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Best States to Practice 2013

September 27, 2013

Article

Here are the best states for physicians to practice medicine in for 2013.

Mississippi native and physician Robert Harris underwent his specialty training in Durham, N.C., and still misses the excitement of being in the epicenter of cultural and educational opportunities. "In Durham, you are right there in 'the Triangle' - all the colleges, lots to do," he says. "I think that's probably what I miss the most."

But that doesn't mean he regrets his decision to settle down and set up his private practice in Mississippi. "It is really a nice place to raise a family, because it's not so densely populated," says Harris. "You do tend to be [more] involved … [and] it seems easier to keep up with your children, because everyone is sort of a neighbor, they are all looking out for each other."

There are numerous factors that determine where physicians decide to practice medicine. Some, like Harris, return to the state where they grew up and others are drawn to places with a greater need for medical professionals. Some make the decision based on family needs. Wherever you chose to hang up your shingle, we know you are curious if the grass is truly greener in another state.

Each year, Physicians Practice looks at quantitative data to determine the most physician-friendly states and the best states for you to run a private practice.

METHODOLOGY

Across the country we've looked at the key factors influencing the profitability and stability of your practice: cost of living, disciplinary actions taken against physicians, tax burden per capita, Medicare GPCI, physician density, and malpractice award payouts per capita. To determine the best states to practice, we've compiled that data and ranked each state according to its aggregate scores.

Our analysis wasn't entirely numbers driven, but it should give you a good idea about practice climates in each state. We also didn't consider lifestyle-oriented factors such as cultural institutions, sports arenas, or proximity to a great Brazilian steak house. These variables tend to be personal in nature - and are based more on each physician's unique history and preference.

If your state is not highlighted here, a more in-depth look at how each state (and the District of Columbia) performs in each data category appears at Physicianspractice.com/best-states-to-practice. We also talked to more than 40 physicians about what they like and dislike when it comes to the practice environment in their states.

Now on to our top five states to practice for 2013:

MISSISSIPPI

The state of Mississippi takes its name from the Ojibwe word Misi-ziibi, meaning "Great River." Mississippi is also a "great state" to practice. In four out of six data categories, it ranked in the top 20 percent; the only state to do so. It ranked No. 1 for both low physician density and low tax burden, and No. 4 "for lowest medical malpractice payouts per capita.". It really is the land of opportunity for physicians.

Harris is an urogynecologist who practices in Jackson, Miss. His practice, Southeast Urogynecology, is the only such specialty group in the state; a surgical sub-specialty of urology and gynecology. Harris says he enjoys the freedom of practicing in Mississippi. "It's a very positive malpractice environment ever since we had [tort] reform. … Once we underwent reform, it's changed; [malpractice] rates are much lower. I think it is a very fair environment now," he says.

He also likes the "small-town" camaraderie he has with both patients and colleagues. "It's a very nice place to practice from a patient-relationship standpoint," Harris says.

Harris says that patients travel from all over the state to get tertiary care. Because Mississippi has a large population of low-income residents, Harris' practice does everything it can to make things easier on patients, recognizing that travel can be expensive. "We try to do everything we can in one visit. We have a portal on our website for … patients if they are coming more than three hours [away]," he says. And for those who can't travel to his practice in Jackson, his practice networks with nurse practitioners and rural family physicians to help patients get the care they need closer to their homes.

Add in a paucity of managed care, positive relationships with payers, and a low cost of living and you can't go wrong hanging up a shingle in the Magnolia State.

Get additional physician perspectives on these states: Alabama / Alaska / Arizona / California / Colorado / Connecticut / Florida / Georgia / Hawaii / Idaho / Illinois / Indiana / Iowa / Kansas / Kentucky / Louisiana / Maine / Maryland / Massachusetts / Michigan / Minnesota / Mississippi / Missouri / Nebraska / Nevada / New Hampshire / New Jersey / New Mexico / New York / North Carolina / North Dakota / Oklahoma / Oregon / Pennsylvania / South Carolina / Tennessee / Texas / Vermont / Washington, D.C. / Washington / Wisconsin

NEVADA

While Nevada is the ninth least-densely populated state in the United States, two-thirds of its population lives in or near the Las Vegas metropolitan area. However, there's much more to the state than casinos and showgirls.

According to urologist David Hald there are plenty of opportunities to get away and recharge. "Nevada has everything: I mean Lake Tahoe is a short trip away … we are relative to the coast in California, the wine country … you can spend a lifetime exploring Nevada," he says.

Hald, who has been practicing medicine in the Reno, Nev., area for 17 years, is also president of the Nevada State Medical Association. He believes that Nevada stands out as a great place to practice primarily for the independence it offers physicians. "…There is such a change right now occurring in healthcare that physician independence and autonomy in a lot of neighboring states is going by the wayside," he says. "But Nevada still offers great opportunity." He says younger physicians can opt to work in large-group settings or set up a solo practice without succumbing to employed status in an integrated healthcare system.

Our data analysis shows Nevada placing near the top of the pack for low physician density, low disciplinary actions, and low malpractice award payouts per capita. Hald concurs. He says that Nevada physicians "fought hard for medical liability reform" about a decade ago.

