Best States to Practice 2014

September 24, 2014

Most physicians want a favorable practice environment. If you want to know where to find it, here's our annual ranking of the best states to practice.

Wade Dowell is a family physician who practices in the small town of Indianola, Miss., population 13,000, and a true native son of Mississippi. Dowell, who is also immediate past president of the Mississippi Academy of Family Physicians, says, "I have lived within 30 miles of [Indianola] my entire life, other than medical school and residency. … I like the rural setting." When he's not treating patients you might find him with a hunting rifle: he's an avid outdoorsman who thoroughly enjoys the varied opportunities for fishing and hunting along the rivers and lakes of Mississippi.

So it's clear to see that he likes practicing medicine in Mississippi. We think it is a great place to practice, too. According to Physicians Practice's annual "Best States to Practice" rankings, Mississippi places at the top of the pack in 2014, as it did last year. Alabama, Texas, and Nevada round out the top four states in the latest rankings, but that shouldn't mean they are the only desirable places to hang up a shingle. The following states also did well in our ranking: Tennessee, South Carolina, Indiana, South Dakota, Arkansas, and Oklahoma.

If you are curious about practice conditions in our top four states, or just wondering why they are so darn physician-friendly, here are the results of our 2014 analysis.
 

Methods

While it is hard to definitively identify the "best" places to practice, we looked at key factors that can affect a medical practice's financial health. Factors such as: cost of living, disciplinary actions taken against physicians, tax burden per capita, Medicare's Geographic Practice Cost Index (which adjusts reimbursement amounts to reflect the variation in practice costs from area to area),physician density, and malpractice award payouts per capita.

Rather than produce a purely numbers-driven ranking, we also looked at the number of times a particular state placed in the top-10 for each category, to gain an overall picture of physician-friendliness. And, as much as we would have liked to include lifestyle factors such as proximity to world-class museums, professional sports teams, skiing, or rock climbing, we realize that individual physicians have different tastes.

If your state is not highlighted here, click here to see a more in-depth view of how each state (and the District of Columbia) performs in each data category.

Nevada: the great outdoors

Nevada is a tale of two regions: the more urban, northern half of the state, which includes Reno and Carson City, and the southern, more rural half. According to Donald Farrimond, a family physician practicing in Reno and president of the Nevada Academy of Family Physicians, there is a significant shortage of primary-care physicians in the rural part of the state. That jives with our ranking, placing Nevada fifth in physician density, ranking from lowest to highest. It also makes our short list for low disciplinary actions and low malpractice payouts.

Because of the demographic differences in the state, the southern part of Nevada has a greater managed-care penetration; making it harder for physicians to negotiate contracts. However Farrimond says the picture is much rosier in northern Nevada. "I think it is a favorable place … to negotiate contracts. … They really haven't introduced capitation up here in the northern parts. So income preservation … is fairly nice."

Nevada boasts grand vistas, mountain ranges, and Lake Tahoe, essentially making it an outdoorsman's paradise; which was a big draw for Farrimond. In fact, after a year out of state following his residency, he returned to Nevada to stay. "I actually love living in Nevada," he says. "If you really enjoy rock-climbing and skiing and fishing and hunting … I don't think there could be a much better place to live."

Alabama: community docs

Family practice physician Julia Boothe says the best thing about Alabama is its sense of community. Boothe, who practices in Reform, Ala., a town of about 3,000 people, says, "I'm not from the community in which I practice, but I was very easily taken in - [members of the community] see you at the local ball games … You are accepted much quicker than you would be in other places."

Boothe also believes that medical education is a strong point for the Cotton State. She notes that Alabama has two allopathic medical schools and an osteopathic medical school, which plans to open a branch campus in Auburn. Boothe, who is also president of the Alabama Academy of Family Physicians, is active in medical education herself; she is an associate professor at the University of Alabama, Tuscaloosa campus. "I have nurse practitioner students [and] residents coming through my office," she notes. "Anytime you have an increase in education, you have … more opportunities to stretch yourself, as well."

Alabama has done very well in our analysis for several years running; this year it placed in the top-10 for all factors except disciplinary actions and Medicare GCPI.

Mississippi: flexible family docs

There are numerous reasons why the Magnolia State is a favorable place to practice medicine. Not the least of which is that it has consistently placed at the top of our list for several years running. Why? Next to liberal amounts of Southern hospitality, Mississippi has a low physician density, which places physicians' skills in greater demand.

Mississippi also ranks in the No. 1 position for lowest cost of living and tax burden; combine that with very low malpractice payouts and you have an ideal environment to set up a practice. The state has also been largely sheltered from the effects of managed care, until recently, according to Dowell. He says because there's no pressure from managed-care organizations, his group practice, Indianola Family Medical Group, which is owned by South Sunflower County Hospital, has "had [the] freedom to practice medicine as it should be practiced, with the patient coming first."

Dowell has enjoyed his relationship with his employer and feels that it has allowed his practice much more autonomy. "In this clinic we do a full range of family medicine, including obstetrics and operative obstetrics. And we are able to do that because we are a public hospital," he explains.

He says his clinic is one of only two in the state that permit their family physicians to deliver babies. He notes, "I'm an old-school family physician. I think that family doctors should have the opportunity to do anything they are capable of doing." However, Dowell thinks those days are numbered as the cost of malpractice insurance for obstetrics has become prohibitive.

Texas: practice freedom

Family physician Elizabeth Seymour completed her residency in Oklahoma and practiced rural medicine there for two years. But she missed home. So she pulled up stakes and reestablished her practice in Denton, Texas, a suburb of Dallas. She says that in rural Oklahoma she did everything from delivering babies, performing C-sections, and caring for children and adults in the hospital. But in the Dallas-Ft. Worth metropolitan area, she has much more choice in how she structures her practice. Another benefit of practicing in Texas? "The malpractice [insurance] was astonishing. It was probably a quarter of what I paid in Oklahoma," says Seymour, a member of the Physicians Practice Physician Advisory Board.

Texas did very well in our analysis, with a low physician density, low cost of living, and a low tax burden. Oh, and did we mention the "astonishing" malpractice rates?  Seymour concurs with our analysis, saying that practice conditions in the Lone Star State are favorable to physicians and business owners in general. "Insurance … not just malpractice … but personal insurance and workers' comp, all the things that go into running a business, it's more business-friendly [here] than it is in other states," she adds, "I have the freedom to do whatever I want," practice-wise.

And she does not have the Texas Medical Board looking over her shoulder, either. What could be better?

If your state is not highlighted here, click here to see a more in-depth view of how each state (and the District of Columbia) performs in each data category.

In Summary

Each year Physicians Practice conducts its analysis of "The Best States to Practice," and each year many states in New England and the Mid-Atlantic region are consistently ranked at the bottom of our list. Why? The usual culprits: a high cost of living, high physician density, greater physician disciplinary actions, and a high tax burden to name a few. Aside from the Aloha State, the remaining four worst states to practice are located on the East Coast. In order from worst to not-so-bad they are:

• New York

• Maine

• New Hampshire

• Maryland

• Hawaii

Erica Sprey is associate editor at Physicians Practice. She may be reached at erica.sprey@ubm.com.

This article originally appeared in the October 2014 issue of Physicians Practice.