Where's the Best Place to Practice?

Young doctors, mid-career doctors and senior doctors, each have different perspectives as to what constitutes the best place to practice medicine. Today, economic, legal, and social priorities are changing the way that doctors pick their practice locations. As a doctor yourself, when pondering over what is the best place to practice, it is important to not only consider salary, but also quality of life. However, with student debts rising well above six figures, it can make a difference whether you are making $250,000 or $500,000 a year. While some states may not be your first choice, you may be surprised to learn about their salaries, cost of living, climate, as well as culture. A recent survey conducted by Doximity was taken among 35,000 health professionals and found that:

• Women earn less than men – A gender pay gap is seen in medicine and the biggest gaps can be found in ophthalmology and cardiology. Men in ophthalmology earn around $95,000 more a year than women and men in cardiology earn around $97,000 more a year than women.
• The largest cities do not always make more money – While New York and Boston are known for their prestigious medical schools and teaching hospitals, their salaries are less than several other areas around the country. On average, an internal medicine physician in New York earns around $234,000 a year – around $14,000 less than the nationwide average. Moreover, the average salary among primary care physicians in Washington D.C. ranked last – 17% below the nationwide average.
• More money can be earned in the Midwest – States in the Midwest make around 13% above the nationwide average. Moreover, states such as South Dakota, North Dakota, and Iowa are among the highest paying states.

The survey revealed that the highest paid states for primary care physicians are Arkansas ($330,000), South Dakota ($305,000) and Iowa ($305,000). The lowest paid states for primary care physicians are Delaware ($218,000), West Virginia ($205,000), and the District of Columbia ($192,000). Moreover, the highest paid states for specialists are North Dakota ($472,000), Wyoming ($433,000), and Idaho ($429,000). The lowest paid states for specialists are Vermont ($299,000), District of Columbia ($298,000), and Rhode Island ($291,000).

According to Medscape, the 10 best places to practice medicine include the following:
1. Minnesota – The 4th healthiest state, the 2nd highest rate of employer-sponsored health insurance in the nation, and the 17th lowest number of malpractice lawsuits.
2. Wisconsin – The 3rd most livable state, the 6th highest physician income, the 2nd highest rate of employed physicians, and the 14th lowest number of malpractice lawsuits.
3. South Dakota – The 3rd highest income and highest rate of employed status, the 7th highest in hospital patient satisfaction, and the 4th lowest number of malpractice lawsuits.
4. Iowa – The 8th highest physician income, the 10th highest in hospital patient satisfaction, and the 6th highest rate of insurance coverage.
5. Vermont – The 2nd healthiest state, the 2nd highest rate of insurance coverage, and the highest rate of hospital patient satisfaction in the nation.
6. New Hampshire – The 5th healthiest state, the 4th highest rate of insurance coverage, the 5th lowest number of malpractice lawsuits, the 5th highest physician income, and the highest rate of employer-sponsored health insurance in the nation.
7. Massachusetts – The 3rd healthiest state, the 11th lowest number of malpractice lawsuits, and the highest rate of insurance coverage.
8. North Dakota – The 12th healthiest nation, the 3rd highest rate of employer-sponsored health insurance in the nation, and the highest income and the highest level of employed status.
9. Maine – The 15th healthiest state, the 2nd highest in hospital patient satisfaction, and the 5th highest rate of insurance coverage.
10. Kansas – The 8th lowest cost of living, the 14th least harsh medical board, and the 22nd lowest number of malpractice lawsuits.

Medscape ranks the best places to practice medicine based on the highest physician earnings, fewer malpractice lawsuits, and lower taxes. While important, the number of uninsured individuals must also be taken into consideration. This is because individuals without health coverage live at a more ill rate and pass away at a younger age as opposed to individuals with health coverage.“What if one were to rank the states based on their overall performance on composite measures of accessibility and availability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity?” wrote Bob Doherty, senior vice president, governmental affairs and public policy, American College of Physicians. The Commonwealth Fund analyzed the 10 best and worse states based on health care performance in general and found that the 10 best performing states included Minnesota, Massachusetts, Wisconsin, New Hampshire, Vermont, Maine, Hawaii, Rhode Island, Connecticut, and Delaware / Iowa (tied). Furthermore, they found that the 10 worst performing states included Arkansas, Alabama Oklahoma, Nevada, Georgia, Kentucky, Texas, Indiana, and Louisiana.

So if you are wondering what the best places to practice medicine are (despite above surveys and statistics), you should take into account several factors before making your decision to open a doctor practice. The “Best States to Practice” project has taken upon it to create a doctor-friendly state calculator to determine your best U.S. states to practice. Due to the fact that each doctor’s needs and preferences are different, the calculator classifies U.S. states based on your individual needs and preferences according to metrics such as cost of living, residency retention, tax climate, GPCI, physician density, and malpractice premiums (avg).

When asked to recommend advice to current medical students regarding what area of medicine to get involved in and where to practice medicine, Christine Nero Coughlin, Director and Professor of Legal Analysis, Writing and Research at Wake Forest University answered: “The only certainty that medical students can embrace is that the practice of healthcare is evolving and constantly changing. So, when considering important decisions about practice specialty and where to practice, students need to identify what factors are most important in their lives personally, as well as factors such as workload, salary, and amount of professional control that will be important to them in their future medical practice. For example, if economic security is the most important factor, the medical student should seek opportunities in areas of the country where physician salaries tend to be higher and costs of living tend to be lower, like the Midwest. If practicing cutting edge medicine is important, medical students may want to explore a specialty or subspecialty, and employment or association with renowned medical schools or teaching hospitals – generally located in larger cities such as Cleveland, Boston, or New York. If having a long-term professional relationship with patients is rewarding to the student, he or she may consider primary care or a medical practice in a rural or less urban setting”.

When asked to classify the best U.S. states for doctors in regards to 5 main indicators, Christine Nero Coughlin answered: “Like the answer to most health care questions, the response to the top five indicators for the best states for doctors is it depends. Specifically, it depends on the physician’s specialty, quality of life factors, and economic factors such as average physician compensation, cost of living, and tax burden. It also depends on other factors including whether the doctor is looking for an urban practice versus a rural practice, or an academic setting versus a community setting. However, when evaluating which state is the best place to locate, physicians should also consider the following common indicators: (1) whether the state is considered friendly to physicians in terms of their malpractice laws, premiums, licensure standards; (2) whether there exists easy access to teaching hospitals and tertiary care facilities; (3) what type of medical system are involved in or dominate the economic base and / or healthcare market; (4) how the state ranks in terms of the overall health of its citizens; and (5) physician density within the state”.