[Podcast] Is New York City a Viable Option For Doctors?

New York City

New York City, is the most populous city in the country; but is it a viable option for doctors?

Watch the video here:

A Note from Scott McDonald on This Week’s Episode

We have been asked about the viability of New York City as a place to practice for a long time.  We thought this might be a good time to clear the air and make a definitive statement on it right now.  As the nation’s largest city, it is certainly a viable option.  Still, the City is losing (a little) a population of -0.3 % per year.  From the standpoint of a very large and dynamic community, that is not bad. There are also indications that many of the people who left are going to come back.  But there is a severe bit of caution that goes along with this.  The returning population is older and much less “family-friendly” than before.  The large numbers of Young Adults are not as likely to come back.

From an employment perspective, this might work out.  Recall that those who left NYC for New Jersey and Florida still love the Big Apple but are not “starting out” as they did before. This MAY turn out to be a big problem in the future.  Crime and a housing shortage are certainly not helping.

But, on the other hand, the rules that have defined other urban areas are not as true in this area.  That has made many demographers more hopeful about NYC’s future.

Still, the nature of the City is unique.  As I have written before, NYC is more of a collection of small cities and villages crammed in an urban setting.  To KNOW the opportunities and risks of such an evolving and diverse community requires special help.

Doctor Demographics is there for you, no matter what type of practice you are considering.

Read the Transcript Here:

Scott McDonald: [00:00:13] Hello, this is Scott McDonald and this is Dr. Demographics. The best place to put a practice now it’s a podcast webinar and as you know, we talk about different places in the United States that are showing particular promise or that our watchers or viewers are subscribers mentioned often in emails to me that they’re kind of interested in hearing more about. This session today is about one such location and it shouldn’t surprise anybody. It’s New York City. Now, let me explain. New York City is the largest city in the United States. It’s an old city. It’s been there a long period of time. And the things that make it unique are truly significant. In short, there are reasons why what I’m going to tell you is going to be true only of New York City and not true of other places in the United States. Not not only about size but about growth and demographic character, about psychographics, traffic and visibility, the places that are going to work for practices and which are not. Now, let me start out by saying New York City is far too large a place for me to do a podcast episode and explain all the places that are going to be good and bad within the Big Apple. That might be worth considering. But if you’re one of those people that’s thinking, I would like to look at New York City and I’d like to know where to go.

Scott McDonald: [00:01:51] I want you to order a report. Now, here, let me explain. There are five boroughs and Long Island in New York City. Each borough is like a separate municipality. There’s data that I have on each borough that shows the potential of particular sites within each borough. And that would be important for you to know. Now. Where should I go in Manhattan? Is not a good question, because Manhattan and even Staten Island and the Bronx and Brooklyn, well, these are such large areas in themselves and they’re extremely complex. So if you go across the river, it makes a big difference as to its potential, that place that you might be considering. But Dr. Demographics is not like other demographic companies. So we’re not going to say, oh, just ask us a question about New York City. You’ve got to have a much more granular way of looking at the city and say, is this going to be a good place or a bad place to go? What are the characteristics of the area? In other words, is it growing? Is it shrinking? Is it aging or are you having a burst of youth? Each burrow, each part of the burrow is going to be different. So please let me give you an overview now. In New York City, we can talk a lot about each burrow as being separate. But I need to hear a little bit about what it is that you want about the locations that are going to be potential for you that you’re considering purchasing or starting up.

Scott McDonald: [00:03:41] I hope that makes sense. Now I’m going to say something that may sound a little. Counterintuitive. I love New York City. I lived there. I have family there. It’s been one of my favorite places on Earth. It’s also one of the places that I hate with a passion. You’re going to hear that fairly often throughout this podcast and throughout other discussions that we have about New York City, there is a love-hate relationship. Now, those people who know New York City are not surprised by this. They understand it. Those people who don’t know it are going to be a little confused and bothered by the fact that I’m going to say something that may sound conflicting. Look. There are so many people that I have dealt with in my career as a demographer, and this includes medical and dental practices of all sorts about why they want to move to this place and no other. In fact, when I lived in New York City, my boss took me aside and said, one thing you have to understand is there are only two or three places in the United States that I. That was him speaking. Considered to be civilized. Other places are not and there are very few that are really civilized.

