is the Educational Program Director and a CERTIFIED FINANCIAL PLANNERTM at MEDIQUS Asset Advisors, Inc. He specializes in wealth management solutions

The equity markets have again pushed against all-time highs. During these times, sentiment amongst investors is often split. Some believe the markets will continue to push higher and continue to buy into the euphoria of the markets rising. Others believe the markets are due for a correction and start pulling out of investments to preserve their profits. This is an action driven by fear. Whether putting more money into the markets with the belief they will continue rising in the short term or pulling money off the table in anticipation of an impending drop, both actions are emotional responses to feelings of euphoria and fear. Investing with emotion can lead to costly mistakes. 

When markets are approaching and sometimes exceeding all-time highs, and there is uncertainty about whether they will head higher or lower, what are some non-emotional actions you can take?

Trending: Healthcare providers career satisfaction is dropping

Having an investment strategy is critical. Staying disciplined during market uncertainty is key to long-term investment success, and your investment strategy is there to protect you from reacting emotionally and making mistakes. The strategy will tell you when to buy, what types of investments to buy, and the circumstances in which it is acceptable to sell. Having this investment strategy will allow you to focus on growing your wealth in a disciplined and planned out manner, while also ignoring the outside noise.

The markets are often cyclical, and while one asset class may be doing well, another may be struggling. This can lead to your asset classes straying from their target percentages. Some categories may become overweighted and others underweighted. One of the keys to long-term investing is keeping your asset allocation in line with its target percentages. If some categories are over or under weight, then your policy is taking on more risk than originally intended.

There are two preferred methods of rebalancing. Option one is to sell a portion of the category that is overweight and reallocate the proceeds to underweight categories. In tax-advantaged accounts like 401(k)s and IRAs, rebalancing is relatively easy to do because you can sell investments without having to worry about capital gains taxes; however, in taxable accounts like individual, joint, and trust accounts, the tax implications of selling must be factored into the rebalancing decision. You could end up owing a hefty capital gains tax if you rebalance by selling an investment with a significant gain. For taxable accounts, rebalancing strategy option two typically works best: add more money to the account and invest in the underweight categories.

Read More: Healthcare Compliance: 7 elements for an effective program

Stockpile cash, invest at opportune times

Knowing when the markets will experience a pullback or correction is nearly impossible. However, when the markets head in a negative direction, excellent buying opportunities may arise and some investments may be trading at a discount. You can be prepared to take advantage of these moments by having cash on hand.

Start by determining the amount of cash you want or feel comfortable sitting in reserves. Use this stockpile to invest in categories trading at a discount during market pullbacks. Since it is impossible to know when the market has hit its bottom, use a dollar cost averaging strategy to invest incrementally over a set period. Buying incrementally removes the risk of putting all your chips on the table at one time and have the investments continue to drop. As markets and investment values continue to fall, you will incrementally purchase at more and more advantageous prices. It may not get you quite the return as if you had perfectly picked the bottom of the market pullback, but that is a difficult, if not impossible feat to get right consistently.

No one can really know whether markets will continue climbing or experience a pullback when pushing record highs. Having a plan in place will allow you to stay disciplined and invest without emotion. Remaining well-allocated and diversified across asset classes will reduce the risk in your overall portfolio. Finally, have a little cash available in case some investments are trading at a discount.

Jeff Witz, CFP® welcomes readers’ questions. He can be reached at 800-883-8555 or at 

Effective June 21, 2005, newly issued Internal Revenue Service regulations require that certain types of written advice include a disclaimer. To the extent the preceding message contains written advice relating to a Federal tax issue, the written advice is not intended or written to be used, and it cannot be used by the recipient or any other taxpayer, for the purposes of avoiding Federal tax penalties, and was not written to support the promotion or marketing of the transaction or matters discussed herein.

The information contained in this report is for informational purposes only. Any calculations have been made using techniques we consider reliable but are not guaranteed. Please contact your tax advisor to review this information and to consult with them regarding any questions you may have with respect to this communication.

MEDIQUS Asset Advisors, Inc. does not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your own tax, legal and accounting advisors before engaging in any transaction.

