First, what is your level of job satisfaction in private practice?
I'm satisfied with it in so far as autonomy is concerned. There's not much bureaucratic wrangling to deal with since we are only a 5 doctor group. There's a lot of scheduling flexibility.
We run a tight ship financially, and overhead expenses have never exceeded 50%, which is considered very good for internal medicine. Our annual earnings are better than the national median for our specialty.
Quality of care is up to par; we are audited regularly by HMOs we contract with and we have always met their quality of care measures. We have never been sued (knock on wood) which is partly due to our doctor-friendly, Republican-leaning community in rural Illinois, and largely due to (I hope) our excellent clinical skills.
The reasons I am thinking of relocating despite all these positives are two-fold: being a small practice, we can not afford to spend too much money on electronic medical records. We still use paper charts because we have a large panel of patients that converting all their charts into electronic records will be too burdensome financially. We can probably make do with paper charts, but it seems obvious that the regulatory climate will eventually push us into adopting electronic records. Small practices will have difficulty making this conversion, while large multispecialty groups in Northern California like Sutter or Mercy Medical Group (which is offering me the job) have the economies of scale to be able to afford it.
The other reason for my wanting to relocate is cultural: while the community where I live in right now is friendly, I still feel like I don't belong here. I'm a big city person, my wife is too.....and after having lived in rural Illinois for 10 years we feel the urge to return to our families and friends in California.
My gut tells me that moving to California will cause me to delay retirement since the cost of living there is high, and our ability to save will be curtailed (though still achievable). In Illinois I am able to stash 25-30% of my income for retirement, while in California, I may struggle with a 10-15% savings rate. Admittedly, this is still higher than most Americans can save, but I also want to retire early like most people on this forum. Medicine is a great career, but I don't want to be consumed by it.
BTW, since you asked, the compensation package Mercy is offering is OK ($175K/year with annual production bonuses and partnership buy-in after 2 years; most partners make between $200-250K). There's the usual 403b with 50% match, health, life, disability and malpractice insurance coverage. Sounds pretty liberal, but then again, this is California we're talking about (where median priced homes are $400-500K).