Scott McDonald: [00:05:11] Now, I might point out that Bob Bennett, who is my boss at the time at this big PR firm I worked in, said San Francisco is one of the only places I could possibly consider living outside of New York City. As I came to know San Francisco, I thought, you’re out of your mind. But I came to understand the things that people consider necessary to live in a place where open practice is going to vary greatly. So I’m not trying to convince you. I’m trying to reveal to you the factors that are going to make this a good or a bad place to be. Do I think that New York City is doomed? Let’s start out with that premise, and I’m going to have to share my screen. Now, I have to say that opening any kind of business in New York City is going to be different than having a practice in New York City. New York is not like any other place on Earth, and I want you to take that seriously. And when it comes to health care practices in New York City, the rules that apply to other places are not going to apply as much here. Let me explain what I mean. If the simple answer is, is New York, we’re going to the answer is, of course, it is worth going to. Is it doomed? Of course not. This is one of the largest cities in the United States, and it’s one of the most dynamic.

Scott McDonald: [00:06:53] But even then, I have to say, New York City is not like other cities in the United States and in fact, different than the whole world. In stating this, it would be wise to explain some of the facts about the Big Apple’s demographics. So let’s talk just a little bit about it. The overview of New York City’s demographics. For such a large and diverse place, the population is about 19.4 million people with a small population decline. In other words, it is going from year to year to be smaller by about. Point 3%. Now, when you talk about demographics like I’m going to tell you, that’s nothing. But it doesn’t show much growth in New York City. That does not mean it’s not changing. New York City is. That’s because so many people come and go in New York City that that’s why that number is relevant. Point 3% negative growth is not much. But you have to understand there’s not much new housing in New York City. There are a lot of retreads. Now, COVID and crime resulted in the losses that are going on in New York City. A lot of people have left, but this is expected to reverse. In other words, this trend is likely to change. Unlike major metropolitan areas in the United States, New York City is not like them.

Scott McDonald: [00:08:41] Now you can go to almost any major metropolitan area in the United States right now, and you’d be surprised by how many people are fleeing the city. Are they fleeing New York City? Well, you could say yes, they are. But even a minor change of 0.3% is a lot of people. And there’s a reason or there are reasons why people have left New York City and two of those obviously covered in crime. A lot of people got a little bit spooked about major cities and they’re there. The covid pandemic that was happening and it was real. And the way the government was handling it was also real. But this is not like other cities. So stick with me. I’ll explain. And by the way, I should say crime in New York City is big. It is a serious problem, not in all parts of New York City, but in certain neighborhoods in New York City. It’s very significant. So the wise thing for you to do if you’re thinking about practicing in the city, and that’s what they call it, by the way, the city. You have to get a report. I’ve got to be able to justify the two statistics on crime. Crimes against people and crimes against property. They’re different statistics and they’re reported differently. The biggest increase in New York City is in adults who are 65 years of age and older. Now what that means and it means a lot.

Scott McDonald: [00:10:20] A lot of older people are staying put or are moving back into the city. Children are not. So we talk about New York City and we talk about families being in New York City, but really they’re very small families and children are becoming rarer and rarer. But that doesn’t mean that people want to pick up and move and leave the city forever. The biggest loss in New York City is the population between 35 and 49 years of age. Now, this is rare because it used to be that the very young adults, and I’m talking about people who are 25 to 35, were where all the growth in New York City was happening. But it’s not the biggest loss, in fact, in the city is in the 35 to 49-year-olds. Why? One of the reasons is people who want to have a family think to move. If you want to have a house, New York City is a terrible place to go. It’s not a good real estate buy, at least not for that age group. So, therefore. I’ve got to warn you, if you are in the 35 to 49-year range, you can expect that people in that age group are going to look elsewhere. Where are they going? Well, a lot of them are going to New Jersey. A lot of them are going to Florida. And I can even tell you where within New Jersey and Florida they’re moving.

