Steve Mortensen is as surprised as anyone to find himself living and working in, of all places, Wichita, Kan. The Denmark-born rheumatologist came to the United States 34 years ago, spending the first 20 in Southern California. But after halfheartedly picking up a recruiting leaflet while attending a medical conference in the early 90s, he says he liked what he read.

“Then I realized that this practice was in Kansas, and I thought, ‘Weeeellll, maybe not.’”

Today, Mortensen says he and his wife couldn’t be happier with their ultimate decision to move to the Midwest, but his initial reaction is hardly unusual. Physician recruiters for states such as Kansas, South Dakota, Oklahoma, and Indiana agree that their greatest challenge to landing new talent is just persuading doctors even to consider them.

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Perhaps this will help: Those four states, along with Texas, are the most physician-friendly in the country, according to Physicians Practice’s biannual analysis. We examined factors that affect a doctor’s ability to work relatively hassle-free while still making a nice living, and found, as in our previous analyses, that the big flat, open spaces of America’s Midwest outshine the glitzier coastal states as attractive places to practice medicine.

In short, glamour is out, and the heartland is in. Let’s find out why.

We’ve been analyzing the relative friendliness of the states every other year since 2003, and we always get plenty of questions on the subject.

Because we emphasize factors such as malpractice climate, reimbursement, and cost-of-living — and not so-called “quality-of-life” issues, including whether you can find a great steakhouse or a nearby symphony orchestra — we find that the simple-life states tend to fare best. Places like Hawaii, New York, and California may be terrific places to live, but the cost of living is just too high. Also, densely populated states tend to be similarly thick with physicians, diminishing the potential advantages gained from the national doctor shortage.

David Cornett, vice president of the Western region for the physician-recruiting firm Cejka Search, says he isn’t surprised by our selections. “They all have a lot of rural areas, and that means there’s always a need for physicians,” he says. “They do have lower costs of living, and they have lower costs of doing business. Also, those states tend to be less bureaucratic.”

With physicians in short supply, this is a time to be a doctor looking for a job. And more physicians than ever appear to be doing so, according to Kurt Mosley, vice president of business development for Merritt Hawkins, a national physician-recruiting firm. “This is the highest physician relocation rate we’ve ever seen,” he told us, pinpointing the annual rate at perhaps 10 percent or higher; five years ago, it was 2 percent or 3 percent. “And we’re seeing a lot of midlife doctors — baby boomers who are saying, ‘I’ve got to make some more money now while I still have some years left before retirement.’”

Little wonder, says Mosley.

“In states where the need is high, hospitals and other employers are willing to do the things necessary to recruit doctors,” he says. “Every practice and hospital is bending over backward to recruit physicians, because physicians are the most powerful force in healthcare. Without them, no prescriptions get written, no admissions get made, no tests get ordered. That’s something that people are realizing more now than they were maybe 10 years ago, as the physician shortage gets tighter.”

These facts put you in an excellent position if you’re looking for work. (Check out Pamela Moore’s October 2006 article on the lengths to which practices are now going to recruit in “Disappearing Docs.”) On the other hand, once recruited, you’re pretty much stuck with the business climate you chose — which is why it’s important to choose carefully.

Our methodology

To understand how we compiled our list of the physician-friendliest states, it’s best to begin with an explanation of why we didn’t consider the subjective, so-called “lifestyle factors” that are typically the main ingredients of those “best places to live” rankings that populate the general press. We did not take into account how many museums, orchestras, or professional sports teams can be found in one place versus another. We did not compare crime statistics or public school system performance. We could not have cared less about the singles scene, the number of decent restaurants, or air quality.

That’s not to say you shouldn’t care about those things. But there is no particular “lifestyle” that most physicians would agree is ideal. Moreover, plenty of other publications already conduct such rankings — we’d suggest Money magazine’s, found at www.money.cnn.com/best/bplive, and Sperling’s BestPlaces, www.bestplaces.net. Both offer demographic data on hundreds of metropolitan regions and have fun, free interactive tools. As for Physicians Practice, we sought only to identify the best places for a physician to work, and so we considered only physician-specific business factors and cost-of-living statistics.