What are the best states for physicians to practice in? Find out in 

 Best States to Practice 2021 exclusive data project.

For our analysis, our editors ranked the states based on 2020 data covering five categories:

Tax climate (state collections per capita)

Physicians Practice obtained the data from publicly available sources and partner organizations. The Cunningham Group provided malpractice premiums for each state. Averages, published in the report, were calculated by 

Here’s a brief description of our methodology: We ranked each state on the criteria described desirable outcome per criteria, then averaging those scores resulted in the ranks of the states below and in other sequences in the slideshow series.

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What are the best states for physicians to practice in? Find out in Physicians Practice®’s Best States to Practice 2021 exclusive data project.

The best states for physicians in 2021: The complete ranking

Krisi Hutson, product line developer at Availity, discusses how a practice’s revenue cycle management can have an effect on patient payments and the likelihood of surprise billing scenarios.

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How a practice’s revenue cycle management can effect patient payments the likelihood of surprise billing scenarios. 

How your revenue cycle management effects patient payment and surprise billing

Considering a relocation? Though these stats were collected before the coronavirus pandemic and subsequent economic stress, these five states had the lowest cost of living across the board.

The Cost-of-Living Index is an average of categories like grocery, housing, utilities, transportation, healthcare, and more.

Best States to Practice: Top 5 states with the lowest average cost of living

Which states do you think came out on top? 

Best States to Practice: 5 states with the lowest average cost of living

More and more, clinical guidelines are becoming interwoven within the fabric of a physician’s practice. Everything from point-of-care clinical decisions to hospital/clinic procedures, and even payer reimbursement decisions, are being influenced by guidelines. Although an important player in the evolution of evidence-based care, clinical guidelines can also be overwhelming to physicians. 

 only 73 clinical guideline entries in PubMed. Today, only 30 years later, there are thousands of clinical practice guidelines that physicians need to know and thousands more being produced each year. Information overload is a real problem for clinicians in modern medical practice; keeping up-to-date is an added strain on professionals who already feel like they don’t have enough time to manage everything on their plate. More than 

 meet clinical criteria for burnout, and clinicians are willing to dash out money for solutions that will help them manage their day with less frustration and more efficiency. 

“The amount of information that physicians need to keep up with is definitely a contributing factor to burnout,” said Dr. Louis Mullie, chief medical officer, and co-founder at Pathway Medical. “The demands on a practicing physician creates challenges in terms of the time they can allocate to finding the most recent evidence-based recommendation as well as any caveats from more recent literature, for each clinical encounter. It’s just not possible given traditional methodologies.”

Tailoring your practice’s RCM to changing times

 that medical knowledge now doubles every 73 days. In 1950 the doubling of medical knowledge was 50 years; in 1980, 7 years; and in 2010, 3.5 years, and it is now estimated to be every 0.2 years. Adding to this, the world’s top medical journals in aggregate publish roughly 7,200 articles each month. To evaluate all this information, it would take a physician more than 620 hours per month. Given that one month holds roughly 730 hours, the problem with manual processes becomes apparent. 

 are working to lift some of that burden by providing physician-friendly, evidence-based clinical guidance via an easy-to-use mobile app. Pathway’s point-of-care guidance tool provides easier access to important clinical information by using natural language processing and machine learning to streamline and automate manual research and analysis processes. Pathway’s algorithms mine more than 100 million medical research sources, and its system includes more than 1 million structured data points.

Point-of-care clinical reference tools aren’t new. Solutions like 

 have been on the market since the early 90’s, and were some of the first to bring the traditional medical textbook to the internet browser. These resources remain some of the most widely consulted by clinicians. However, they have not significantly changed their “textbook in a browser” model since they were introduced 30 years ago. Given the rapid expansion of medical knowledge, more and more physicians now experience these tools as too slow, cumbersome or outdated.

The next generation of point-of-care reference tools is unique in that the tools operate as data companies, while other tools like UpToDate and Medscape operate more as traditional publishers. For example, Pathway’s database understands the links between symptoms, diseases and treatments, given its unique and granular data structure. This “Medical Knowledge Engine”, as the company calls it, is what allows Pathway’s system to display information contextually, and to provide a user experience that is up to par with modern standards.

