Selecting America's most physician-friendly states is a subjective and imprecise task, and the methods employed by Physicians Practice were unscientific. The list of friendliest states is meant as a starting point for physicians considering a move; a way for physicians to compare the conditions in their own states with those in more ideal states; and as a platform on which doctors can discuss business climate issues with patients, policymakers, and others.
Though unscientific, the evaluation was fair. The data examined are relevant, accurate, and as current as possible:
• Malpractice climate: States listed by the American Medical Association as "in crisis" were disqualified. Those few that are "currently OK" were given extra consideration.
• Physician-patient ratios: Gathered from federal data and reported by the Rural Policy Research Institute, physician-patient ratios touch on a range of issues, from physician salaries to contract flexibility. In our analysis, a lower ratio was better.
• Cost-of-living: Using data from 2000, the states were indexed against each other by the U.S. Bureau of Economic Analysis. The median score was 1; states with high costs-of-living received higher scores. Connecticut is the costliest state; its score is 1.122. In our analysis, a lower score was better.
• Reimbursement: Medicare uses a similar 1-point median for its Geographic Cost Indices. Since the government reports scores for large metropolitan areas, some estimating was required for some states. Commercial payers often tie their reimbursement rates to Medicare. In our analysis, a higher score was better.
• Cost-of-living/reimbursement margin: Neither can be looked at in a vacuum since they are closely related. But the relationship is imprecise; some states have relatively high costs-of-living despite lower reimbursements, and vice versa. In our analysis, the two indices were compared, and the states with bigger positive margins were considered more favorable to physicians.