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Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020
| Contributor Information
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Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
The COVID-19 pandemic has helped to redefine a "best place to practice." Besides weighing compensation, practice conditions, and quality of life, doctors might now consider social distancing, surge capacity, flattened curves, and government responsiveness.
In selecting this year's best and worst places to practice, we've taken those concerns into consideration and have included some COVID-specific metrics to ascertain states' medical preparedness for and responsiveness to the pandemic.
Of course, states are not monoliths and COVID-19 is unpredictable. The situation will continue to be fluid as hot spots migrate and states begin to open up. Still, doctors want to practice medicine where they feel supported and where they and their families can thrive. With that in mind, here are our best places to practice in 2020.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
1. Best State: Minnesota
In addition to being the beautiful "Land of 10,000 Lakes," Minnesota has a renowned public hospital system and ranks among the top 10 healthiest states. Experts praise the state for having a well-crafted crisis standards-of-care plan. The state has a low rate of adverse actions against physicians.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
2. Best State: Washington
Washington ranks highest among the states for overall livability, and its already solid health system has shown dramatic improvement in recent years. With its mountains, coast, rainforest, and desert, Washington offers something for everyone. Although it was the state with the first identified case of COVID-19 and has been hit hard by the pandemic, pundits give Gov. Jay Inslee credit for aggressive crisis management.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
3. Best State: Massachusetts
Known for its rich history and institutions of higher learning, Massachusetts ranks in the top 10 for livability, overall health, and quality of the health system. The state has suffered a blow from COVID-19 but has earned high marks for its support services, as measured by relief and medical services, food and housing assistance, and unemployment support. Adverse actions against doctors are low. Massachusetts is in the top 10 of states taking aggressive action against COVID-19.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
4. Best State: North Dakota
Rugged North Dakota offers more than just unspoiled countryside and outdoor fun. The state ties with five other states for having the highest level of public health emergency preparedness funding per capita, according to WalletHub. It offers a favorable regulatory and malpractice environment, and its doctors placed high on the happiness scale.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
5. Best State: Vermont
As if the scenic Green Mountains, autumn foliage, and Ben and Jerry's weren't enough, Vermont is ranked the healthiest state in the nation. WalletHub says it's in a six-way tie for states with the highest public emergency preparedness funding per capita. The state gets high marks for the quality of its public hospital system and a low share of residents without insurance.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
6. Best State: New Hampshire
Beautiful New Hampshire offers easy access to both urban centers and wilderness. The state gets high marks for livability, physician happiness, and overall health. Adverse legal actions against physicians were in the bottom quintile among the states. In early May, state officials said New Hampshire would redouble testing efforts at nursing homes following a spate of COVID-related deaths.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
7. Best State: Colorado
If you like to hike or ski, Colorado has you covered. With so many outdoor activities, it's not surprising that Colorado is a healthy state. Doctors have a slightly higher rate of burnout, but outside of work they're among the happiest. Per capita malpractice payouts are low and the state's health system is ranked in the top 10.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
8. Best State: Utah
Known for its high quality of life, low crime, and beautiful landscape, Utah is more affordable than neighboring Colorado. In addition to being very livable, the population is healthy and the health system is strong. Still, nearly half (49%) of Utah physicians surveyed say they are burned out. Utah is traditionally very community oriented, and a WalletHub survey listed it as a tough state for self-isolating.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
9. Best State: Nebraska
In addition to hosting awesome tailgate parties around football games, Nebraskans are known for being a happy, friendly lot. Physicians there are far less likely to complain of burnout and far more likely to say they're happy outside of work compared with doctors throughout the country. The state gets high marks for livability and is in the top 10 for cost-adjusted compensation.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
10. Best State: Idaho
In addition to easy access to national parks and the lowest cost of living in the region, Idaho's malpractice payouts per capita are among the lowest in the country and doctors are happy there. The state scored in the second quintile for most metrics. It's in the top half of states responding strongly to the COVID-19 crisis.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
11. Best State: Maine
Maine offers much more than lighthouses and lobster rolls. The burnout rate is low, malpractice payouts per capita were the lowest in the nation in 2019, and the state has been ranked one of the most supportive in the midst of the pandemic. Maine retains an above average number of medical residents post-training.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
12. Best State: Connecticut
As the gateway between New York and New England, Connecticut offers a best-of-both-worlds mix of urbanity and country charm. The state ranks among the top five in overall health and the quality of its health system. It has also been aggressive in addressing the pandemic. But doctors report an above average rate of burnout, and physician compensation, adjusted for the state's high cost of living, ranks fairly low.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
13. Best State: New Jersey
The Garden State, also known as the "Diner Capital of the World," ranks in the top quintile for overall health. Its health system is in the top 20 nationwide. Physician burnout and happiness in New Jersey are about on par with the national average, but malpractice payouts per capita were high.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
14. Best State: Wisconsin
The Badger State often flies under the radar, but it's affordable, beautiful, and filled with enthusiastic sports fans. It also ranks in the top half for adjusted compensation, malpractice payouts per capita, and overall health. Burnout is low and the state's livability rating is high.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
15. Best State: Maryland
Whether you're looking for easy access to DC or a charming small town, you can find it in Maryland. Its doctors are a little less likely to be burned out and a little more likely to be happy outside of work compared with peers nationwide. The state ranks high in livability, but it comes at a price: The cost of living is also high, as are the number of adverse actions against physicians.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
