Relocation – It's Not for the Weak

by Jarrod Shapiro, DPM Joined Mountain View Medical & Surgical Associates of Madras, Oregon July 2008

The worst part of relocation is the actual moving. As physicians most of us have been forced to relocate several times during college, our training, and early careers. I’ve managed to move 10 times in the past 10 years! Few things seem to test our patience, preparedness, and perseverance better than moving. Additionally, moving is almost always more expensive than we budget for. To this end I wanted to provide a realistic view of the expenses incurred while relocating. This will apply not only to those in my situation (relocation after a short time in practice) but also for residents completing their programs, students, and even practitioners who are moving to new opportunities. Before I dig into the nitty-gritty of moving, I wanted to answer a question I received a short while back.

Ben Olsen, DPM asked this question:

"Prior to moving did you accumulate any documentation in preparation for board certification? Curious how you planned on handling this with the relocation."

This is a great question considering how important board certification is. After I started practice I read through the ABPS certification process (www.abps.org) to figure out what their requirements were. I had already started a list of my surgical cases to track my numbers and categories. Then a few months before I left I started photocopying all of the charts from my surgical cases, in addition to copying all of the pertinent radiographs and OR records from the hospitals. This is actually a very time consuming process which required quite a bit of my personal time. To make matters worse, many of my charts are hand-written because my prior boss did not dictate or use EMR. As it gets closer to applying for the boards I will have to transcribe these records. I would advise any associates at the start of their surgical careers to closely track your cases and copy everything you can just in case. I had a very amicable split with my prior employer (we’re still friends) but it’s not always the case.

Now, back to the move. Listed below is a general breakdown of the direct moving costs I incurred. These are the actual expenses I submitted to my new employer for reimbursement (I negotiated a $5000 relocation stipend into my contract – I should have asked for $10,000 – it would have made the move easier). Keep in mind there are many ways to relocate, and what I’m describing are the choices I made. I could have done it differently, and it would not have been wrong or right, just what was most appropriate at the time.

Here are the particulars of my move. We rented a 24 foot diesel Budget moving truck which I drove from Lansing, MI to Madras, OR (approx 2200 miles). I opted out of their insurance since my car insurance covered the truck. Gas was very expensive at almost $5.00/gal diesel. I paid to fly my wife and son to Oregon and stay in a hotel until I arrived with the truck (traveling across country with a 3 year old is not my idea of fun!). A professional mover may have been easier and would have been slightly cheaper, but they had a 7 day arrival window. I had allowed myself 2 weeks between jobs to move, and I needed to control when I arrived. Additionally, after a comprehensive review of various moving companies, the overall satisfaction rate of patrons was low. I wasn’t about to trust anyone with my stuff!

Direct Moving Costs:

As you can see my direct moving costs were greater than my moving reimbursement. Keep in mind, though, the indirect costs to move. These include house rental deposit and first month’s rent, utility start-up deposits, local cable and internet access deposits, automobile registration, driver license fees, home “moving in expenses” (for example, I had to install a mailbox), and renter’s insurance. These expenses are in addition to my financial aid loans, credit card bills, etc. All of these expenses occurred BEFORE I received my first paycheck. All in all the total direct and indirect relocation expenses came to about $10,000.

Here are some recommendations to make your move less stressful:

1. Negotiate at least a $10,000 relocation stipend into your contract. Request to be given this money BEFORE you move.

2. Plan your move far ahead of the actual moving date if possible. For example, gather boxes, supplies, etc over time.

3. Secure moving help to move out and in, the more the better.

4. Create an address change list to notify all contacts of your new address. This is especially true for financial aid payments. Don’t get yourself in trouble with the autopay feature of your loans.

5. Review all your moving company options, whether it’s U-Haul, a professional mover or a U-Pack moving “box.” Different options are appropriate for different people.

6. Save as much money as possible before the move for the “unexpected”. In my case I wasn’t paid for about six weeks after I left my prior job.