Articles

Investing when markets are at all-time highs

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.

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: 20-11

Perhaps you’re looking to relocate and considering a state where you can establish your own reputation quickly. Look no further than these 5 states with the lowest amount of practicing physicians.

However, keep in mind that fewer physicians might mean that more potential patients have established relationships with those already established in these states.

Best states for physicians in 2021: 5 states with the lowest physician density

A lower number of practicing physicians may mean greater opportunity to establish your own reputation.

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, 

In the majority of treatment and disclosure of protected health information (PHI) scenarios, parents or legal guardians are entitled to provide informed consent for the treatment of the minor and may request the minor’s medical records. From both a legal and an ethical standpoint, informed consent is fundamental to medical treatment because of the value placed on a patient’s autonomy. As the 

American Medical Association’s Code of Medical Ethics Opinion 2.1.1

, “[p]atients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care. Successful communication in the patient-physician relationship fosters trust and supports shared decision making.” Typically, the older a child becomes, the more “weight” is given to their perspective – this is known as assent.

Like most situations, there are exceptions. 

 addresses access to medical records, including those of minors. §401.55(c) states,

. You may request access to your own medical records in accordance with paragraph (b) of this section.

Requests on a minor's behalf; notification of or access to medical records to an individual on a minor's behalf.

(i) To protect the privacy of a minor, we will not give to a parent or guardian direct notification of or access to a minor's record, even though the parent or guardian who requests such notification or access is authorized to act on a minor's behalf as provided in § 

(ii) A parent or guardian must make all requests for notification of or access to a minor's medical record in accordance with this paragraph and the procedures in §§ 

 of this part. A parent or guardian must at the time he or she makes a request designate a family physician or other health professional (other than a family member) to whom the record, if any, will be sent. If the parent or guardian will not designate a representative, we will decline to release the requested information.

(iii) Where a medical record on the minor exists, we will in all cases send it to the physician or health professional designated by the parent or guardian. The representative will review the record, discuss its contents with the parent or legal guardian, then release the entire record to the parent or legal guardian. The representative does not have the discretion to withhold any part of the minor's record. We will respond in the following similar manner to the parent or guardian making the request: “We have completed processing your request for notification of or access to _____'s (Name of minor) medical records. Please be informed that if any medical record was found pertaining to that individual, it has been sent to your designated physician or health professional.”

(iv) In each case where we send a minor's medical record to a physician or health professional, we will make reasonable efforts to inform the minor that we have given the record to the representative.

There are also situations where a minor may give informed consent for his/her care. As 

(a) State law not requiring parental consent to treatment.

 alone has the legal capacity under the applicable state law to apply for and obtain 

, any written consent for disclosure authorized under 

 of this part may be given only by the minor 

. This restriction includes, but is not limited to, any disclosure of 

 for the purpose of obtaining financial reimbursement. These regulations do not prohibit a part 2 

 consents to the disclosure necessary to obtain reimbursement, but refusal to provide 

 may be prohibited under a state or local law requiring the 

The main take-away from this CFR section is that the type of treatment being sought by a minor (i.e., substance use disorder, sexually transmitted diseases), as well as the law in the state in which the individual is seeking treatment is critical to determine what is permissible and what is not.

Overall, parents are entitled to provide informed consent for their child’s treatment, as well as receiving medical records. However, there are treatment exceptions where parents do not need to give consent, and this is based on state law.

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at

in Houston. Rachel can be reached through her website,

When considering the treatment of minors, as well as the release of the related protected health information, there are considerations not to overlook.

Confidentiality and consent considerations when treating minors 

A member of Nashville-based Bass, Berry & Sims PLC, focuses his work on fraud and abuse issues for physician practice groups and other healthcare provider organizations.

At the outset of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) relaxed restrictions on telehealth services, allowing telemedicine to be provided to more patients, in more locations, through more varied modalities, and by a broader range of healthcare practitioners. Within that new regulatory environment, the provision and use of telehealth care exploded. But the history of government healthcare fraud and abuse enforcement efforts teaches one unassailable lesson: increased utilization inevitably leads to increased government scrutiny. 

