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You can buy a home in Baltimore near Penn station for pretty cheap. There's also a big difference between urban and semi urban

The city. I considered the MARC, but I have to go out to Herndon, VA and Fairfax, VA area so its just more convenient to drive. It's a tough commute at times, but a good podcast gets me through the drive. I have been WFH for all of 2020 an 2021, so now I just stay in Baltimore. WFH shift is working out great!

A lot of times the answer is a domestic partner working at one of the Baltimore hospitals

Yep, that's the case for me. The plausible choices for me personally are basically remote work, commuting to DC on MARC, or starting a company with a remote cofounder.