At a recent talk I gave to radiology residents at a prominent teaching hospital in New York City, I was reminded that doctors in big cities face surprising income pressures.

You would think that for most professions, moving to a world-class city would allow you to maximize your potential income.  However, this is not the case for physicians in cities like New York City, Boston, and Washington D.C.  Here starting doctors’ salaries are $50,000-$100,000 lower than the salaries outside the urban areas.

Large cities are the places where most doctors complete their training.  Physicians may begin their education in smaller communities, but by the time their residencies are finished, they have often lived in major metropolitan areas, where they may have met their spouses, and started families.  This feeds a desire to stay in major metropolitan  cities after residency, in addition to the obvious attraction of a large city.  However, this also leads to a glut of physicians competing for a limited number of positions each year.

When there are too many physicians in a given market, it drives salaries down for the physicians in that market in a way that often appears unsustainable.  What is a new doctor to do?  One possibility is to simply accept lower salary expectations with the hope of making up the pay deficit in the future.  However, for most doctors the best answer is to widen your expectations in terms of what types of communities might be acceptable.  There are good high paying job for doctors across the United States so long as you can look beyond the largest cities on the east and west coasts; and the quality of life in these communities can rival what large cities can provide.