“Medical guidelines offer clinical guidance, albeit in a way that’s not really adapted to clinical practice,” says Jordan Levy, a general surgery resident from Toronto. “They’re typically PDF documents that aren’t easily searchable, they contain a lot of information that’s not useful at the point-of-care, and it’s hard for a physician to assess their relevance or quality, especially in a clinical context, where time is of the essence. Tools like UpToDate help, but they’re not exactly tailored for quick searches at the bedside.”

 is another tool that has been gaining popularity and introducing a more modern approach to decision support. The Berlin-based company started as an educational resource focused on materials specific to the USMLE Step and NBME Shelf exams but has now expanded to cover more bedside decision support content. Over 50 medical schools around the world have adopted it as an essential study resource.

, Benedikt Hochkirchen, co-CEO of AMBOSS stated, “Medical knowledge is exploding and it is almost impossible for doctors to quickly obtain reliable clinical information. Our mission is to connect every doctor with precise medical knowledge to provide the best possible care.”

Telehealth fraud and abuse enforcement efforts unlikely to taper

 is another tool that combines medical knowledge with machine learning algorithms to give guided help with diagnosis, anamnesis, workup planning and access to clinical reasoning.

While these systems can add significant value to the healthcare industry, clinical decision support technologies have also come with substantial challenges. Although they have been around for a number of years, many of them have not been integrated into the clinical point-of-care devices that healthcare professionals are using. Solutions like Pathway and Kahun have answered the challenge, however, by meeting physicians and other healthcare professionals where they are at – on their mobile devices.

Given that medical knowledge is expanding faster than a physician’s ability to assimilate and apply it effectively, the industry’s approach to medical knowledge must fundamentally change. New platforms like Pathway and AMBOSS, which blend gold standard medical knowledge with a modern user interface and advanced technologies, are a leap in the right direction.

Tools that can help with point-of-care clinical decisions.

New clinical guidance tools improving evidence-based care

, MBA, CFP, AIF is a principal and co-founder of 

. She specializes in working with physicians and executives in the healthcare industry. Her passion for working with physicians comes from being a pediatrician’s spouse for more than three decades. Julie has been featured on Forbes’ list of America’s Top Women Wealth Advisors since 2017 as well as Forbes’ 

Taking on medical school debt can be a smart investment to increase your future earning potential. However, you still need to pay off that debt in a smart way to make sure that it doesn't cost you any more than it needs to.

1. Don't Throw All Your Cash at Your Debt

This may seem counter-intuitive, but don't throw every last cent from your paycheck towards paying your loans off early. It's always important to keep some cash on hand in an emergency fund, to cover unexpected events like car repairs or health expenses. You don't want to turn relatively inexpensive student loan debt into credit card debt because you had no cash savings to cover an emergency.

Next, think about other goals you have, such as buying a home or getting married. Again, not keeping extra cash to cover these expenses could lead to you feeling pressured to take out new debt at a higher rate.

Understanding HIPAA's Medical Record Transfer Rules

Income-driven repayment programs, such as ‘Pay as You Earn’, cap your monthly student loan payments at around 10 percent of your income. While you might want to knock your student loans out as quickly as possible, trying to do so during residency or even the first few years of your career could put you in a needless cash crunch.

If you're worried about interest, remember that federal income-driven plans cap the amount of interest that can accrue while you're in the plan. Finally, you can always make extra payments above the minimum when you can comfortably afford to do so.

You'll likely be bombarded with offers from private lenders offering to refinance your federal student loans at a lower rate. If these loans were equal, it would be a smart move, but that is not always the case.

Federal student loans have several benefits including income-driven repayment options, public service loan forgiveness opportunities, and a more forgiving way of dealing with financial hardships (such as long-term disability). Therefore, if you refinance to a private loan, you're taking on added risk for the lower rate.