Telehealth Enforcement Efforts Pre-Date the COVID-19 Pandemic

Many physicians began to utilize telemedicine increasingly in recent years as a means to expand access to healthcare before the COVID-19 public health emergency. As such, it is not surprising that enforcement actions related to telehealth also appeared to be on the rise even pre-pandemic. Here are three examples where prosecutors allege illegal kickbacks were paid to doctors who prescribed treatments for patients without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen:

In April 2019, the U.S. Department of Justice (DOJ) 

 against 24 individuals, including executives of five telemedicine companies and three licensed medical professionals; prosecutors alleged that durable medical equipment (DME) companies paid illegal kickbacks and bribes in exchange for Medicare patient referrals for DME.

 against 35 individuals, including nine physicians, associated with dozens of telemedicine companies and cancer genetic testing laboratories in a similar scheme. The DOJ claimed that the fraudulent scheme caused more than $2.1 billion in improper billing to Medicare. 

 against the owner of two telemedicine companies alleging improper payments to physicians and nurses in exchange for DME orders, part of a 

 that implicated $480 million in Medicare billing. 

Why social media is important to your practice

Telehealth’s Expansion and Heightened Enforcement

Historically focused primarily on rural areas and populations, increased access to telehealth services in 2020 caused an explosion in telehealth utilization. Before the pandemic, less than one percent (0.1%) of Medicare primary care visits were provided through telehealth; but by April 2020 that percentage 

 to nearly half (43.5%) of all such visits. 

Not surprisingly, increased access to and use of telemedicine led to increased billing for telehealth services, and, as a result, heightened scrutiny by government enforcement agencies. Telehealth fraud was the focus of the 2020 national healthcare fraud takedown, 

: The government claimed that the fraud schemes involved more than $6 billion in alleged loss and that $4.5 billion of that total related to schemes involving telemedicine. 

What to Expect Next and How to Prepare for It

As long as utilization of telehealth services remains high, corresponding scrutiny and government enforcement efforts will remain focused on this area. 

Physicians and other providers should expect and prepare for that scrutiny. Pre-pandemic enforcement efforts likely focused on the most egregious cases. As those efforts broaden, however, the government likely will scrutinize not only more providers but also conduct that may not necessarily appear on its face to be clearly fraudulent.

Past enforcement practices indicate that the government will analyze data points such as increases in billing, patient visits, and the number of new patients to attempt to locate both outlier providers and providers who have experienced a notable increase relative to their historical data. For example, given the efficiencies of telemedicine, it would not be surprising for a physician or practice to be able to see more patients than before telehealth restrictions were loosened. Nonetheless, the government may view an increase in visits, patients or claims submitted as a red flag.

Two False Claims Act settlements underscore the importance of not taking kickbacks and proper billing

Although a physician or practice cannot completely insulate itself from potential scrutiny, there are numerous ways to best position for or attempt to avoid that scrutiny:

Many of the telehealth fraud enforcement actions to date involve complex schemes that implicate many different parties playing different roles in providing telehealth services. Physicians should not and cannot rely on other parties’ representations that certain practices or arrangements comply with applicable regulations and restrictions.

Clear documentation of patient engagement remains particularly critical with telehealth, where regulators will surely focus on the legitimacy of the patient relationship and the necessity of the services provided, including any prescriptions or follow-up care.

Telehealth services are subject to a rapidly changing regulatory landscape. Providers should have a specific process in place for tracking and staying up to date on the current rules.

Audit, analyze, and know your own data—examine your practice from a regulator’s viewpoint to determine in a timely fashion whether red flags are being raised.

Carefully document compliance-related measures and decisions.

Working closely with legal counsel to review compliance measures and any questions that arise are critical as practices continue to offer telehealth services to better serve patients.

, a member of Nashville-based Bass, Berry & Sims PLC, focuses his work on fraud and abuse issues for physician practice groups and other healthcare provider organizations

The history of government healthcare fraud and abuse enforcement efforts teaches one unassailable lesson: increased utilization inevitably leads to increased government scrutiny.  

