I'll give you the other side of the coin. My husband is IM in Pittsburgh as a hospitalist because he got residency in Youngstown. First screw the tristate for not considering giving preference for their own unlike the rest of the county. My husband ranked both FM/IM in CT, NY, NJ and he did rotations in all those programs but one.

Youngstown was next on the list after that. He gets to Youngstown and tells them he's staying local since I moved to Pittsburgh 8 months into residency. They gave him the shittiest outpatient rotations and gave Ohioans the good ones. Most of them specialized or didn't stay in the area.

So he pisses off his program by not staying on for outpatient after finishing residency. That residency program killed his dream of opening a practice early on. Now he's a hospitalist, makes good money, we have LCOL, loans will get paid off, WLB and doesn't take work home.

All of the PCP practices are closing and the hospitalists' workloads are increasing because those old PCP rounded on their patients at the hospital. No one wants to take over their practices, it's not worth it.

Now we are living here until the loans are paid off, we don't need early intervention since NJ has an income cap unlike PA, and our kids are out of public preschool. When we move back I fully doubt my husband switch to PCP. Our trajectory changed so drastically by matching in the Midwest.