My Best States to Practice 2012

From PhysiciansPractice.com October 11, 2012

If you’re wondering where the most ideal places to practice medicine are, our Best States to Practice project has been a great place to start for the last 10 years. We gather and analyze the data that most affect physicians’ practices, then rank the states on their performance in each category.

You can find out this year's best and worst states to practice, based on our 2012 data, as well as access a clickable map of the United States to see how physician-friendly your current state is as well.

Because individual physicians’ needs and preferences differ, we’re now putting the power in your hands to determine your Best States to Practice. Below are the six data categories that we use in ranking the states (and below that are detailed explanations for each metric).

Choose a weight for each of the metrics, making sure that the total equals 100 percent. For example, you might alter the weight for the Medicare metric depending on your practice’s Medicare patient mix.

Then click on the “Calculate My Best States!” button to see how the states rank based on your preferences. The name of each state is linked to further information about that state.

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Idaho, Texas: Best Places For Physicians To Practice

From the lakes of Minnesota, to the … clinics of Tennessee? The best places to practice medicine may surprise you.

According to a report prepared annually by Physicians Practice, an online media and resource tool for doctors, Idaho, Mississippi, Tennessee and Texas rank highest on the this year’s list, based on metrics like malpractice frequency, reimbursement and overhead costs. The idea is that the more stress-factors — like disciplinary actions and tax burdens — that exist per capita, the less desirable the locale would be.

The ranks do not, however, take into account lifestyle factors like cultural attractions and recreation, so doctors may need to do some research before moving their families to a place with no movie theater.

That could be why the worst places to practice include vacation destinations like New York, Washington, D.C. and Hawaii. In these states, the report says taxes and malpractice might be high enough to overshadow the benefits of living near conference destinations and Broadway.

THE WORST STATES TO PRACTICE:

In his 26 years of practicing medicine, dermatologist Steven Shapiro has practiced throughout the country — from the East Coast to the West Coast. But when he chose to move south 17 years ago, he stayed. "I was very impressed because I had been in practice in New York and in California prior and it was an entirely different attitude in Mississippi; a friendlier attitude with much more open and receptive feelings by the patients and community," Shapiro says.

But it wasn't just the friendly Mississippians that convinced him to set down his roots there — it was the friendly physician practice environment as well. "There's a significant need for physicians, so that in itself makes it very desirable because it's very easy to build a successful practice if you're a dedicated physician," he says. On the other hand, practicing in New York was not so easy, says Shapiro. "The financial issues involved in being in practice in New York are very, very complex, and it requires a lot of effort just to keep your head above water," he says, noting the high cost of living, taxes, rent, nurses' salaries, and malpractice liability.

This year, New York is among six locales stood out at the bottom of the pack, with Hawaii, Maryland, Washington, D.C., New Jersey, and Connecticut. All, unfortunately, had an extremely high cost of living, tax burden per capita, malpractice award payouts per capita, and number of disciplinary actions taken against physicians.

Nonpracticing family physician David Jaworski is well-acquainted with the trials of working in a less physician-friendly state. He's practiced in Connecticut for 25 years. Like many of the worst states, he says it's beautiful with close proximity to major cities — but physicians pay dearly to live and practice there. Jaworski says the malpractice climate also takes a toll. Without tort reform, malpractice lawsuits are a huge burden in Connecticut, he says. Jaworski's never been sued himself. "That's a miracle these days," he says.

Shapiro, the New Yorker turned Mississippian, says his experiences practicing across the country have shown him just how influential geography can be on career satisfaction. "I'm 67 and I have no intention of retiring," he says. "I still have a very active full-time practice and I wake up every morning enjoying what I do, enjoying the people I'm around. And, I feel that practicing in Mississippi has definitely prolonged my career. I don't know that I would still want to be actively involved in practice if I stayed in New York all of these years — I probably would not."

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Hawaii 2012 Data

Cost of Living: 165.79

Disciplinary Actions: 3.53

Tax Burden: $4,399

Medicare GPCI: 1

Physician Density: 317

Malpractice Award Payouts: 11.94

KEY

Cost of Living: First quarter 2010 data from Council for Community and Economic Research

Disciplinary Actions: Public Citizen’s Health Research Group report on the rate of state medical boards’ serious disciplinary actions taken per 1,000 physicians between 2009 and 2011

Tax Burden: State and local tax burden per capita in fiscal year 2009 compiled by the Tax Foundation

Medicare GPCI: 2012 Geographic Practice Cost Indices (GPCIs) and Anesthesia CF by State and Medicare Locality report, compiled by E-MDs with data from CMS

Physician Density: Doctors per 100,000 residents, from the U.S. Census Bureau Statistical Abstract of the United States: 2012

Malpractice Award Payouts: Amount paid in medical malpractice claims per capita in 2010, from the Kaiser Family Foundation

Hawaii 2011 Data

Medicare Geographic Adjustment Factor: 1.074

Cost-of-Living Index: 165.56

State Income Tax Burden, Per Capita: $4,399

Medical Liability Insurance Average Premiums

• Internal Medicine: $10,000

Physicians Per 100,000 Residents: 317

Medical Board Disciplinary Actions per 1,000 Physicians: 4.38

• General Surgery: $37,000
• OB/GYN: $62,000

KEY

Cost-of-Living Index: Computed by the Council for Community and Economic Research. Median: 100.

State Income Tax Burden, per capita: From the Tax Foundation.

Medical Liability Average Premiums: From www.MyMedicalMalpracticeInsurance.com; ranges supplied for where averages vary widely by location and insurer.

Physicians per capita: From the U.S. Census, reflects competition level.

Medical Board Disciplinary Actions: From Public Citizen, reflects physician autonomy.

Work GAF: CMS ’ Geographic Adjustment Factor is an adjustment in Medicare pay based on cost-of-doing-business differences. Median: 1.0.