Scott McDonald: [00:11:51] But just trust me right now, that age group is looking for the exits and they’re the ones who are. Are fleeing, in other words. But it doesn’t mean everybody is fleeing and not for the same reasons. People in New York City notoriously hate to travel any distance to their doctor. Now, this is always been true in metropolitan areas. Nobody wants to travel to get to the doctor. How far are they willing to go? Well, it’s a difficult statistic, but generally speaking, they want to stay within about a seven-minute drive time distance from their place of residence. Not their home, but their place of residence. About 7 minutes. That’s actually going down. It used to be that New York City had the longest commute for people going to the doctor and it was closer to half an hour. Now, in some kinds of specialty practices, half an hour is not at all unusual, particularly for plastic surgeons. People want to travel a distance to get there. But for a dentist or for general practice physician, they don’t want to go far. So if you’re trying to determine how desirable is this site to serve as a practice location, you have to say who is within that seven-minute drive time. And what’s the likelihood that that population is going to increase? And if you have a hook to get them in, let’s say by language or ethnicity or nation of origin, that’s the population.

Scott McDonald: [00:13:31] You have to consider the seven-minute drive time. Now New York City is one of the most diverse racial and ethnic cities anywhere. And by saying that, I want you to understand there are a lot of languages spoken in New York City, and the school system is really pulling its hair out, trying to figure out how to handle the diversity and languages. It is one of the most significant divisions among doctors. So when doctors say I have a successful practice, they are often saying I am serving a large population of fill-in-the-blank. And that is the basis of my success or the challenge I have in my practice. It’s going to be race and ethnicity and even language within that area. The divisions in New York City are that way. You may say, well, that’s not very politically correct. And the answer is that’s true. It really isn’t. But it is true anyway. So if you come to me and say, I want to practice in New York City, I’m going to say, let’s talk about who you are racially, ethnically, and by your language group. And I can actually tell you how successful you’re likely to be within New York City in that particular place. But people from Haiti, the Dominican Republic, Cuba, and Tonga are not in the same places as the other people.

Scott McDonald: [00:15:06] So we’re going to have to talk about the racial and ethnic country of origin and language groups to make a decision on how successful your practice will be in that place. Now, please understand all of the boroughs have these characteristics. So if you were to go to Brooklyn, I can tell you what neighborhoods in Brooklyn are going to have people who are of that particular ethnic racial language group and how successful you might be if that is who you’re trying to appeal to. I hope that makes sense. Now mass transportation orientation is a big deal to practice locations. And I mean by that. New York City has one of the most successful mass transportation systems in the country. People do take the subway, but they take busses as well and occasionally take cabs and Uber. Now, people who are long-term residents don’t favor it. Uber or Lyft. They want to primarily go by mass transportation like busses and in subways. Where those transportation arteries flow is what you need to know to determine the success of your practice. This is a big deal. Now, please do not forget this truth about New York City and its residents. They reinvent themselves in surprising ways periodically. Not everybody thinks, Well, I know New York. Now you don’t. You know something about New York, but where to go and how you’re going to survive is going to change every ten years or so.

Scott McDonald: [00:16:59] Now I say that because if you look at the voting districts and you look at how the boroughs are set up and who their borough leadership is, they’re going to reflect the people who are there. And that is not a constant. Now, the city is reborn and dies every few years. As I say here, yeah, the landmarks and the buildings are the same mostly, but the people and how they live is not set in stone. I’ll give you an example real quick. Greenwich Village people know where it is. The same thing with Tribeca. These are set places that are identified by streets. But what the streets are and who lives in them are going to change. If you look at just Harlem, Harlem ain’t Harlem anymore. It’s very different. As an example, waves of Irish and Italians, Chinese, and Eastern Europeans, very rich and very poor, just keep coming. Hispanic in New York City is a generic term. Spanish speakers is not but wit countries of origin. In New York City, people come from. It’s different. There’s no such thing as a Hispanic New Yorker. It has to be defined more narrowly by the country of origin. I hope that makes sense. But I know enough and my team knows enough about these divisions to make it worth going to us. I’ve got to warn you a little bit about other vendors of data, because they don’t understand the nuances of psychogeography, which is what we’re talking about.

