Measuring what matters: How our 2025 best states to practice rankings have evolved

Every year, Physicians Practice compiles our ranking of the best states in which to practice medicine. These rankings are built from multiple data points that shape physicians’ professional and personal lives. In 2024, we based our list on seven factors: cost of living, physician density, state business taxes collected, average malpractice insurance rates, quality of life, women’s health care, and the Geographic Practice Cost Indices used by Medicare to adjust payments.

For 2025, we kept all those measures but added an eighth: physician happiness with pay. This new measure reflects the reality that even in states with favorable economic or quality-of-life factors, dissatisfaction with compensation can significantly influence physicians’ feelings about practicing there.

Shuffling at the top

The top five in 2025 look different from the year before. In 2024, Idaho held the top spot, followed by Wyoming, North Dakota, South Dakota, and Iowa. This year, Wyoming rises to No. 1, Iowa moves to No. 2, Idaho falls to No. 3, and South Dakota holds fourth place. Mississippi is the most notable newcomer to the top five, moving from 27th place in 2024 to No. 5 in 2025.

Wyoming’s climb is linked to its strong showing in categories such as taxes, where it ranks first this year, and quality of life, where it placed fourth. Iowa’s improvement is driven by consistently strong results across multiple measures. Mississippi’s leap into the top five reflects its second-place finish in cost of living and solid performance in physician pay satisfaction.

Nebraska, seventh overall in 2024, remains in the top 10 this year, buoyed by ranking first in physician happiness with pay. North Dakota, third in 2024, slips to eighth in 2025.

Middle movers and stagnant states

Several middle-ranked states experienced noticeable shifts. Oklahoma, 21st overall in 2024, holds a strong position in cost of living for 2025, ranking first in that category. Colorado, which placed 14th in 2024, is 18th this year.

At the other end of the spectrum, some states remain in the bottom tier for both years. New York, New Jersey, and Maryland each continue to post low overall rankings, affected by high costs and lower scores across multiple categories. Hawaii, despite strong scores in women’s health in 2024, remains near the bottom due to consistently low rankings in cost of living and physician pay satisfaction.

Why we added ‘physician happiness with pay’

This year’s new metric, physician happiness with pay, was based on community-sourced data from thousands of verified, anonymized salary submissions. Physicians rated their satisfaction with pay on a 5-point scale. This measure adds a new dimension to the rankings by capturing how physicians feel about their compensation, rather than relying solely on structural or economic indicators.

The results of adding this category are telling. Nebraska, first in this new measure, benefits in the overall rankings despite mixed performance in other areas. Nevada, second in physician happiness with pay, and Arkansas, third, also see stronger positions in the overall list than they held last year. Conversely, states such as New Mexico and Hawaii rank at the bottom in this category, reinforcing their overall lower standings.

What the rankings reveal

Looking at both years, the changes illustrate how shifts in even one category can impact the overall picture. Mississippi’s rise shows how strong results in cost of living and pay satisfaction can outweigh weaker rankings in quality of life. Nebraska’s stability near the top is reinforced by high physician pay satisfaction, even if other factors are less competitive.

Adding physician happiness with pay also helps differentiate states that might otherwise appear similar. For example, two states could have comparable scores in taxes and cost of living, but the one with higher physician satisfaction with pay will now have a clearer advantage in the overall ranking.

Looking ahead

Our methodology will continue to reflect objective and subjective measures of what makes a state a good place to practice. Economic conditions, tax policies, cost of living, and quality of life all remain critical. But by adding physician happiness with pay, we now include a factor that captures how physicians themselves evaluate their working lives in each state.

The 2025 list underscores that there is no single formula for “best.” Each physician must weigh the factors that matter most for their career and personal priorities. These rankings aim to give a fuller picture to help make those decisions.

You can find the full results here