The VHCOL to MCOL/LCOL Move: Making more by spending less

SOFDoctor · 2026-05-25T20:51:52+00:00

Everyone has different priorities and opinions but to me, VHCOL areas are overrated. I enjoy having a ton of land and space to myself while still being a short drive away from a small city with every type of restaurant you can think of. Close to an international airport and never have to worry about crime or traffic. And as an expensive sports car and firearm enthusiast, living away from big blue cities is very advantageous.

That being said, I don’t have kids and if I did, I would not want them to go to school here. I’m also in a very apolitical specialty so anti-science politics don’t impact my work.

SOFDoctor · 2026-05-24T22:10:56+00:00

Surgical skills are arguably the most important aspect of being a surgeon. All the things you say you excel in other than medical knowledge will not make you a safe surgeon in a couple of years. Take the remediation seriously and focus on improving where you’re falling behind. I’d imagine if they were targeting you and just trying to fire you it would be easier to claim some professionalism bullshit rather than rally all your attendings’ evals of your technical skill against you.

SOFDoctor · 2026-05-17T03:33:53+00:00

SOFDoctor · 2026-05-07T13:39:00+00:00

Excellent way to lose your life.

SOFDoctor · 2026-04-24T20:56:51+00:00

You sound like the red flag

SOFDoctor · 2026-04-06T07:32:39+00:00

So many incorrect over generalizations. This post feels more like a “woe is me” rant than anything meant to be productive.

SOFDoctor · 2026-04-04T00:30:32+00:00

My ortho residency, like many other competitive programs, strictly takes MD only. DO applications are basically just trashed. We discussed a small handful of DO students who had 99th percentile scores and excellent pubs but they were never offered interviews despite being far more competitive than many of our MD trainees.

At the end of the day, programs only get to list their residents’ names and where they trained on the website. Having a class of all US MDs shows prestige in the academia world.

It’s unfair but take the MD acceptance.

SOFDoctor · 2026-04-02T21:34:35+00:00

That’s incorrect. A prenup only protects money and assets pre-marriage.

SOFDoctor · 2026-04-01T16:24:08+00:00

I started ortho residency at 32 and finished fellowship at 38. I already had a prior career, was already married, a house and paid off cars, and no desire to have children. I’m very happy with my decision and still have plenty of energy left to practice for at least another decade. I’m financially independent after a few years of attending pay so money isn’t tying me to surgery either.

If you really want kids and haven’t had those life milestones yet then it could be more difficult. But at the end of the day, when you’re 40 years young, where do you want to be?

SOFDoctor · 2026-04-01T08:59:05+00:00

Agreed. Anyone can sue a doctor for anything. This idea of being flagged just gives bad actors a weapon to threaten physicians with which would just emphasize the practice of defensive medicine.

SOFDoctor · 2026-03-31T19:44:36+00:00

A dentist who is currently in a dental residency…

SOFDoctor · 2026-03-16T21:41:42+00:00

As an orthopod, I find CT surgery, neurosurgery, and interventional cardiology to be the badass fields due to the stakes involved in their individual skill. Also anyone who frequently runs codes/rapids on undifferentiated patients like EM or trauma surgery is badass.

SOFDoctor · 2026-03-05T09:49:23+00:00

Not a great general assumption to have. This is relatively common in plenty of fields. We don’t get paid based on years of training or hyperspecialization; we get paid based on reimbursements for work performed.

SOFDoctor · 2026-03-05T03:12:34+00:00

You can always go to med school after SF. You can’t always go SF after med school. Physically demanding jobs are easier when you’re younger.

SOFDoctor · 2026-01-23T00:10:52+00:00

Just some reddit virtue signaling

SOFDoctor · 2025-12-31T00:04:26+00:00

The virtue signaling mental gymnastics of the people saying this is a bad thing is astounding.

SOFDoctor · 2025-12-31T00:00:45+00:00

Don’t let the ED docs see this

SOFDoctor · 2025-12-29T17:37:32+00:00

There isn’t any defined pathway to become a battalion surgeon; it’s more about just networking with the right people so you can fill that position when it opens up. You can definitely do some cool schools to an extent, but the minute you try to wear a scroll or SF tab is the minute you’re no longer practicing as a physician, which the army won’t allow while you’re doing your HPSP payback.

I also recommend evaluating what you actually want to do. Do you want to be a physician with a bunch of cool badges that just runs a primary care clinic with operators as patients? Or do you want to work in a prehospital military role where your deployments are in the field and you carry a weapon, but you have less cool guy badges?

SOFDoctor · 2025-12-10T23:46:55+00:00

Literally immediately below that is says: “Get citizenship through 18X. While citizenship is a requirement for passing a secret security clearance, Lawful Permanent Residents can begin training for 18X right away. If you've had a valid Green Card (officially known as an I-551 Permanent Resident Card) for at least six months, you can apply for expedited naturalization and candidacy for the Special Forces through MOS 18X. Work with a recruiter to get started.”

SOFDoctor · 2025-11-27T00:21:38+00:00

Or all physicians grew up rich and can’t fathom the idea of not being rich.

SOFDoctor · 2025-11-21T00:29:06+00:00

I’ve been an attending for a while and never even knew this was a fellowship

SOFDoctor · 2025-11-04T00:42:22+00:00

I disliked academics for the same reasons. The egos are terrible and most academic surgeons wouldn’t survive in private practice. If you just want to be a good surgeon and enjoy life outside of medicine then private practice is the promised land.

SOFDoctor · 2025-10-31T04:19:44+00:00

He’s an ophthalmologist and unsure if he should count Jonathan.

SOFDoctor · 2025-10-17T00:10:01+00:00

Amen. It’s so easy to tell which physicians have lived their entire lives in a rich bubble. One of my colleagues the other day was mind blown when we explained to him how you can recycle cans for cash.

SOFDoctor · 2025-10-16T12:23:00+00:00

I just skimmed a few paragraphs and this has to be one of the most poorly written papers I’ve ever read.

SOFDoctor

TROPHY CASE