Best States to Practice 2012 - Best and Worst

For our annual Best States to Practice report, we look at hard, comparable facts: cost of living, disciplinary actions taken against physicians, tax burden per capita, Medicare GPCI, physician density, and malpractice award payouts per capita in each state. We don't consider lifestyle-oriented factors such as climate, proximity to cultural institutions, or recreational opportunities. Such factors have less influence over your daily practice, and they are relative. While some of you are lured in by a state's beautiful golf courses, for instance, others care less about hitting the links. But all of you, we'd be willing to bet, care a whole lot about tax burden. Here's a look at some of the best and worst states identified in this year's report, and some feedback from the physicians who practice there. If your state is not highlighted here, we've compiled all the data on every state (and the District of Columbia) on the main Best States to Practice State.

IDAHO: FOR ALLOWING DOCS TO BE DOCS: As a U.S. Army physician, Ted Epperly practiced in his fair share of locations before settling down in Idaho, including Maryland, Georgia, and the District of Columbia. "Idaho stands out as one of the best," says Epperly, who now practices family medicine in Boise. Idaho is the least physician-dense state in the country, has a low cost of living, and a low rate of disciplinary actions taken against physicians. But to really see why the state shines, you have to look beyond the numbers. Idaho physicians can really focus on being physicians, says Epperly. "We're less penetrated by managed care, so I think physicians have a good degree of personal autonomy and individuality in terms of practice style," he says. In addition, since fewer doctors practice in the state, physicians can enjoy their full scope of practice, says Epperly. "I do everything from deliver babies, to take care of kids, to older people at the end of life, and everything in between."

MISSISSIPPI: FOR EASE OF PRACTICE: Emergency medicine physician Steve Demetropoulos has practiced in Pascagoula, Miss., for 25 years. And like Shapiro, he says practicing in Mississippi is less burdensome than in other states. "We've had really great luck recruiting ... and I think a lot of it's because of the cost of living," says Demetropoulos, who is also president of the Mississippi State Medical Association. "We get people that come here from California and say, 'We couldn't even buy a home there and we can have a really nice home here.'" Another lure is the "fantastic" malpractice environment, he says, noting that malpractice liability rates are currently at a decade-long low in the state. Demetropoulos says the low physician density (it's the third least physician-dense state in the country) makes patients really value their doctors. "The people appreciate us and they show it," he says.

TENNESSEE: FOR ENTREPRENEURSHIP: Memphis-based internal medicine hospitalist Wiley T. Robinson says Tennessee is friendly to physicians' wallets and their careers. For one thing, it has the lowest cost of living in the country and no state income tax. "We struggle like everyone does to try to balance expenses versus revenue, but for the most part that helps our situation here," says Robinson, who is also president of the Tennessee Medical Association. Tennessee physicians also band together when times get tough. In the 1970s, for instance, when many malpractice insurers closed up shop in Tennessee, the state's physicians formed a physician-owned mutual company that provided malpractice coverage — and it's still going strong today. "It's physician-owned and led, and that certainly makes a difference," says Robinson. In addition, he says, the state is a prime spot for physicians looking to start or transition their careers. "A person straight out of training could easily find a job either A., being employed, or B., set up their own independent practice and be quite successful."

TEXAS: FOR STRENGTH IN NUMBERS: Though Texas physicians face the same stressors as doctors in other states — such as declining reimbursement and increasing overhead — the strong sense of community among physicians lessens the burdens, says Houston-based neonatologist Michael E. Speer. "The physician population is very collegial and works well together," he says, noting that the Texas State Medical Association has nearly 46,000 members. "Most states can't even come close to that number — even if they have a fair number of physicians," says Speer. In addition, since the passage of tort reform in 2003, Texas physicians have experienced less anxiety due to malpractice concerns. "Being a climate where malpractice is not dispensed willy-nilly as it seems to be in other parts of the country, we've been able to attract over 10,000 physicians" since 2003, says Speer, who is also president of the Texas Medical Association. The state's physicians also enjoy the seventh lowest cost of living in the country, a low tax burden, low physician density, and the fourth lowest average medical malpractice claim award payouts per capita.

THE WORST STATES TO PRACTICE: In his 26 years of practicing medicine, dermatologist Steven Shapiro has practiced throughout the country — from the East Coast to the West Coast. But when he chose to move south 17 years ago, he stayed. "I was very impressed because I had been in practice in New York and in California prior and it was an entirely different attitude in Mississippi; a friendlier attitude with much more open and receptive feelings by the patients and community," Shapiro says. But it wasn't just the friendly Mississippians that convinced him to set down his roots there — it was the friendly physician practice environment as well. "There's a significant need for physicians, so that in itself makes it very desirable because it's very easy to build a successful practice if you're a dedicated physician," he says. On the other hand, practicing in New York was not so easy, says Shapiro. "The financial issues involved in being in practice in New York are very, very complex, and it requires a lot of effort just to keep your head above water," he says, noting the high cost of living, taxes, rent, nurses' salaries, and malpractice liability. This year, New York is among six locales stood out at the bottom of the pack, with Hawaii, Maryland, Washington, D.C., New Jersey, and Connecticut. All, unfortunately, had an extremely high cost of living, tax burden per capita, malpractice award payouts per capita, and number of disciplinary actions taken against physicians. Nonpracticing family physician David Jaworski is well-acquainted with the trials of working in a less physician-friendly state. He's practiced in Connecticut for 25 years. Like many of the worst states, he says it's beautiful with close proximity to major cities — but physicians pay dearly to live and practice there. Jaworski says the malpractice climate also takes a toll. Without tort reform, malpractice lawsuits are a huge burden in Connecticut, he says. Jaworski's never been sued himself. "That's a miracle these days," he says. Shapiro, the New Yorker turned Mississippian, says his experiences practicing across the country have shown him just how influential geography can be on career satisfaction. "I'm 67 and I have no intention of retiring," he says. "I still have a very active full-time practice and I wake up every morning enjoying what I do, enjoying the people I'm around. And, I feel that practicing in Mississippi has definitely prolonged my career. I don't know that I would still want to be actively involved in practice if I stayed in New York all of these years — I probably would not."