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a company that specializes in strategic healthcare initiatives such as mergers and acquisitions, management services organizations, private equity, succession planning, physician partnerships, and strategic planning. He can be reached at 

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Your monthly collection of insights from the Physicians Practice Pearls writers is available now!

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Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

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Christopher Mazzolini is the Editorial Director of Medical Economics, Physicians Practice, and Patient Care Online.

It's hard to overstate the importance of some decisions.  In the life of a physician, the choice of where to practice would certainly fall among them.

“Location can impact your daily practice, as well as your career trajectory and quality of life outside of work,” says 

, a PCP at Spring-Ford Family Practice in Royersford, PA and ACE Medical Director for Tandigm Health. “Choosing the right type of practice – large or small, independent or system-owned, single- or multi-specialty – can also go a long way toward overall job satisfaction.”

The best time for making this choice varies. Sometime during the residency seems to be the best option for most, with earlier starts allowing more time for exploration. But waiting until the third year is also acceptable if the delay is not too long, according to 

, executive vice president of Merritt Hawkins/AMN Leadership Solutions. “Given the dampening effect of Covid on the job market, it’s better to job hunt earlier in the year and not wait until you are a few months out,” he says.

Regardless of timing, selecting where to practice merits careful investigation. In making your decision, consider these tips.

1.  Don’t rule out the independent and/or small group route

Although large healthcare systems have much to offer, other possibilities may be worth considering. Independent or smaller groups may offer increased reward potential, more autonomy, less bureaucracy, greater flexibility, and an ability to limit payors, says 

, CEO of Private Health Dallas in Texas.

Of course, there can also be a downside, with the potential for increased financial risk, reduced negotiating power for contracts, reduced benefits, or fewer referrals.  But for some physicians, smaller is simply a better match. 

It may be tempting to stick with the familiar, but that can be a mistake.

"In terms of geography, think outside the box," Singleton says. "Don’t be bound by preconceptions."  Rather than limit your choices to a few areas you know, consider the qualities and options you want in a location, whether that means good schools, cultural and recreational amenities, or something as basic as safety.

, chief medical officer of VillageMD and Village Medical in Houston, TX feels identifying a work environment that's a good cultural and clinical fit is essential.  "Working with like-minded physicians is critical to long term career satisfaction," he says. If your clinical interest is in wellness and prevention, a practice with large skilled nursing or hospital obligations would likely not be a good fit. If you have a young family and specific family interests, look for organizations and locations that will give you both the time and opportunity to engage in those activities. 

Unless you’re totally on your own, any location decision should include family considerations.

“If the location is not the right fit for you and your family, that may not be the best practice for you,” says 

, president of The Physicians Foundation. “I know of physicians who had the opportunity to practice their dream job in their dream city, but because their spouses were simply not happy there, they had to relocate.” In fact that almost happened in Price’s case. He found a location and practice which seemed ideal, but his wife quickly realized that the area was almost devoid of young families.  They looked elsewhere, finding an alternative that proved to be a better fit. 

If the goal is starting a private practice rather than joining an existing one, facilities planning should commence up to two years in advance. In looking for space to lease, the search should begin 12 to 14 months ahead of the planned opening, says 

, executive vice president at Transwestern, a national commercial real estate firm.  When looking to build a new property, physicians should start the site selection process 18 to 24 months before opening This allows enough time for finding the site, negotiating the sale of the land, closing on the land, designing the facility and constructing a new building.

, medical director of plastic surgery at Modernizing Medicine in South Florida, advises supplementing research with personal insights. “Talk to those that came before as you are finishing residency,” he says.  “Ask what the landscape and journey looked like for them.” Talking to people in a community where you might want to live can also be helpful, but keep in mind that their own agendas can color the information offered. Insightful sources of info may include CEOs of hospitals in the area. “They are often more than willing to talk and will give you a good picture of the landscape,” Rosenthal says.

The American Medical Association recommends creating a checklist for investigating and acting on practice choices. Such a list might include lifestyle factors, available practice options, steps in become practice-ready and key components of employment contracts. Other resources can be found in AMA’s training module, “Choosing the Practice That’s Right for You,” at 

Regardless of timing, selecting where to practice merits careful investigation.

Deciding where to practice: Seven tips for success

The 10 best states for physician cost of living 2024

With the cost of living rising everywhere, finding a place you can afford to live and practice can be difficult.

To give more insight into which states are the most expensive to live and work in, we present our rankings. These are the 10 states with the lowest cost of living for anyone running a physicians practice.

The cost of living ranking was based on the 

Missouri Economic Research and Information Center

, which itself based its ratings on averaging the indices of cities and metropolitan areas in each state.

Which states have the lowest cost of living?

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The 10 best states for physician quality of life

The actual practice of medicine is only part of deciding where to start your practice.

To give more insight into which states have the highest quality of life, we present our rankings. These are the eight states with the highest rankings for anyone running a physicians practice.

For the quality of life metric, Physicians Practice used Wallethub’s 

 rankings which were based on adjusted cost of living, lowest annual cost of in-home services, their own taxpayer ranking, the percentage of the workforce aged 65 and older, museums per capita, theaters per capita, percentage of population aged 65 and older, life expectancy, and property crime rate.

The 10 states that ranked highest in our quality of life metric.



The best states for women's health

With many states legislating around women's health, it can be dicey finding a place where you can practice medicine without fear of legal reprisal.

Here are the nine best states for women's health.

A new metric for this year's rankings, the women's health metric is based on the 

2024 State Scorecard on Women’s Health and Reproductive Care

Which states rated the highest for women's health care?

Christopher Mazzolini

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