What makes a state physician-friendly

Every year, Physicians Practice publishes its Best States to Practice ranking — a data-driven look at which states offer the most favorable environments for physicians and medical practices. The 2025 list is out, and you can check it out to see the full rankings.

The rankings are based on eight key factors, ranging from cost of living and tax burden to malpractice insurance rates, women’s health, and — for the first time — physician happiness with pay. That last measure reflects something many of us feel but don’t always quantify: how satisfied physicians are with their compensation, regardless of the structural conditions in which they practice.

What stands out this year isn’t just who’s on top, but the variation between states. For example:

• Nebraska, which ranks seventh overall, leads the nation in physician happiness with pay, despite middling scores in other areas.
• Mississippi leapt from 27th place last year to No. 5 this year, largely due to its second-place ranking in cost of living and stronger pay satisfaction.
• States like New York, New Jersey, and Maryland remain at the bottom due to high costs and low satisfaction, reinforcing long-standing challenges in those markets.

Most physicians won’t move — so what can we do?

The reality is that most physicians aren’t going to relocate their practices just because another state ranks higher. Physicians have deep community ties, patient panels, family considerations, and financial realities that make moving impractical.

So instead of asking “Where should physicians move?” the more productive question is: What can we do to make our states more physician-friendly?

This is where advocacy comes in.

Turning rankings into action

The Best States to Practice data offers more than bragging rights — it’s a roadmap for advocacy priorities. Each category represents a lever that can be influenced through legislative action, regulatory reform, or community engagement. Consider:

• Tax policy:Wyoming ranks first in the tax category, while New York is dead last. State medical societies and physician advocacy groups can engage with legislators to push for tax relief for independent practices, such as exemptions on business personal property taxes or credits for rural service.
• Malpractice reform:States with lower malpractice costs tend to create more favorable practice environments. Targeted reforms — like caps on noneconomic damages or pretrial screening panels — can reduce liability costs without sacrificing patient safety.
• Workforce policy:Physician density and GPCI adjustments affect reimbursement and practice viability. Advocacy for better Medicare adjustments, rural recruitment incentives, and scope-of-practice clarity can make a meaningful difference.
• Physician compensation transparency:Nebraska’s top ranking in pay satisfaction shows that fostering transparent, competitive compensation models — whether through health systems, groups, or state policy — can boost morale and retention.

A strategic opportunity

For medical societies, advocacy groups, and health system leaders, these rankings are more than interesting statistics — they’re strategic intelligence. They tell us where our states are falling short, and give us data points to make the case for change.

If your state ranks low in cost of living, taxes, or malpractice affordability, that’s a signal to organize. If your state performs poorly on physician pay satisfaction, that’s a cue for employers and policymakers to take a hard look at compensation structures. If women’s health scores are lagging, that’s an opportunity to align advocacy with public health goals.

My take

Physicians can’t always vote with their feet — but they can vote with their voices. By using data like theBest States to Practice rankings to inform advocacy, physicians and their allies can work to shape their practice environments, not just accept them as they are.

You don’t need to be in the No. 1 state to make a difference. But you do need to know where your state stands — and what levers are available to improve it.

Check out the full rankings.