7. Give yourself time to move and learn your new location. Two weeks is not enough if you have to move across country.

8. Save all of your receipts. You can deduct moving expenses on your federal taxes if you move more than 50 miles.

Relocating to a new town, whether it’s 50 miles or 5000 miles, takes a lot of work. With some planning (and a little luck) it doesn’t have to be a terrible experience. What moving tips have you found to be useful? Write in with your experiences.

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]

***Free Advice***

I am for giving free advice as Dr.Shapiro states so eloquently. I find that it does not hurt too much and I have gotten a few patients by giving a small amount of advice. Plus it makes me feel like I'm giving something back to the community.

John Spina DPM
291 Smith Street
Brooklyn,New York 11231
[email protected]

***Treating all patients***

...I too wish for those days of treating everyone, insurance or not, however, had to go the route to make a living, My family needs to eat, go to college etc. Life especially for beginning pods is tough. Still love podiatry, even though financially sometimes it is rough....I have always enjoyed your articles.

John Shapiro
[email protected]

Time: A Doc's Best Friend

by Jarrod Shapiro, DPM Joined practice July 2006 of John K Throckmorton, DPM Lansing, Michigan The Rolling Stones said, "Time is on my side." That's doubly true for medicine. As physicians, we have an armamentarium of options available for the treatment of disease and disability. These may include anti-inflammatory modalities, prostheses, physical therapy, and surgery, among others. I would posit that TIME is another very powerful method available to us.  A common new patient complaint for me, as well as just about any podiatrist, is hallux valgus-associated pain. In my opinion, this is a surgical issue. However, I usually recommend some form of nonsurgical care before undergoing surgery. In addition to whatever comfort measures I prescribe, I'm also adding the unspoken treatment of TIME. I'm getting to know my patient: if they cannot comply with simple nonsurgical prescriptions, how are they going to be compliant in the postoperative period? This noncompliance may be physical as well as psychological. If my patient has a balance issue and cannot remain nonweightbearing after a Lapidus procedure, my choice of surgical procedures will vary accordingly. On the other hand, if my patient cannot follow simple instructions like stretching exercises or appropriate shoegear, then I will likely not perform any surgery. Time allows me to better appreciate these types of limitations. Time is also important in wound care circles. I've had patients in the hospital with severe PAD and gangrene that have undergone revascularization. In many instances, it is better to wait and watch for demarcation before performing a definitive procedure. Again, time is an important part of the plan. So, the last thing I would want would be to see my wound patients every day. Although it would be monetarily profitable, I need the luxury of time to appreciate the changes in the wound as time progresses. Perspective is power. The same argument applies to many traumatic situations. We all know the classic discussion about fracture blisters. Some advocate incising through the blisters, while others approach it with a "wait and see" attitude. They are prescribing time to diminish the edema and allow the blisters to, at least begin to resolve. Isn't the Gustillo and Anderson classification of open fractures based on a prescription of time? This classification is essentially a time-based system that links greater risk of infection with greater time since injury. Time (and antibiotics) are prescribed to allow for infection resolution before delayed primary closure. Human beings are experiential creatures. We absorb and understand the world around us as individual experiences — as moments in time- within a greater context. As wonderful and rich as this may make our everyday lives, medicine requires a broader view to be effective. In essence, medicine is a dynamic process which constantly changes, and TIME is the required component to appreciate this change. When I look back on my medical school and residency training, I see this time period as both a series of individual events (first day of school, white coat ceremony, graduation) within a larger framework (obtaining the knowledge and skills necessary to become a practicing physician). We're all well aware of the investment in time to become a physician. Time is our prescription, which gives us the opportunity to become seasoned physicians. In our high-paced life, taking extra time to allow an event to come to completion on its own may be exceedingly difficult. I would urge you to keep in mind the tool of TIME as an ASSET in your professional and personal life. Just as it's an important part of our medical arsenal, so is TIME important in our personal lives. Jarrod Shapiro, DPM PRESENT New Docs Editor [email protected]