What are the friendliest states for
physicians? Here are America's best places to practice
Publish date: Jul 22, 2009
By: Locum Life Staff
By: Locum Life Staff
Primary care physicians in demand
almost everywhere, there's not a region in the nation that wouldn't love to
claim you as its own. The question is: Which state is best for your bank
account, your career, and your peace of mind?
To determine the best states in
which to practice, we evaluated a number of factors: overall compensation,
malpractice liability insurance rates, cost of doing business, health insurance
competition, and the mix of public and commercial payers. We also considered
quality-of-life factors such as residential real estate prices, natural
amenities, and weather.
We talked with physicians, state
medical societies, and physician placement experts who recruit doctors to
hospitals and group practices around the country. We tapped into survey
information from the Medical Group Management Association and the Medical Liability
Monitor, which publishes an annual state-by-state review of malpractice
liability insurance rates. We also pored over data from the U.S. Census Bureau,
the National Association of Realtors, and the Kaiser Family Foundation, among
other sources.
Here's hoping the greenest pastures
are just outside your window.
10 ALASKA
Why doctors love it here: If the mere thought of Alaska makes you shiver, you may be
in for a surprise: Even northern climes break 70 degrees during the summer, and
two of Alaska's largest cities—Anchorage and Juneau—have predictable seasonal
changes. Also, hospitals and groups are offering bonuses up to $50,000 to
primary care doctors who relocate.
Why you might not: Alaska's vast wilderness can be a shock to some. Statewide,
food and housing costs are higher than the national average for cities its
size, and if you're looking for a more relaxing schedule here, forget it: There
were 267 outpatient visits to for-profit healthcare facilities per 1,000
Alaskan residents in 2007, compared to a national average of 146, according to
Kaiser Family Foundation's State Health Facts Web site. Average annual primary
care compensation: $310,000 (internal medicine, based on Delta Physician
Placement data over several years)—plus, Medicaid fees are more than twice the
national average, according to Kaiser.
Malpractice liability insurance
annual rate (for internal medicine, from the Medical Liability Monitor 2008
Annual Rate Survey): $8,856 to $10,891
Major health systems: Banner Health (Fairbanks), Providence Health & Services
Alaska (Anchorage)
Best town you've never heard of: Sitka (population: 8,800). The state's fourth-most-populous
city boasts a rainy but mild year-round climate compared to most of the state.
This gulf-coast town is a whale-watching destination with plenty of water and
wildlife recreation, and numerous seafood restaurants. It's home to the Sitka
Medical Center and Community Hospital.
9 WEST VIRGINIA
Why doctors love it here: West Virginia's 7.5 percent unemployment rate in April
didn't reach the 10 percent mark of neighbors Ohio and Kentucky, according to
the U.S. Bureau of Labor Statistics. And while the rest of the nation saw its
income drop last year, the Mountaineer State's personal income and wages went
up, according to West Virginia University. One recruiter has seen primary care
physicians land annual compensation offers of $200,000 to $225,000.
Why you might not: Despite reforms in 2001, malpractice liability insurance
rates, while on the downward trend (most dropped by 9 percent in 2008), are
still some of the most expensive among the 10 Best Places to Practice. The
state is also gradually enacting a number of corporate and income tax reforms,
which add to an already higher than average tax burden, according to the Tax
Foundation.
Median annual primary care
compensation (all primary care specialties, based on MGMA 2009 survey data): $151,500
Malpractice liability insurance
annual rate: $20,528 to $23,057
Major health systems: Partners in Health Network (Charleston), West Virginia
University Hospitals (Morgantown)
Best town you've never heard of: Beckley (population: 16,830). A longtime coal-mining hub,
Beckley, located in southwest West Virginia, about 45 minutes south of
Charleston, is home to the 8,200-student Mountain State University.
8 ALABAMA
T. Michael Harrington, MD, family physician in Birmingham Harrington is the chair of
the Department of Family and Community Medicine at the University of Alabama at
Birmingham
Prior to moving to Alabama in 1984,
the Virginia native practiced in the U.S. Navy and in a rural Florida town on
the Alabama border. T. Michael Harrington, MD "It's a good medical
practice environment," he says. "Our malpractice premiums are
reasonable, we have good support from our medical societies, and from a primary
care physician point of view, we've got great specialty support."
