Location, Location, Location

Faster than I expected, I'm starting to look at my 4th year electives. It's tough - there's not much time to work with, a lot of uncertainty about what kind of elective I can get, or even what electives I want to get. Not knowing exactly what specialty I want yet makes it that much more challenging...

Anyway, the reason I bring this up is that I've increasingly become aware of how difficult it is to control where you live when doing your training. I've always been told that one of the best ways to ensure the career you want is to be flexible about location. Be willing to move anywhere in the country and your chances of getting your first choice specialty are very high. Be willing to move anywhere in the country and you'll get the fellowship you want, or the job you want after that.

I'm willing to move. And I'm not particularly interested in the major city centers (Toronto, Montreal, Vancouver) that tend to be uber-competitive, so my chances of ending up where I want to are at least reasonable. However, while I'm willing to move if necessary, I'd rather not move around too much over the next few years. In some career pathways, moving 4 times within a decade, potentially halfway across the country, is very plausible. For example, both Internal Medicine and Pediatrics go for three years before their subspecialty matches, each of which are typically followed by a 1-year fellowship before finding employment. That's potentially one move for residency, one move for subspecialty, one move for fellowship, and one move for work. Four potential moves total, assuming no second fellowship or locum work, both of which are entirely possible.

Granted, staying at one institution between med school and residency, residency and subspecialties, subspecialties and fellowship, and/or fellowship and employment is often an option. Most students do their residency at their home schools, after all. However, staying put isn't always a possibility. Not every residency, subspecialty, or fellowship exists at every school. Jobs aren't always easy to come by in locations with residency programs. The programs that exist where I want to stay may not be high-quality or tailored to my needs. They may not want me as a resident/fellow/employee either.

That's giving me a lot of pause when it comes to considering a long-term career pathway. If I'm going to move for residency, I'd rather not set myself up to have to move for a subspecialty or for fellowships. That's easier said than done, especially outside the competitive large cities.

This realization is also exposing a fairly fundamental conflict in my career/life planning. I'm ambitious, but I also work to live, not live to work. Optimizing my career goals means moving, a lot. Optimizing my life outside of my career means moving as little as possible. I'm not sure how easily I'll be able to find that balance.

Yet, finding that balance is now the goal. As a plan my electives, I also start to set my career path in motion. I've only got 16 elective weeks to find locations/programs that fit me well, fit my family well, and have some desirable career options moving forward. These weeks are also my best opportunities to show those programs that they should want me in their programs. Choosing electives may be the first "career" decision I've truly had to make so far since starting medical school, and I'm just now recognizing what kind of an impact these choices might have. Fingers crossed I make some good decisions!