New M.D.

I'm On The Road — Again

By Lauren A. Eckstein, M.D., Ph.D.

Regular readers of this column (at least those few who routinely make it to the end of the articles) may have recently noticed a change in the author's bio.

I've recently relocated from the Jules Stein Eye Institute at UCLA in Los Angeles — where I have completed my residency in ophthalmology — to the Scheie Eye Institute in Philadelphia — where I am now completing my fellowship in oculofacial surgery.

Of course, as I am just a few days into a 2-year training program as I write this, one could hardly consider that I am near to completing much of anything. But that is a subject for another column. Instead, I thought I would reflect on one of the unique challenges that face all of us during our lengthy training.

Relocating for Medical Training

Many professionals outside of medicine travel for their education. However, following the completion of their didactic instruction — at the end of law school or business school, for instance — they might reasonably expect that they will find permanent employment.

Even if they choose (or are forced) to change positions or employers at some time in the future, most non-medical professionals whom I have known anticipate remaining in the same geographic region. They likely presume that where they now call home will remain "home." Indeed, for nearly all of my friends and colleagues who are not associated with the medical profession, this has been true. They may have moved for college and again for professional school, but they have not relocated thereafter.

Not so for most medical professionals. For many, being able to take advantage of highly regarded educational and training opportunities requires moving multiple times in a very short period. I moved for university, medical school, internship, residency and again for fellowship. This averages to a major relocation approximately every 3 years.

Moving Has its Challenges

To be sure, this has been an exciting process. I have been fortunate to live in many dynamic and enriching communities while at the same time receiving unmatched educational opportunities. I have explored parts of the country within which I never dreamed of living and have grown tremendously as a consequence of the unique cultures and people to which I have been exposed. Nevertheless, it has at times also been a struggle.

Although the rewards may be great, numerous challenges arise from moving frequently. Obviously, there is the difficulty of orienting to a new community: securing a place to live, building a new circle of friends or even just finding a good place in Philly to get a decent burrito (clearly, finding a great cheesesteak place is not a problem here). But there are other challenges that uniquely confront medical practitioners: negotiating novel credentialing processes, securing a new medical license, re-establishing a reputation within the community (both professional and lay) and many others.

Relocating Can Hurt a Career

Although most of these challenges may be successfully addressed and rapidly overcome, the time required to develop a reputation within the community can be significant. As such, the cost associated with some of these relocations may be very high, once factoring in the effects of diminished referrals, reduced productivity and lost revenue. Of course, these financial effects are minimal during the early stages of medical education, but they may become significant during specialty and subspecialty training. For many, these financial repercussions may delay the ability of a practitioner to repay education loans and may even contribute to reluctance among new graduates to seek additional subspecialty training.

New Position is an Opportunity

While I have been spared the effects of some of these economic realities during my most recent move, I have had to confront many other challenges. Some are already complete (I have found a great new place to live, for instance), but many more remain a "work in progress" (if anyone can direct me to a good Mexican restaurant here in Philadelphia, I'd love to hear from you). Nevertheless, I am delighted by my new position and excited by the vast opportunities to learn as a physician and grow as a person that once again await. OM