Telehealth fraud and abuse enforcement efforts unlikely to taper

Memorial Day weekend starts the “100 Deadliest Days” of summer when personal liability risks for physicians and their families spike. Here are some basic risks and risk management issues to be aware of to make sure this vacation season doesn’t cost you your wealth.

After a year of lockdown conditions America is getting vaccinated and ready to travel and enjoy some vacation time starting with the Memorial Day holiday. Unfortunately, this happy time is also known as the “100 Deadliest Days” because of the annual spike in accidents, injuries, and fatalities that occurs every year during the traditionally summer vacation season in the period between Memorial Day and Labor Day,.

I am routinely contacted for hep by physicians I have to turn away from helping because they are looking for help 

when the law prohibits most asset protection

 measures that could have been legally and predictably implemented in advance. What will surprise most physician readers is the fact that in the last 18 months, the number one reason I have been contacted late by physicians and their spouses in a panic over losing everything wasn’t because of a medical malpractice claim, rather it was because they were underinsured on their automobile insurance and failed to have a seven-figure umbrella policy in place. Then, 

they or family member got into an acciden

t with significant injuries or fatalities and were informed their liability would exceed their policy limits.

I advise my clients, friends, and family members that an umbrella policy of 

 in place is the single most vital and cost-effective asset protection tool for every physician. If your net worth is higher, consider matching it. Given the low cost of this coverage and the ease with which you can have your agent add it with a single phone call, there is no reasonable excuse to expose yourself one day longer if you don’t already have one in place.

Know the risks; why is summer more dangerous?

As with many risks, management and leadership go a long way, including 

. Make sure you have clearly established and 

 guidelines about the appropriate use of your homes, vehicles, and other property by your family and all guests, including your own—it’s not always the kids that burn the house down.

A combination of factors leads to increased risks:

More children, including adult college-aged children, are out of school and have more unsupervised free time.

Children are spending more time driving for leisure purposes, often unsupervised and with friends, which leads to distracted driving accidents.

Adults, including yourself, are often spending more time driving, traveling, and entertaining third parties.

Summer often sees the greatest use of vacation homes, boats, jet-skis, recreational vehicles, and other “weekend warrior” hazards that may have individuals engaging in activities beyond their ability or while impaired.

Lawyers know when someone is going on a vacation because we get calls like, “Can you do an estate plan in two days?” If you don’t have one in place, consider doing it before the paragliding trip to Costa Rica, or even something less adventurous, and give yourself time to work with a professional and make good choices. It doesn’t have to be a masterpiece to start, so don’t be intimidated into doing nothing instead of at least having something basic and functional that can be amended or expanded later.

If you can answer these simple questions, you have most of the basics an estate planner will need:

Who should have guardianship of my minor children?

Who should have healthcare power of attorney for me if I’m incapacitated?

Who should have financial and legal power of attorney for me if I’m incapacitated?

A number of popular vacation destinations including California, Arizona, and Colorado have fully legalized recreational cannabis sales. Whether this is a conversation you need to have with your children or one that hits closer to home, please avoid needing a “vacation lawyer” by remembering:

It’s usually not legal to consume in public

It’s not legal to drive or sail impaired

Know your limits, it’s all medical grade

, 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

Memorial Day begins the “100 Deadliest Days”.

Asset protection, insurance, and seasonal summer risks

If you are an accountant, you may not be a fan of the generalizations made in this article. The article is designed for physicians as an overview of the topic of goodwill. We are not trying to make physicians accountants here, but rather to give them a high-level overview of what goodwill is and how it factors (or doesn’t factor) into a medical practice sale.

Notice we aren’t suggesting what goodwill “is”, because there is much variability, as we will cover throughout this article. In short, the purpose of goodwill is to compensate the seller for the effort she put into building the medical practice.

Broadly speaking, the value of a medical practice goes far beyond a collection of assets (e.g. medical equipment, office furniture, etc.) and inventory (e.g. medical supplies, office supplies, etc.). A medical practice has intangible assets such as practice brand, the reputation of the practice and its providers, its patient base, its loyal referring physicians, etc. These intangible assets are what go into the determination of goodwill. For medical practices, goodwill is often the largest component of the sale price (unless of course there are large included assets that are new). As an aside, there may also be other applicable factors in the goodwill of the practice such as copyrights, trademarks, patents, trade secrets.