Why doctors love it here: Primary care physicians are landing $250,000 to $300,000 in
some areas of the state. Alabama had low medical malpractice activity in 2007
in terms of both number of claims and dollars, according to the Kaiser Family
Foundation. In fact, a 2008 study by a medical law journal found Alabama to be
the "most difficult" environment for malpractice plaintiffs among two
other neighboring southern states. The cost of living in this low-tax state is
below average, with an average single-family home in the Birmingham metro area
selling for $130,400 in the first quarter of 2009.
Why you might not: If it weren't for Medicare and Medicaid, Alabama might be
considered a single-payer state. Blue Cross Blue Shield of Alabama controls
95-plus percent of the health insurance market in most of the major population
areas, according to the American Medical Association's "Competition in
Health Insurance" market study released last year.
Median annual primary care
compensation: $263,687
Malpractice liability insurance
rate: $7,484
Major health systems: Baptist Health (Birmingham), DCH Health System
(Tuscaloosa), University of Alabama at Birmingham Health System (Birmingham)
Best town you've never heard of: Scottsboro (population: 14,863). In the northeast corner of
the state, Scottsboro is nestled along the Cumberland Mountains and 70,000-acre
Lake Guntersville. Aside from the outdoor activities, Scottsboro is home to the
Unclaimed Baggage Center, which sells luggage and personal contents that go
unclaimed by airline passengers. It's like the world's largest garage sale,
every day.
7 MINNESOTA
Why doctors love it here: Minnesota offers some of the lowest malpractice rates in
the country and the opportunity to consult with (or work for) one of the
world's most respected health systems: Mayo Health. Though Minnesota is a
high-tax state, the cost of real estate has remained stable, according to the
National Association of Realtors, with an average single-family home in
Minneapolis dipping from $199,000 to $174,000 last year.
Why you might not: Independents need not apply. Mayo Health, Allina Hospitals
& Clinics, and MeritCare HealthSystem dominate the state, but if you're
looking to switch from private practice to working within a giant,
integrated—highly efficient—system, Minnesota is for you.
Median annual primary care
compensation: $176,764
Malpractice liability insurance
rate: $3,375 to $5,106 (Median: $4,500)
Major health systems: Allina Hospitals & Clinics (Minneapolis), Mayo Health
(Rochester), MeritCare HealthSystem (statewide), Sanford Health (statewide)
Best town you've never heard of: Waconia (population: 9,151). Located on the shores of Lake
Waconia, just 30 minutes west of the Twin Cities, Waconia boasts plenty of
natural beauty as well as its own community indoor water park and health club.
6 OREGON
James Lace, MD, pediatrician and founder of Childhood Health Associates of
Salem
Lace founded his solo practice right
out of residency in 1977. Today, it includes 11 physicians, 2 physician
assistants, and 2 pediatric nurse practitioners. "Liability reform is and
will remain an elusive goal for the foreseeable future in Oregon," says
Lace, alluding to the 1999 expiration of a limit on pain and suffering
malpractice awards. "Despite the negative aspects of practice here, I have
no reservations in recommending Oregon as a great place to practice pediatrics
and to raise a family."
Why doctors love it here: Despite its politically liberal legislature, Oregon has
consistently ranked as a business-friendly state and last year placed No. 9 in
the Tax Foundation's State Business Tax Climate Index. The health insurance
market is only moderately concentrated, according to the AMA's study, making it
easier to negotiate better rates. Oregon did not suffer a drastic plunge in
real estate values, according to the National Association of Realtors, with an
average single-family home in Portland dropping from $286,000 to $264,000 last
year. Oregon also has 13 national forests, more than 200 state parks, and 363
miles of public coastline.
Why you might not: Oregon has one of the largest uninsured populations in the
country at 22.2 percent, according to Kaiser—a figure that will likely increase
with the state's high unemployment rate (12.1 percent in April).