And, he credits the low rate of disciplinary actions to the selectiveness of the Nevada State Board of Medical Examiners. Hald says that the state has a lengthy medical licensing process, which includes a thorough screening in the hopes of reducing disciplinary actions later on. He adds that his state "is typically considered one of the more difficult" in which to obtain a medical license.

ALABAMA

Southern traditions are alive and well in the Cotton State. "Alabama is largely a rural state steeped in Southern culture and tradition, where everyone is your neighbor and being friendly just comes naturally," says family medicine physician Tom Kincer, in an e-mail.

Kincer, who is the program director for the Montgomery Family Medicine Residency Program, based in Montgomery, Ala., and also the president of the Alabama Academy of Family Physicians (AAFP), says "being an integral part of the larger community has always been part of my life." He notes that it isn't unusual for him to run into patients and their families at the local Walmart.

What makes Alabama a great place to practice? Kincer says the state has little managed care, allowing patients to select their own physician and to develop a solid doctor-patient relationship. It also enjoys a "strong medical association with participation from all specialties." The AAFP offers membership to medical students and residents, which Kincer says "fosters their participation throughout their career."

Our data also shows a low physician density, minimal tax burden, and low rates of malpractice award payouts per capita, resulting in an ideal physician-friendly climate in Alabama.

Kincer's advice to young physicians thinking of setting down roots in Alabama? "Find the town that fits your lifestyle and the type of practice you desire," he says. "…Get involved with your medical association from the beginning … Lastly, become part of your community … The sense of belonging to something larger than yourself will keep you motivated through the tough times."

TEXAS

Just about everything is larger in Texas. The Lone Star state is the second largest in the United States with 26.1 million residents in 2012, according to the U.S. Census Bureau. But, it also has a multiplicity of small towns.

Terri Eckert is a geriatrician practicing in Athens, Texas, a small town of roughly 13,000 people, located in the northeastern part of the state. She says the best part about practicing medicine in Texas is being needed. "We have a lot of rural communities in Texas and there's definitely a need for physicians in those areas," she says. She adds that "the next-closest geriatrician is probably a two-hour drive from here. So I'm kind of overwhelmed with patients."

She also likes the fact that the Texas Medical Association has a strong presence in the medical community. "They are really proactive and you can call them anytime you have a problem or a question," she says. Eckert says she feels that the Texas legislature is also "pretty pro-medicine and pro-physician."

That mirrors our data: Texas ranks No. 1 in malpractice award payouts per capita. It also has a low physician density. Yet, that can be a disadvantage for some physicians. Eckert, who recently closed her practice temporarily because of difficulties getting paid through Medicare, says, "Being a geriatrician, Medicare is, you know, my bread and butter. And [the low reimbursement] is really a problem for us. …I just can't take everyone's new Medicare patients."

TENNESSEE

Tennessee is the birthplace of country music, the blues, and rock and roll. It is also a favorable place to practice medicine. This year, it scored second among all states for both lowest cost of living and lowest tax burden.

Christopher Young is an anesthesiologist in private practice working at Chattanooga, Tenn.-based Erlanger Medical Center. He is also president of the Tennessee Medical Association (TMA). Not only did he grow up in Tennessee, but his father was a physician who practiced there as well.

"What I like about practicing in Tennessee is that it is a comfortable place to practice," he says. "… I think there are several different types of practice opportunities for people to participate in; there's teaching opportunities, private-practice opportunities, [etc]." To illustrate that diversity, he points out that Tennessee has many rural areas with poor populations, yet it also boasts preeminent medical centers like Vanderbilt University.

Our analysis places Tennessee in the top quartile for lowest malpractice awards payouts per capita. Young agrees: He says the advocacy of the TMA has helped improve the liability environment for physicians. He adds even though physicians are facing significant challenges, he thinks things will work out in the end.

"Doctors are going to be fine," says Young. "There's a lot of change, but I think the practice of medicine has gone through changes before and things have always turned out OK."

In Summary

Selecting the best states to practice is not exactly a science. But it does involve looking at an amalgam of practice conditions. Through our analysis, we found:

• Hands down, the Southern states were most often favorable to physicians, as they are less densely populated, making it easy to set up a practice.

• States in the Rocky Mountain region also make great places to practice. The wide-open reaches of Nevada did well in our ranking.

• New England and the Mid-Atlantic states fared the worst in our analysis. High cost of living and greater physician density made it pricey to do business in these areas.

WORST STATES TO PRACTICE

While living and working in a large metropolitan area can mean lots of opportunities for physicians and their families, there are definite downsides, not the least of which is the cost to do business. The worst states to practice this year shared these negative traits: a high physician density; high cost of living; high tax burden; and expensive malpractice coverage. The following states made the bottom of our list:

• New York

• Hawaii

• Maryland

• Connecticut

• Massachusetts

For more on this year's Best States to Practice ranking, check out our interactive tool to help you find your best state and our interactive map with links to 41 physician profiles.

Erica Spreyis assistant managing editor at Physicians Practice. She can be reached at erica.sprey@ubm.com.