Scott McDonald: [00:18:46] Lifestyle’s language group how people live. If you are only going by computer-generated data, you’re going to make a huge and expensive mistake. I’m not just saying, Oh, we’re better than they are. I’m just saying that’s true. Now there is a seismic shift going on demographically. In New York City, but few seem to see it. They just don’t get it or want to see it. It is a new ethnicity and culture than it had before. Now the reason I bring it up is if we look at people who are newly arrived Spanish speakers who come from, say, the Dominican Republic, they’re not going to be the same as they were 15 years ago. The population does move. It shifts around. A lot of people leave the city to go to other places, and unless you understand it, your value of the practice is going to diminish. So what I’m telling you, I think, is pretty important to know. It’s a projection of the future. And yes, Dr. demographics does look in the future as what it is in Harlem. Now, remember, Harlem was a place where African-Americans often settled, and there is a part of it that became Spanish Harlem. All right. I’ve heard it. I’ve seen it. But the thing is, Harlem is not Harlem anymore. What is Tribeca? Remember, Tribeca was formed. To look at a specific neighborhood and identified itself with that population.

Scott McDonald: [00:20:27] So if you look at Dumbo, which is under the Dumbarton Bridge, you have to understand the people living there now are different than they were 20 years ago. What defines the Upper East Side? Is New York City still the sum of its parts? Yeah, it is. But who lives in the Upper East Side versus the Upper West Side is an issue that has changed over time. It isn’t set in stone, and therefore you’ve got to know if you’re going to buy a practice or start up a practice in that area. You have to get a current read on what the population is like and what they’re going to become. Please do not misunderstand me. I love this city. I do. But like many people, I hate it too. But for many, it is the only place they can live happily. They’ve got roots. They like the energy. They like the excitement. And if you don’t understand that this is not the place for you. I’m going to make something, a statement that’s going to bother some people. And that is the majority of people living in New York City are tourists. And I mean by that, these are not people who have put down long roots. They don’t have as much of a multigenerational history. And that makes them different. It doesn’t make them bad. It just means they’re different. So you have to understand the difference between people who are kind of visiting long term and people who are the.

Scott McDonald: [00:22:07] The pioneers who set down roots there their different. Now let’s continue to go through our discussion of understanding New York City. Tourists don’t count. They only think they understand the city, but their visitors wear the costume of a tourist. Now, it doesn’t have to be a thing that says, I love New York like those t-shirts. But there are a lot of people, because they’re young, getting their education there that are going to move away. And they’re not the kinds of people to base practice upon. They’re tourists. They come and they go. There are a lot of people who work in New York City that don’t live in New York City. They’re commuting in. And those people are, in a way, tourists as well. Again, I don’t mean to be offensive, but I just know from my work that this is something you need to know. New York is really a series of neighborhoods and small towns with their own passions, loves, hates, and identities all crammed together. Yes, New York City is a huge city, but this little thing I found and I’ve been backed up by research, it’s actually a bunch of smaller villages and towns. Now, I don’t know if you know this. Gangs obviously do. But there are some streets that if you cross, you’re going to get beaten up or shot.

Scott McDonald: [00:23:40] You don’t know that. But it can be known, and that’s what I want to help you with. If you’re drawing your patients primarily from one part of the city, it doesn’t mean they’re going to stay with you long-term. So we have to talk about it. You can only really know your neighborhood. And I say this because there are so many long-term New Yorkers who say, yeah, I know the city, but what they’re really saying is, I know this four or five-block area and I know it very, very well. Owning a practice here means that you’re coming to know your own village. Outside of that, everyone is a casual stranger. So New York City does not have an identity. Certain cities. You know, I was going to say Boston right then. But the truth is, Boston is actually like New York City and there are neighborhoods like Southie that are not like other places. And you have to understand what makes Southie healthy. And the same thing is true of Harlem. Or the Dumbo area or Tribeca. To understand how your practice will grow or not grow in this area, I’ve got a lot of doctors who’ve come to New York City, who’ve lost their shirt, wound up working for someone else, and their dream of practice ownership didn’t flower. This could have been avoided with better research. For this reason, demographic facts can tend to be confusing.