When you start getting a bigger paycheck, avoid the temptation to dramatically increase your spending. Some people say to keep living like a resident, but you don't even need to take it that far.

Prioritize building an emergency fund, mid-term savings goals, maxing out your retirement accounts, and paying down your student loans. Once those goals are met, you can treat yourself a little for your hard work.

5. Budget Your Salary, Invest Your Bonuses

It's a good idea to create a budget based on your fixed salary. Treat any signing bonuses, annual bonuses, or overtime compensation as an unexpected windfall. Use them towards an extra student loan payment or as a way of meeting your savings goals faster.

Financial planning impacts from the pandemic

6. Pay Off Higher Interest Student Loans First

There is no benefit to paying off smaller student loans first, and most of the time you'll only have one monthly payment even with multiple loans. Pay off the highest interest rate loans first to pay less in interest over time.

When you're doing this, watch how your payments are applied. If you set a monthly automatic payment higher than the minimum, it may be divided between all of your loans. The same thing applies if you make an extra payment without specifying the loan it should go towards. If you pay online, there should be an option to select the specific loan you want to make a payment on.

. She specializes in working with physicians and executives in the healthcare industry. Her passion for working with physicians comes from being a pediatrician’s spouse for more than three decades. Julie has been featured on Forbes’ list of America’s Top Women Wealth Advisors since 2017 as well as Forbes’

Please Note: Atlanta Financial Associates is a tradename. All services provided by Atlanta Financial Associates investment professionals are provided in their individual capacities as investment adviser representatives of Mercer Global Advisors Inc. (“Mercer Advisors”), an SEC-registered investment adviser principally located in Denver, Colorado, with various branch offices throughout the United States doing business under different tradenames, including Atlanta Financial Associates.

All expressions of opinion reflect the judgment of the author as of the date of publication and are subject to change. Some of the research and ratings shown in this presentation come from third parties that are not affiliated with Mercer Advisors. The information is believed to be accurate, but is not guaranteed or warranted by Mercer Advisors.

This content is developed from sources believed to be providing accurate information, and provided by Twenty Over Ten. It may not be used for the purpose of avoiding any federal tax penalties. Please consult legal or tax professionals for specific information regarding your individual situation. The opinions expressed and material provided are for general information, and should not be considered a solicitation for the purchase or sale of any security.

Pay off debt in a smart way to make sure that it doesn't cost you any more than it needs to.

Medical School Debt: Best practices when paying it off

Krisi Hutson, product line developer at Availity, discusses when providers should begin discussing payments for services with patients.

When providers should begin discussing payments for services with patients. 

When to start discussing payments with patients

If you’re looking to move and secure the best financial situation for your family and practice, you might want to avoid these five states with the highest average cost of living.

Index is an average of categories like grocery, housing, utilities, transportation, healthcare, and more.

Best States to Practice: Bottom 5 states with highest average cost of living

Avoid these states for your best financial situation.

Best States to Practice: 5 states with highest average cost of living

StethoscopeGavelKeyboardMalpracticeLaw_202753258.png

We’ve recently covered a variety of issues that can threaten physicians’ wealth ranging from the predictable and recurring seasonal 

 and the asset protection and estate planning issues associated with 

 investing. As much I have taken great efforts to remind physicians to think of their legal risk factors holistically— beyond just malpractice risk—and to include their risks as employers, investors, property owners, and even parents, medical malpractice claims remain a serious risk that requires proactive defensive planning.

We’ll start our review of medical malpractice lawsuit risk with a look at some facts and numbers that will help you understand and hopefully manage your position on the lawsuit food chain based on factors including specialty, location, and compensation. In addition to the details below, consider 

; male physicians generally earn more than their female colleagues (earning nearly sixty thousand dollars more a year among primary care physicians and nearly ninety thousand more among specialists) and self-employed physicians earn an average of just of fifty thousand dollars more per year than employed physicians in the same specialty.

Which Medical Specialties Get Sued the Most?

Here are the 10 specialties hit with the most lawsuits, according to a wide-ranging 

that surveyed a national sample of 4,300 physicians across 29 specialties.


