I did residency in Manhattan, the GI guys in private practice did fairly well, but the market is beyond saturated. There are a lot of teaching programs in Manhattan alone (Sinai, NYU, Cornell, Beth Israel/St Lukes Roosevelt, Columbia, Metropolitan) not to mention the outer boro programs like SUNY Downstate and Einstein, plus not far away you have LIJ, NYMC, or NJMS across the Hudson. Then of course there are a ton of private guys. Having grown up in the NYC suburbs and trained in manhattan, I'd say its a great place to train, but I wouldn't want to practice there - in private practice overhead is enormous, the market is saturated, and your cost of living is about the highest in the country (SF has higher housing costs, by NYC is higher everything else), not even getting into the fact that you have NY state and NYC income tax.If you're just looking to be in the area, would strongly consider expanding your radius about 15-20 miles outside the city proper; you'll then be looking at Westchester, LI, and NJ which will have much lower costs of living. I'll probably be headed back east from fellowship next year, probably headed to NJ.