Scott McDonald: [00:25:18] It often helps to have someone who is a demographer who knows how to read the data. And that data is not just demographic, it is psychographics, the lifestyle of the people there and therefore it matters. That’s why I believe practices fail and doctors move away sometimes at a significant financial loss. I don’t want you to fail and I don’t want you to lose money. Strangers who come to New York City cannot make casual friends in the city. I mean. I’m going to say something again that’s offensive and I don’t mean it that way, but people who are not there long-term don’t put down the roots and have a certain lack of understanding of what a friend in the city is. And it takes sometimes years to develop. When I say friends, I mean a patient base can also be true. The referral base that forms the patient base is going to change over time. Cosmetic surgeons in New York City are a fairly small minority of health care providers, but they develop a group of people who love them and trust them. And over a long period of time, it becomes extremely important. If you want to get any kind of referrals, it means you must learn the bodegas. I don’t know if you don’t know what a bodega is. Trust me, it’s a little retail hub that is in a neighborhood, but they’re different.

Scott McDonald: [00:26:59] Each bodega is different, the owners are different. The languages they speak, what they’ve got, and what they have as customers are different. Now, the same thing is true of churches. Some people say, well, is New York City a particularly religious place? And some people say no. But look, the basis of the neighborhood is often the church. You got to know the priest. You got to know the rabbi. You got to know who the preacher is. And that part of town that is an access point for you to know the clubs. And by the way, I use the term club very loosely. We’ll just call it an association place. And those people who are New Yorkers know what I’m talking about. You’ve got to know the clubs. You’ve got to know the old people. You’ve got to know what building in this practice area is looking for young people to move in. Yeah, because. Everybody in New York City knows everybody else in that neighborhood, that village. And that’s what you have to understand about its demographics. To practice here. You have to know where to find a cab. Any hour of the day. That’s what I mean by regularly. Uh, cabs, Uber, Lyft, they all have their places where the drivers hang out and know and they know each other. You got to know where the pocket parks are. And if you don’t know what a pocket park is, it is an outdoor recreational place in New York City, and they call them pockets or pocket parks.

Scott McDonald: [00:28:45] You got to know where the cop bars are now. Cops in New York. Divided by precinct are not like the same as they are in other cities. I love New York cops. I really do. But you’ve got to know who they are so they can know who you are. You have to make friends. The regulars. Now, the regulars are the people who live and hang out. They know what the soup is all about, what to throw on the stoop and what not to who the people are that belong and who don’t. The regulars are going to be the one that, for your practice, is going to be the biggest asset you can have. And they’re not always young and they’re not always rich and not always poor. But they’re the people who you have to know. You have to know what not to look at. And this surprises a lot of New Yorkers as well. You’ve got to know what not to look at too closely and what you should and should not see in the city. Now, I’m not trying to say anything about New Yorkers or about the city. I’m just saying it’s the truth. And the longer you live here, you begin to say, Am I a regular? Do I know what to look at? Do I know who fits and who doesn’t fit in my neighborhood or area? If you’re going to be a doctor who owns a practice here, you’re going to have to know who the regulars are.

Scott McDonald: [00:30:20] Now, short of that, you’re just a tourist. And you should have stayed in Jersey. No. Some people are insulted by it. I know that. Please don’t be that. That isn’t really an insult, but. People who are New Yorkers know what they’re looking at. To practice here means you cannot live at arm’s length in a city. That you’re going to hate in time or from time to time. So. No, don’t hold things at arm’s length. Arm’s length. You got to be passionate and you got to embrace it. And if you can do that, your practice can do well. But short of that, you’re in danger. Now, let me tell you a few other facts about New York City. The residents in New York City may be in decline, maybe more than that 0.3% I talked about. But we know that it is not growing because there’s no new housing. That the housing laws and ordinances that exist here are very complicated. And a local can explain it to you. But not a realtor. I don’t know if that makes sense. But trust me, they know what properties are rent-controlled and which ones are not, how to move a rent-controlled property, how to get around the regulations and the laws, how to get something fixed and who can fix it, and how to get a good deal.