1. General surgery
2. Urology
3. Otolaryngology
4. OB-GYN & Women's Health
5. Surgery, specialized
6. Radiology
7. Emergency medicine
8. Cardiology
9. Gastroenterology
10. Anesthesiology

Risk vs. Reward – Which Medical Specialties Earn the Most?

ranking of 29 distinct medical specialties

 where average earnings ranged from a low of $221K a year for pediatricians to a high of $526K a year for plastic surgeons, these are the top ten.

. The top ten states with the highest average physician income ranged from $329K to $348.

What States Are Highest Risk for Doctors?

Again, if you think that all the lawsuit action would be states with the highest populations or the biggest urban centers overflowing with plaintiff’s attorneys, you may be surprised. 

These are the top ten most litigious states

 for doctors, from a low of 63% (Arizona) of all physicians in the state being sued, to a high of 75% in Kentucky.

Top Ten Most Litigious States – Percentage of Physicians Sued

Malpractice insurance is a vital line of defense and after remaining steady for nearly a decade, prices are rising across the country according to a recent 

. From 2010 to 2018 insurance premium prices rose nationally on 12-17% of all specialties and varied widely based on location and specialty. They rose by about 25% in 2019 and 30% in 2020. Surprisingly, the report is explicit that the recent increase is not due to COVID-19 related claims, as there has not been time for the industry to adjust to data from 2020. Premiums and premium increases vary widely based on a variety of factors including medical specialty as well as the local legal climate including variances in both consumer and lawyer behavior. Geography is also a big factor, as one example OB/GYN faced base premiums ranging from $49,804 in one California county to over $200,000 in Miami.

These numbers provide the backdrop for our continuing discussions that will include at the causes of these claims and a variety of defense strategies available to informed physicians that will make you a hard target.

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. Learn more at

While physicians face many financial and legal risks, the elephant in the room is always your professional liability and the risk of a malpractice lawsuit. We start an in-depth look at the facts about these lawsuits including where they happen, who they happen to, and what they cost.

Asset Protection: Malpractice risk by the numbers

, is the Founder and Chief Health Innovator of 

a cloud-based software platform that enables personalized management of health conditions across populations. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, an industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.

Whether we realize it or not, every day we're benefiting from application programming interfaces (APIs). If you're paying with PayPal, logging into Facebook, or making vacation plans on one of the popular travel booking websites, it’s an API that makes these actions possible. APIs are a hallmark of the consumer experience, enabling safe and secure data sharing and supporting functionality between devices, applications, and people.

By enabling interoperability, APIs power so many aspects of our economy. Yet compared to other industries and sectors, healthcare lags behind in adopting or implementing technology or new capabilities that can further assist in improving workflows and outcomes. Strapped with legacy systems and proprietary technology, information sharing in the healthcare space is difficult. Legacy systems result in unnecessary roadblocks for providers that can benefit from sharing patient records to deliver the best care for patients. And while patients want greater access to and control over their own health data, that has been inexplicably difficult to achieve.

Fast Healthcare Interoperability Resources (FHIR)

, however, this is all changing. As this API standard is more broadly adopted, we can expect a significant impact on the healthcare ecosystem. FHIR will deliver greater consistency for structuring medical data and supporting new, innovative applications to enhance collaboration and care. And, in the era of growing healthcare consumerism, FHIR APIs also give patients more convenient access to their health information from any device, at any time.

You’re Not Alone: How clinicians deal with grief

More Patient Data Provides Greater Healthcare Opportunities

Today, there is a staggering amount of data being generated about our health from apps that monitor your activity and sleep to the DNA test you received for Christmas. In addition to the typical clinical data, such as test results and imaging, patients are asking their doctors to consider patient-generated health data from wearables and remote monitors when making treatment decisions and recommendations, which have become even more commonplace during the COVID-19 pandemic.

healthcare accounts for about 30% of the world's data volume

. By 2025, the compound annual growth rate of data for healthcare is expected to reach 36%, growing more than three times faster than any other sector, including media and entertainment, financial services and manufacturing.

