The Best States to Practice in 2015

October 2, 2015
Erica Sprey

We crunched the data and ranked each of the 50 states to help you find your next practice home.

The Western United States evoke images of rugged independence, wide-open spaces, and breathtaking mountain vistas. Perhaps that is why three of our top "best states to practice" hail from that region. These states have lower rates of physician density, cost of living, and tax burdens; all factors that make practicing medicine easier on independent docs. The physicians we spoke to also told us that, in the West, there is a certain attitude, a slower pace of life that imbues their communities with friendliness and appreciation for each other.

METHODOLOGY

Physicians Practice has been ranking the best states to practice for nearly a decade, and in that time there have been significant changes in the business of practicing medicine. However, the economic factors that make a great place to practice are more immutable. This year's Best States to Practice, Sponsored by The Doctors Company, examines state data on cost of living, physician density, disciplinary actions taken against physicians, tax burden per capita, malpractice paid loss (the amount paid in malpractice awards per state), and Medicare's Geographic Practice Cost Index (which adjusts physician reimbursement based on regional variation in the cost to treat patients). Rather than tally an average ranking for every state, we used an algorithm to make our determinations. From there, we calculated the five best states to practice medicine in 2015: Idaho, Nevada, Georgia, Texas, and Utah.

If your state is not highlighted here, a more in-depth look at how each state (and the District of Columbia) performs in each data category is available at bit.ly/beststates-map. If it is, see if you agree with our analysis.

IDAHO: A GOOD VALUE

Idaho is indeed the Gem State. This year, it garnered the second lowest state ranking in both physician density and cost of living. It also boasts few physician disciplinary actions and a low tax burden, making it easy for a physician to thrive.

Osteopath Brandon Mickelsen practices family medicine in Pocatello, Idaho, a town of about 50,000 residents nestled in the foothills of the Rockies. Born and raised in the state, he says "Idaho has the things that I love to do - I love to be outside and go snowshoeing and snow skiing and waterskiing and hiking and camping."

The low physician density means there is also a shortage of doctors, most deeply felt in the medical specialties. But fortunately Pocatello is home to a family medicine residency affiliated with Idaho State University, and Mickelsen, who is the residency director, says that means plenty of primary-care providers for his community.

Mickelsen, who also holds a leadership position with the Idaho Medical Association, counsels his residents to carefully consider their motivations for choosing a location to set up practice. "…The physician salaries are lower in Idaho as a general rule, and so oftentimes, people look at that and think 'Oh, I don't want to go to Idaho because I'll make less.' But … [I am] often pointing out that the cost of living is dramatically different. For me, the house that I've purchased here in Pocatello would be two or three times as much if I were still living in Maine."

NEVADA: ROOM TO SPREAD OUT

Nevada has a higher cost of living than the rest of our top-five states, but that is offset by lower physician density, disciplinary actions, and malpractice payouts. Family physician Jeffrey Ng is part of a group practice in Henderson, Nev., and says he migrated from a small practice in Connecticut because of the need for physicians. "They have a community here that makes it very attractive for young doctors, because the cost of living is much more affordable vs. California. And the neighborhoods that are out here are modern. It's a newer city, newer town."

Ng, who is president-elect for the Nevada Academy of Family Physicians, says he also enjoys the climate and opportunities for recreation in Las Vegas. "The weather is what really draws you here as well as the entertainment - I mean it is Vegas," he says, "You get the glitz and glamour of it."

Las Vegas has many hospitals that call it home. There are three major health systems and a medical village complex (hospital center, senior living, and retail space) under construction. Ng says it is a little more difficult for young physicians to start out in independent practice because of the saturation of large health systems and insurance corporations in Nevada, but notes that does open up more opportunities to become an employed physician.

GEORGIA: FAMILY FRIENDLY

Having previously practiced on both the East Coast and West Coast, pediatrician Jennifer Shu is happy practicing medicine in Atlanta, where she is a partner at a 12-physician group practice.  She says it is a good fit for her current circumstances, following time spent in California as an employed physician and New Hampshire at an academic practice. "Being in private practice in Georgia, I feel like, at least in our practice, we still have a lot of independence. We can make our own decisions and still manage to have a viable business," she says.