Scott McDonald: [00:31:53] Because everybody’s got a cousin and does a deal. Shoppers are going to be in decline in New York City. There was a time in when people came to the city to do shopping. I am kind of surprised, and a little saddened by the fact that shoppers are not staying in the city to do their shopping. It could just be that they’re moving to different stores that they like. But shoppers are being discouraged by crime and by shoplifting. And a lot of it is going to the city elders, the people who are running the city. And I’m kind of sad about that. Employers will switch, switch seats and change hands often. So you may think in midtown that this big building has a lot of people that are doing the same thing. But in fact, some people come to New York City just to get their ticket punched. I’m talking about employers and employees, but many of the employers are multigenerational. They’ve been here a long time and they’re looking to hire locals. If you’re a doctor who wants to go to New York City, you have to understand who those people are. The difference between them is when they’re going to be good to come in and when they’re not. New York City, like the United States, is an idea that will keep reinventing itself over time.

Scott McDonald: [00:33:23] And then the United States isn’t what it was 100 years ago. It’s likely going to change in 50. For those willing to make the transition here, it can be a wonderful place. Now I want to go on record as saying that New York City can be a wonderful place, but you can’t be at arm’s length from it. You have to be passionate. You have to remember to learn about the village and the small town in your neighborhood. There are mavens, people who know there are. Some are young, some are old. But you have to find the people who know. Just be careful because there are some doctors who will claim to be mavens but are not. They don’t know it. You need to get to the people who know. Long timers are different from short timers. And that’s what I was saying really about tourists. Now ignore the tourists, the politicians, and the media hype. There are a lot of people who have something they want to say about their area, and they’ll act like the smart guys. I don’t think that’s true. And if a person’s a tourist, they’re living somewhere else, very often, not practicing somewhere else. Politicians come and go, and often they’re going to say whatever it takes to get their job done. And most politicians and I’m not trying to criticize them, but most politicians in New York City.

Scott McDonald: [00:34:58] Know where their money and power come from. And doesn’t come from where a lot of people think. Media hype is really to be ignored. Now, I believe that celebrities, New York celebrities are really tourists. They act like they’re not, but they are. I would ignore them. The New York Times is made up of people who don’t live in New York anymore. And the same thing is true of The New Yorker, and The Atlantic magazine. I don’t trust them anymore, and neither do most locals. The Village Voice is kind of smutty. I’m just getting at the fact that sometimes you have to be careful about who you’re listening to, to learn about the city. I can. I think the only people who are long-termers are really the ones to get information from. To make it New York City. You must learn whom you could ignore, not who to listen to, but who not to listen to. And there are a lot of people who are in city government and that are running in the boroughs that don’t know anything. They are on the take. They got a buddy who helped him in. The people who really know sometimes may not have a title. And they’re the ones to listen to. Now, this is Scott McDonald and doctor demographics. You can learn a lot more about our services because I list all the prices in our web page at doctor demographics dot com info at doctor demographics dot com is our email address.

Scott McDonald: [00:36:45] You can call us at 808 490499. And I strongly recommend we talk because there’s a lot of information that we can put in a report, but there’s a lot of information that we can’t put in a report that you still ought to know. And this is going to be truer in New York City than almost any other. Now, in September, we’re having our webinars. This is where you can practice four times for kinds of practice or the nonpractice ended on Abraxas or emergency care facilities and oral maxillofacial surgery offices. We are charging for attendance and there will be a discount voucher. So if you attend you can get $45 off a report we’re going to offer and that’s a pretty good deal, frankly, because mostly pays for itself. Now details are going to follow. Please pay attention to our website. Attendees Well, we’re not going to allow a huge number because we want to maintain a little bit of conversation through the process. I have to say, I love health care. I love the doctors that I deal with. I love people who want to know places and things about operating and how things don’t. If we can help you out, I look forward to talking to you. This is Scott McDonald on behalf of Mike Green, one of the smartest guys out there in the area of health care demographics. Take care. Look forward to talking to you later. Bye bye