Median annual primary care
compensation: $172,495
Malpractice liability insurance
rate: $5,479 to $10,568 (Median: $8,111)
Major health systems: Legacy Health System (Portland), Oregon Health and Science
University (Portland), Providence Health & Services (statewide)
Best town you've never heard of: Klamath Falls (population: 19,662). Just north of the
California border, Klamath Falls has lured many former Californians with lower
housing costs and an alleged 300 days of sunny weather each year, according to
the city's Web site. Klamath Falls' largest employer is the Sky Lake Medical
Center, a hospital and outpatient clinic.
5 NEW HAMPSHIRE
Why doctors love it here: With high taxes, high costs of managed care, and high
malpractice premiums in Massachusetts, New England earns a bad rap as a
challenging place to practice. New Hampshire, on the other hand, has a 1
percent state income tax, low malpractice rates, and a diverse commercial payer
mix that keeps reimbursements competitive. The Granite State also boasts
classic New England beauty and more affordable housing in most areas than you'd
find in Connecticut or Rhode Island.
Why you might not: Compared to other states, New Hampshire dedicates fewer
funds to loan repayment and forgiveness, and receives less support from private
organizations for those purposes, according to a study released last year by
the state's medical society, which also pointed out that New Hampshire is often
not competitive with surrounding states on recruitment incentives for primary
care providers.
Median annual primary care
compensation: $157,015
Malpractice liability insurance
rate: $9,429 to 16,810 Major health
systems: Capital Region Health Care Corporation (Concord), Dartmouth-Hitchcock
Health System (Lebanon)
Best town you've never heard of: Littleton (population: 4,631). "Nineteenth-century
inns are flourishing on Main Street," according to New Hampshire magazine.
"Upscale restaurants and galleries are sprouting in once-abandoned
storefronts." Littleton is big on picturesque small-town New England
qualities, but it's only a few hours by car from Boston or Montreal.
4 NORTH DAKOTA
Robert Beattie, MD, family physician, chairman of the Department of Family and
Community Medicine at the University of North Dakota School of Medicine and
Health Sciences
Prior to joining the university in
2005, Beattie, a North Dakota native, spent 15 years with a rural, 15-physician
group practice that covered 22,000 square miles and 25,000 people.
"Practicing in North Dakota is about relationships," says Beattie.
"We take care of people we know, we know their families, and as a family
doc, I also take care of those family members. It's a very comfortable
environment in which to live and practice."
Why doctors love it here: Follow the money. North Dakota is perched atop the largest
contiguous oil deposit in the lower 48 states, and new drilling techniques have
created something of an oil boom here. Demand for physicians is peaking, thanks
to the thousands of people relocating to operate the hundreds of new wells.
Compensation is strong: One recruiter reports seeing family physicians earn
$350,000 a year, including bonuses. Moreover, Medicaid reimbursement in the
state is 43 percent higher than national averages and about even with Medicare
reimbursement. Unlike the rest of the country, North Dakota home values
actually rose through last year (an average single-family home in Bismarck sold
for $134,900 in 2006 and $155,200 at the end of 2008, while Fargo showed a
smaller increase, according to the National Association of Realtors). The state
is paradise for fans of the outdoors, boasting 17 state parks, 1,300 designated
campsites, and the 70,446-acre Theodore Roosevelt National Park.
Why you might not: While population has been on the rise in the last three
years, North Dakota remains the third-least-populous state in the country, so
feelings of isolation could be considerable. Plus, the northeast corner of the
state has an average winter temperature of about 3 degrees.
Median annual primary care compensation: $184,418
Malpractice liability insurance
rate: $6,021 to $12,770
Major health systems: MeritCare Health System (Fargo), SMP Health System (Fargo),
Trinity Health (Minot)
Best town you've never heard of: Williston (population: 12,512) is one of the oil boom towns
in the northwest corner of the state. As a result of the employment demand, the
town is home to Mercy Medical Center, which includes a cancer center, primary
care clinic, and wellness center. Williston's average high temperature of 19 degrees
in January is comparable to most Upper-Midwestern states.