That control is also expressed in physician work schedules. A full time schedule for Shu and her partners "is considered four work days a week," she says, "and we take turn working on weekends and covering night calls … So as far as weeknight quality of life with [my] kids, once I'm done at work, I'm done."

In our analysis, Georgia enjoys a low physician density, cost of living, disciplinary actions, and tax burden; all factors conducive to running a small business. The only gray cloud is a higher ranking on malpractice payouts; something which Shu says has not affected her. She thinks the pressures on physicians in other parts of the country aren't as demanding in her region; issues such as hospitals buying out smaller practices or capitation. Shu also says she appreciates having a state-wide immunization registry, something that is not universal across the U.S.

Because Atlanta is in a large metropolitan area, there are plenty of opportunities for family fun and recreation. "For kids there's very high-level sports … and there are some excellent schools - both public and private."

TEXAS: A BIG SOUTHERN WELCOME

Texas has many attributes that make it physician friendly. This year, it scored well on low physician density, cost of living, disciplinary actions, and tax burden. The only trouble spot was a higher ranking on malpractice payouts. But malpractice insurance is affordable for most physicians, says osteopath Daniel Rousch, a psychiatrist who has been practicing in the Dallas/Ft. Worth area for nearly 18 years. "From a Texas standpoint, malpractice [insurance] is much easier to come by and much easier to pay because of tort reform. More doctors have malpractice insurance and aren't flying naked," he says.

Rousch also appreciates the low cost of living in Texas, which does not assess a state income tax on its citizens.

One of Rousch's greatest joys in practicing medicine, aside from caring for patients, was the opportunity to practice medicine with his father, who is also a psychiatrist and is now retired. There was a collegiality between them, he says, that he thinks is lacking for many physicians nowadays. "… Instead of looking at each other as comrades and as helpers and as team members, we look at each other as competition and as adversaries," he says.  Rousch thinks this outlook is exacerbated by the dominant insurance model where physicians are not allowed to participate in collective bargaining.

One thing that isn't lacking, says Rousch, is the abundant Southern hospitality. "I can honestly say with a straight face that my children have never met a stranger. My wife has never met a stranger. People are very nice … There is always a smile and a handshake and 'How are you doing?'"

UTAH: RUGGED INDIVIDUALS

David Jack has been practicing family medicine in Utah on the outskirts of Salt Lake City for more than 30 years, but in the beginning he wasn't planning on setting up a practice in his home state. "I went to high school and undergraduate college here in Utah, [and] never thought I'd come back to roost," he says, "But as I went around the state and trained and served elsewhere [in the military], I found Utah had more to offer than almost any other state."

Utah scored well in our economic metrics and stands out as a state where there is room to practice medicine autonomously. Jack says that stems from the rugged, independent mindset that Utahns share. "There are a couple of large hospital groups in Utah … that prohibit physicians from being avant-garde on their own. The smaller groups however aren't saddled with that monolithic healthcare plan. They take other healthcare plans that permit more flexibility," he says.

But Utah isn't just about independence, Jack says, "We have a beautiful state that has everything from the desert to the mountains, and everything in between - and quite a moral, ethical climate here. People are concerned with families and doing the right thing, and it's kind of a fun area because of that."

THE FIVE WORST STATES TO PRACTICE

We hate to call names, but we'd be remiss if we didn't mention the states that fell to the bottom of our list. Certainly, there is something to be said for the axiom "to each their own," and we admit our analysis does not account for proximity to cultural events, professional sports teams, fine dining, or the hubbub of urban living. However, these states generally had higher physician density, greater tax burdens, higher cost of living, and greater malpractice payouts; all factors which make it more expensive to run a practice.

The five worst states to practice in order from worst to not-so-bad are:

• New York

• Maryland

• Hawaii

• California

• Massachusetts

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

This article originally appeared in the October 2015 issue of Physicians Practice