When physicians are looking at pricing their practice for a sale, they will most likely have discussions with their accountant about the dollar amount attributable to goodwill. The same holds true for physicians looking to purchase a practice. The difference is the perspective about how much money should be allocated to goodwill. Indeed, unlike with the pricing of assets, there is more variability in the calculation of goodwill and thus it is often referred to as a “blue sky” calculation.

If you would like to know more about the methods behind calculating goodwill, you can ask your accountant about these:

When it comes to negotiating goodwill, the interests of the buyer and seller are at odds with one another due to tax implications. The two parties must agree on the allocation of the components of the price of the practice and, in part, this will depend on the advice each party receives from their respective accountants.

It is extremely important for this step that you get with your accountants because they will look at any personal tax implications for you as well as (in the circumstance of a buyer acquiring an additional practice) the financial standing of your existing practice.

As a general rule of thumb, the buyer wants to maximize the allocation to tangible assets which are generally depreciated over a 5-7 year period, whereas the value of goodwill is amortized over 15 years. The seller, however, usually desires to minimize the allocation of the purchase price to tangible assets. From the standpoint of the seller, the dollar amount allocated to goodwill is generally classified as a capital gain with lower tax rates than ordinary income rates.

At the end of the day, however, the dollar amount attributable to goodwill is a negotiating point between buyer and seller, regardless of who did the calculation or what method was used. Valuing a medical practice for an acquisition involves finding a price that is mutually acceptable to both the buyer and the seller. Naturally, the seller will want to ask as much as possible and the buyer will want to pay as little as possible. This is especially true with the goodwill component. In my experience, the buyer tends to feel the goodwill amount is too high and the seller tends to feel it is too low. Successful negotiations of the medical practice transaction seek to strike a reasonable middle ground.

Goodwill assigned to a departing physician

As previously mentioned, there are many factors that can be attributed to goodwill in the price of a medical practice. One of those factors is the following that a physician brings to the practice—this is one of the sticky points that can cause heated negotiations.

Undoubtedly, patients may come to a practice to faithfully see ‘Dr. Jones’ for treatment and referring physicians may be loyal to sending patients to the practice to see him too. However, how do we handle goodwill in the case where the practice has just one physician (‘Dr. Jones’) and he is retiring upon the closing date of the sale? As just mentioned, patients come to see 

, so when he is gone, there is no guarantee that the following will remain for the buyer (‘Dr. Smith’). Consequently, why should ‘Dr. Smith’ allow for an allocation to goodwill for this specific factor?

It is worth repeating that there are many factors that contribute to goodwill and thus I’m not saying goodwill should be zero dollars just because the buyer is retiring. Even if there is just one physician, there may be other providers such as nurse practitioners and/or physician assistants who do indeed have their own contribution to goodwill. Additionally, there are many other factors that may increase the goodwill dollar amount; you just want to think twice about allocating significant dollar amounts in goodwill to the departing physician.

Goodwill can include almost any intangible quality of a medical practice that makes it more valuable than just its assets. These could include word-of-mouth name recognition due to years of advertising, a great reputation for patient care, or anything else that contributes to the practice’s net revenue that cannot be accounted for based solely on its assets. Because of all this, it is important to have a group of skillful advisors on your team. An accountant is invaluable (whether you are the buyer or the seller) as she can assist with valuations and look out for your specific interests as they pertain to tax implications. A transactional consultant is invaluable (whether you are the buyer or the seller) as in addition to helping facilitate the entire process, he can assist in the skillful art of negotiations between the two parties.

, a consultancy specializing in strategic healthcare initiatives for physician practices. His firm helps devise and implement strategies that will allow practices to remain competitive and solvent. E-mail him

A high-level overview of what goodwill is and how it factors (or doesn’t factor) into a medical practice sale.