3 INDIANA
Why doctors love it here: The Hoosier State was the first in the nation in 1975 to
enact medical malpractice reforms and has consistently performed as a low-tax,
affordable, and rewarding state to practice in, with a high quality of life.
There are excellent medical centers in multiple parts of the state. The most
recent real estate bubble didn't have much effect here: An average
single-family home in Indianapolis sold for $111,000 last year, down $8,000
from 2006, according to the National Association of Realtors.
Why you might not: Although by no means unique to Indiana, the state is
dominated by two commercial health plans, so about 75 percent of your
commercial revenue (if you go into private practice) could be dictated by those
two plans. And if you're a downhill skier or love the mountains, Indiana may
not be the place for you.
Median annual primary care
compensation: $183,555
Malpractice liability insurance
rate: $8,752 to $11,576
Major health systems: Clarian Health (statewide), Community Health Network
(Indianapolis), Parkview Health (Fort Wayne), St. Vincent Health (Indianapolis)
Best town you've never heard of: New Castle (population: 18,347). Situated 49 miles
northeast of Indianapolis, New Castle offers small-town living close to the
city, but is also home to Henry County Memorial Hospital.
Notable landmark: The New Castle Fieldhouse, with a seating capacity of
9,375, is reportedly the world's largest high school gymnasium.
2 WISCONSIN
Why doctors love it here: A progressive state legislature capped non-economic damages
for medical malpractice liability before it became a crisis, as it did in other
Midwest states such as Illinois, Michigan, and Ohio. Wisconsin is the
second-most-insured state, and more than 61 percent of its residents carry
employer-sponsored coverage—more than 10 percentage points above the national
average. With more than 15,000 lakes, it's a great place to live if you love
watersports and the outdoors.
Why you might not: The Badger State ranks higher than average for state and
local tax burden per capita, and most areas get four feet of snow each
year—even more in the northernmost reaches.
Median annual primary care
compensation: $190,240
Malpractice liability insurance
rate: $3,946 to $8,236 (Median: $6,923)
Major health systems: Aurora Health Care (Milwaukee), Ministry Health Care
(Milwaukee), University of Wisconsin Hospital and Clinics (Madison)
Best town you've never heard of: Ripon (population: 7,619) is about 90 minutes south of
Green Bay and the home of Ripon College and Ripon Medical Center, which
includes a heart and lung center and cancer clinic.
1 TEXAS
Robert Frischer, MD, solo gynecologist in Wichita Falls
Originally from New York, Frischer
completed medical school and residency in Cincinnati, joined the Air Force, and
was relocated to Texas in 1978. He opened his solo practice in 1980.
"Texas is a great state, and I am originally a New York City Yankee,"
he says. "The liability situation is very good, with continued drops in
malpractice rates. Insurance problems, at least in my area, are not as bad as
what I hear from docs in other states and in larger cities."
Why doctors love it here: The Lone Star State offers the best of all worlds for
physicians: a variety of cities with excellent medical centers, no state income
tax, great compensation, and low real estate costs—an average single-family
home in the Dallas-Fort Worth area sold for $135,700 in the first quarter of
this year. Tort reform in 2003 makes Texas a leader in low-cost malpractice
liability insurance despite being the second-most-populous state in the nation.
Texas's median annual malpractice liability insurance rate is $16,655 (compare
to $21,052 in New York and $32,328 in Florida).
Why you might not: Almost one-quarter of Texas's population was uninsured in
2007, according to the Kaiser Family Foundation, and less than half of its
residents had employer-sponsored coverage. Hot, humid weather dominates the
southern portion of the state.
Median annual primary care
compensation: $197,042
Malpractice liability insurance
rate: $8,839 to $31,668 (Median: $16,674)
Major health systems: Texas Medical Center (Houston), University of Texas
Southwestern Medical Center (Dallas), Seton Healthcare Network (Austin)
Best town you've never heard of: Huntsville (population: 35,078). This bucolic town,
situated between Dallas (pictured) and Houston, is surrounded by the Sam
Houston National Forest and includes Huntsville Memorial Hospital and Sam
Houston State University.
