Big City Exodus

Podcast Transcript:

The Big City Exodus

Welcome to The Perfect Place to Put a Practice Podcast! I’m your host, Mike Green, from Doctor Demographics. Today, we’re exploring a major shift that’s reshaping where doctors and practice owners are setting up shop. We’ll look at why practices are moving out of bustling urban centers to suburbs or even entirely new states, years after the initial COVID disruptions. If you’re thinking about relocating your practice or starting fresh, this episode is packed with insights to help you navigate the trend. 

Okay, welcome to all of you good people, and we want to thank you for listening and supporting the podcast for our now over 300 episodes. Also, for those of you who are in the dental world, if you haven’t gotten my book titled “Dental Marketing Mastery” yet, it is available in both softcover and kindle versions now on Amazon. We’ve received a lot of great feedback from it, and I know that it will be helpful for you in your marketing efforts moving forward.

Alright, let's dive into today’s topic. The "Big City Exodus" isn’t just a catchy phrase—it’s a real, ongoing trend that started accelerating during the COVID-19 pandemic and has continued to gain momentum in the years since. We’re now in 2025, about five years removed from the height of the crisis, and what began as a reaction to shutdowns and restrictions has evolved into a strategic rethink for many practice owners. Practices are leaving high-density cities for suburbs, smaller towns, or even crossing state lines. This isn’t about politics; it’s about adapting to new realities in patient behavior, operational costs, and quality of life. Today, we’ll break down the data behind the trend, share real-world examples, discuss the pros and cons, and give you actionable tips if you’re considering a move.

First, let’s set the stage with why this exodus is happening. During the early days of COVID in 2020 and 2021, many big cities enforced strict shutdowns that forced non-essential businesses, including many healthcare practices, to close temporarily. This hit urban areas hard, where high rents, dense populations, and reliance on foot traffic amplified the challenges. Practices in places like New York City, San Francisco, and Chicago saw revenues plummet as patients delayed visits or sought care elsewhere. But even as things normalized, the experience prompted a reevaluation. According to U.S. Census Bureau data from 2023, over 5 million people moved out of major metropolitan areas between 2020 and 2022 alone, with many heading to suburbs or Sun Belt states. This population shift dragged patients—and thus business opportunities—with it.

For healthcare practices, this meant following the flow. A 2024 report from the American Dental Association highlights that about 12% of dental practices relocated between 2021 and 2023, with a notable uptick in moves from urban to suburban or interstate locations. Veterinarians and optometrists saw similar patterns, per data from the American Veterinary Medical Association and the American Optometric Association. Why? Patients who relocated during the pandemic often stayed put, seeking local care in their new homes. Practices that didn’t adapt risked losing their patient base. Plus, remote work became permanent for many, allowing professionals to live farther from city centers without commuting hassles.

Let’s zoom in on a specific example: dental offices moving from New York City to areas like Atlanta. New York City was one of the hardest-hit areas during COVID, with mandatory shutdowns lasting months for non-emergency dental care. Many dentists faced empty chairs, mounting bills, and uncertainty. Fast-forward to today, and we’ve seen a wave of relocations. For instance, a client of ours—a general dentist in Manhattan—decided to move his practice to the Atlanta suburbs in 2022. Why Atlanta? The city saw a 1.5% population increase in 2023 alone, driven by inflows from northern states, according to Census data. Lower commercial rents (often 30-50% cheaper than NYC), a growing family-oriented demographic, and easier access to talent made it a no-brainer. His patient volume grew 25% in the first year post-move, as he tapped into underserved suburban markets. This isn’t isolated; the ADA notes that interstate moves for dentists increased by 18% post-2020, with destinations like Georgia, Texas, and Florida leading the pack.

But it’s not just dentists—veterinarians are following suit. Pet ownership surged during COVID, with the AVMA reporting a 6% increase nationwide. Urban vets in cities like Los Angeles struggled with space constraints for larger animals or boarding facilities during shutdowns. Many have shifted to suburban spots in places like Orange County or even to states like North Carolina, where land is cheaper and pet-friendly communities are booming. Optometrists, too, are moving. With more people working from home, demand for vision care tied to screen time has risen, but urban practices faced higher overhead. A 2023 AOA survey showed 10% of optometry practices relocated, often to suburbs where they could offer expanded services like contact lens fittings in larger, more affordable spaces.

Now, let’s talk about the broader trends we’re seeing in 2025. The exodus has matured from a knee-jerk reaction to a calculated strategy. Key drivers include cost savings: Urban commercial real estate costs have stabilized but remain high—think $50-100 per square foot in NYC versus $20-40 in Atlanta suburbs, per CBRE real estate reports. Quality of life plays a big role too; many practice owners cite better work-life balance in less crowded areas, with easier parking, shorter commutes, and family-friendly environments. Patient demographics have shifted as well—suburbs now house more young families and retirees, creating demand for pediatric dentistry, senior eye care, or family vet services.

Data from the Bureau of Labor Statistics shows healthcare job growth in suburban and exurban areas outpacing cities by 15% since 2022. This means easier hiring for staff like hygienists or technicians, who often prefer suburban living. Plus, technology has helped: Telehealth, adopted widely during COVID, allows practices to maintain ties with former urban patients while building new local ones.

Of course, it’s not all smooth sailing. There are pros and cons to joining the exodus. On the pro side: Lower operational costs can boost profitability by 10-20%, per industry benchmarks. You might gain a competitive edge in underserved areas, where patient-to-provider ratios are more favorable—think 2,000 patients per dentist in some suburbs versus 1,500 in oversaturated cities. Marketing becomes more targeted too, focusing on local SEO and community events rather than expensive urban ads.

But cons exist: Relocating means upfront costs like moving equipment, licensing in a new state, and rebuilding your patient base. It could take 6-12 months to ramp up, so cash reserves are crucial. If your specialty relies on urban density—like high-end cosmetic dentistry—you might need to adapt services. And don’t forget cultural shifts; suburbs often have different patient expectations, like more emphasis on convenience and family care.

If you’re considering a move, here’s some practical advice. Start with data: Use tools like our Doctor Demographics reports to analyze population trends, competition, and income levels in target areas. Look at states with strong post-COVID recovery, like Texas (up 1.6% population growth in 2024) or Florida (1.1%). Factor in your specialty—vets might thrive in pet-heavy suburbs, while optometrists could target areas with aging populations. Budget for the transition: Expect $50,000-$150,000 in moving costs, but offset with potential savings. Finally, test the waters—consider a satellite office before a full relocation.

Before we wrap up, remember that this trend is about opportunity. The big city exodus has opened doors for practices to thrive in new ways, following patients and embracing change. At Doctor Demographics, we specialize in helping you find that perfect spot, whether it’s a suburb or a new state. If you’re curious, head to our website at doctordemographics.com for a free consultation.

Alright, folks, that’s it for today’s episode of The Perfect Place to Put a Practice. I hope you’ve got fresh ideas on navigating the big city exodus and positioning your practice for success. If you found this helpful, please subscribe, leave us a review, and share this episode with a colleague who’s eyeing a move.

If you’d like to continue this conversation, visit us at www.doctordemographics.com or give us a call at (844) 704-0499. We'll see you on the next episode.