Goodwill: How it factors into a medical practice sale

Ericka L. Adler, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.

, there are more physicians working outside physician-owned practices now than in the past. While almost half of physicians (49.1%) are still working in physician-owned practices, this number is 11% lower than 2012, at which time 60% of physicians reportedly worked in physician-owned practices. 

It’s hard to fully understand what this survey actually says about the prevalence of physician-owned practices. I have helped sell many physician practices to hospitals, private equity, and similar investment groups over the past 10 years, so perhaps this type of activity can explain where some of the independent physician practices have gone. However, there are also many physician groups that still look and operate very much like private practices, but which are not 100% independently owned by physicians. This means they were likely not “counted” in this survey and the results may actually be misleading about how many independent physicians there really are in practice. 

Five things physicians should consider when creating their financial plan

Many physicians coming out of training today appear to opt to work for a hospital, believing that the administrative hassle will be less and that the hours will be more steady and secure. This may or may not be true, depending on the actual employer and specialty. These same physicians often have expressed to me a disinterest in the business of medicine or in the entrepreneurial spirit that being a practice owner may require, which can explain why hospital employment is the right fit for them. Hospitals are also a particularly good choice for those interested in academics and research, and often can offer loan forgiveness/repayment programs, or service as FQHCs, which can be a priority for physicians coming right out of training. Exiting the COVID-19 pandemic, many physicians are also looking for the security they feel an institutional employer can offer, whether this is an accurate premise or not. 

Another great choice for physicians is the independent practice route, and there are many thriving private practices in this country. My impression is that physicians in private practice are generally very happy with their jobs. Working for a private practice is a lot like running a small business. In an independent practice, physicians engage in decision-making and self-governance, they take on developing compensation arrangements that suit their needs, and they decide how best to run everyday operations. Independent practices also have the luxury of developing the kind of practice they want, without the restrictions that an institution can present and without needing their employer’s permission. This approach is especially appealing to those physicians who want more of a say in the company for which they work.

I recently spoke with Dr. Andrew Gordon, President of Northwest Neurology, a large independent practice located in the Chicago area, and I asked him what he thinks of the American Medical Association Survey results and what it says about the decrease in private practice physicians. Dr. Gordon strongly believes that private practices are the better option, stating “private practices often offer better work conditions, greater autonomy, and greater income. Young doctors who are going to health systems and not even considering private practice could be missing out on great opportunities. Many doctors who work for health systems end up going private after they learn the hard way that the institutional job is not what they expected it to be.” 

While a physician must work hard to be successful in either the private practice or hospital employment approach, hospitals can often have less flexibility to incentivize physicians or elect to cap compensation (sometimes as a result of legal restrictions and other times due to bureaucracy), which can be stifling for physicians who feel they do not see the benefit of their hard work. Additionally, adding new services and products for patients can be more easily achieved in an independent practice, whereas in the hospital setting the process and timeframe for getting approval for new products and services can be daunting. Finally, while both types of employers can be good lifestyle choices, physician who work for themselves have the luxury of choosing their own hours and workstyle, which many find liberating.

How to improve your practice’s online presence post-pandemic

There is no perfect employer, there is only the perfect employer for the particular physician! Some physicians prefer a more corporate hospital setting and others the independence and opportunity a private practice can offer. While we continue to see consolidation and acquisition of independent physician practices across the country, it would be a mistake to believe that independent practices are going anywhere!

, JD, LLM has practiced in the area of regulatory and transactional healthcare law

for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.

Though recent survey data suggests fewer physicians are choosing private practice, the data may be misleading. Hospital or private practice employment should only be chosen after carefully weighing the pros and cons of each. 

Private practices thriving, despite AMA survey

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These five states are home to the largest number of physicians.

While on the surface this means a richer peer community, it also means far greater competition for patients.

Best states for physicians in 2021: 5 states with the highest physician density

Source: Kaiser Family Foundation, Total Professional Active Physicians, March 2021; U.S. Census Bureau Annual estimates of the Resident Population for the United States, Regions, States, and Puerto Rico for 2021.

These states have the greatest number of physicians working, meaning greater competition for you.