a week. Your gas costs alone (let alone your lack of a social life) might make the tax savings hardly worth it.

My advice? You need to decide, first of all, if you want to stay in California or not. That has everything to do with your whole life, not just your business. It is expensive, but so are most places you’d actually want to live.

If you want to stay, then find a business model that makes staying there feasible. This is easier said than done but practices that are cagey about cost control, contracting, marketing, and collections can and are doing just fine.

Part of the process, too, is realizing what you can realistically expect and what you are willing to give up to stay where you are.

Generally, if you move somewhere less attractive, you may make a little less, though it’ll go further, but then there aren’t very many nightspots filled with celebrities where you can spend your cash.

Finally, check out our article on the best places to practice.