This data has great value. By having a full picture of a patient’s data—collected both in the office and generated during their daily lives—providers can tailor and optimize care for each individual. However, the proprietary or product-specific solutions employed by each provider, hospital, and health system have long stood in the way of effective healthcare data utilization.

Congress sought to change this with the 21st Century Cures Act, which is intended to 

accelerate medical product development and bring new innovations and advances to patients

 who need them. Enabling support for FHIR APIs was the first step toward this vision, as it creates a standard nomenclature for the data elements and a standard API for exchanging data. Substitutable Medical Applications and Reusable Technologies (SMART) on FHIR improves that functionality by ensuring that any app can easily integrate into the user experience of any EHR system, portal, Health Information Exchange or other health IT system. SMART on FHIR addresses the issue of secure authentication between systems (such as single sign on) and allows providers to access third-party applications inside of their EHR user experience.

 in healthcare, adoption of FHIR-enabled applications by healthcare providers or patients is still in nascent stages. The bulk of FHIR adoption is being done by larger, more advanced health systems, which are leveraging the APIs for patient-record exchange, clinician-enabling tools, and patient-facing solutions, according to a CHIME/KLAS Research report. In fact, 

about one-quarter of organizations surveyed noted that they have gone live with FHIR APIs and are able to rate their satisfaction

, whereas nearly 40% said that they could rate their satisfaction on implemented FHIR APIs.Notably, 40% of respondents said they weren't attempting to use them at all. 

The initial use cases for APIs tend to center around 

patient access and clinical decision support

as data exchange among healthcare providers treating the same patient, are not yet as prevalent

. One reason could be that vendors still vary significantly on the data elements they permit for FHIR APIs and standardization of patient-centered healthcare data mandated by U.S. Core Data for Interoperability (USCDI). Other factors holding back use of APIs for provider information sharing include terms of use agreements governing relationships between providers, EHR vendors, and third-party application developers and the terms and conditions, which didn't include details, such as costs.

Asset protection, insurance, and seasonal summer risks

Real-Life Applications: FHIR-based platforms for providers and patients

Despite the lack of widespread use and initial early lack of consensus on a FHIR standard, there have been promising applications of FHIR APIs. For example, Georgia-based Emory Healthcare now offers 

 that enables providers to document procedure details and track outcomes with integration to surgical and clinical schedules. Through the app, patients can self-report post-operative details, such as nausea, pain, medication usage, and physical therapy outcomes, while doctors can search by patient, procedure or multiple patient characteristics to find patients with similar cases to compare therapy regimens.

FHIR app to manage deep brain stimulation (DBS) procedures

or Parkinson’s disease and other neurologic conditions. DBS is a long, multi-step process that’s often frustrating and confusing for patients, inefficient for providers and administrative staff. Much like tracking the items you order from Amazon, the app keeps patients and providers on the same page and offers transparency in the complex pre-and post-surgical process. The DBS app allows patients to view appointments and communicate with their clinical care team, while providers can use the app to enroll patients in the program, send reminders and configure their treatment journey -- all from within their existing EHR experience.

These types of applications are just the start of game-changing offerings in healthcare. Our industry is on the cusp of significant innovation unleashed by FHIR that will enable EHR vendors, app developers and providers to truly improve care and the patient experience. As the industry moves forward, we must ensure all information – from data generated by consumers using at home devices and patient-reported outcomes, to details in EHRs and third-party data – is included and adoption is encouraged amongst providers of all sizes and types. By effectively supporting widespread interoperability and data exchange, FHIR APIs have the power to fundamentally reinvent the healthcare ecosystem.

, a cloud-based software platform that enables personalized management of health conditions across populations. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, an industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry

As the industry moves forward, we must ensure all information is included and adoption is encouraged amongst providers of all sizes and types.

Why innovation with FHIR APIs strengthen our healthcare ecosystem

Podcasts

Physicians Practice® spoke with John Harrison, CCO of Concord Technologies, about how documentation technologies can improve workflows in practices. 