16. Best State: Hawaii
Everyone knows Hawaii as an island paradise, but they may not know that its population is among the healthiest in the nation. The Commonwealth Fund ranks Hawaii's health system No. 1 in the country. After adjusting for the state's high cost of living, doctors make less in Hawaii than in other places, but they're still happier and less burned out than doctors in most other states.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
17. Best State: Iowa
Known for its fantastic state fair and friendly residents, Iowa can also boast about having a top 10 health system. The state is in the top 15 for livability, and only 38% of Iowa doctors told Medscape that they're burned out (compared with 47% nationwide). Cost of living–adjusted compensation is in the top half, and the rate of adverse actions against doctors is low.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
18. Best State: New York
Because the coronavirus has been so virulent in New York, one might overlook the state's positives, especially those located outside of New York City. But from Niagara Falls to Cooperstown and the Baseball Hall of Fame, New York has a lot to offer. Since 1990, New York's health ranking has climbed 29 places — more than any other state — to No. 11. Similarly, its health system ranks fourteenth. Burnout and happiness outside of work are close to the national average.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
19. Best State: Rhode Island
Rhode Island offers 400 miles of coastline. Its health system is considered strong. By the end of April, Rhode Island had tested more residents for COVID-19 per capita than any other state, leading it to discover many infections that might have gone undetected elsewhere. It has great cultural diversity and many historical sites.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
20. Best State: California
Redwoods. The Pacific Ocean. Yosemite. California is a gorgeous (and expensive) state. Per capita malpractice payouts for physicians were low last year, and both the overall health of residents and the state's healthcare system ranked within the top 15. The state boasts by far the highest retention rate for medical residents, but many California doctors say they're unhappy outside of work.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
21. Best State: South Dakota
In addition to lots of outdoor recreation and good schools, South Dakota is home to five of the top 15 rural hospitals in the United States, according to the National Rural Health Association. Doctors there are far happier and less burned out than their peers in most other states. Cost-of-living compensation for physicians is in the second quintile, but malpractice payouts per capita were somewhat high last year.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
22. Best State: Virginia
Virginia is for lovers, but it's also for physicians. A top 10 state for livability, doctors there are a bit happier at work and at home versus the national average. Adjusted for cost of living, physician compensation is middling. In terms of population health, Virginia was well rated in 2019, thanks largely to improvement in the advances-in-outcomes category.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
23. Best State: Montana
Montana is sprinkled with a number of highly livable towns and cities, but it's the unspoiled wide-open spaces that draw residents to the state. The state boasts the fourth highest retention rate for medical residents and, along with Nebraska, has the highest share of doctors who say they're happy outside of work. Population health and the health system are rated in the middle of the pack.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
24. Best State: Michigan
Sandwiched between two Great Lakes, Michigan is an outdoor playground, and doctors in the state report favorable burnout and happiness scores. Cost-adjusted compensation is high, and malpractice payouts and adverse actions against doctors are low. COVID-19 has hit the state hard, but Michigan moved aggressively to close schools and restaurants within days of the state's initial outbreak and issued a stay-at-home order within 2 weeks.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
25. Best State: North Carolina
From mountains to coast, North Carolina has a lot to offer. Malpractice payouts per capita are low, actions against doctors are infrequent, and cost of living–adjusted compensation is in the second quintile. Despite those positives, doctors in North Carolina are a little more likely to say they're burned out and a little less likely to be happy outside of work. North Carolina received high marks for innovation in healthcare delivery to diverse populations.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
Worst States
While we've used consistent metrics, "best" and "worst" are subjective terms. Many doctors practicing in "worst" states report high levels of happiness. What's more, although a state as a whole may not perform well according to our criteria, many communities outperform their states.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
1. Worst State: Arizona
Arizona is known for its sunshine and beautiful cities, but the Grand Canyon State scored low in terms of adverse actions against doctors and its support in responding to the coronavirus. The state also ranks in the bottom half in terms of overall livability, population health, compensation, and the quality of its health system. Still, doctors in Arizona reported less burnout and a higher degree of happiness outside of work.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
2. Worst State: Mississippi
Mississippi is a state of extremes. Although physicians there reported among the highest compensation (when adjusted for the state's low cost of living), the state's health system and the health of its population ranked very low. The state also scored poorly in terms of livability and its response to the coronavirus, ranking 45th in aggressive action taken to contain the virus. On the bright side, only a third of Mississippi physicians say they are burned out, compared with 42% nationwide.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
3. Worst State: South Carolina
South Carolina is rife with Southern charm, but the health of its population and its overall health system present challenges for physicians. It's in the bottom half of states in terms of physicians' adjusted compensation and malpractice payouts per capita. The state also falls in the bottom quintile in terms of its response to the coronavirus.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
4. Worst State: Nevada
Sunny Nevada offers panoramic views and no state income tax. However, it's also one of the most aggressive states in terms of adverse actions against physicians, and its overall health system ranks poorly. Livability and cost of living–adjusted compensation are on the lower half of the list. Nevada ranks No. 10 in terms of physician burnout.
Best & Worst Places to Practice 2020: In the Time of COVID-19
Shelly M. Reese | June 9, 2020 | Contributor Information
5. Worst State: West Virginia
John Denver sang about West Virginia as "almost heaven," and the state's stunning hills and mountains make it an outdoor-lover's playground. But West Virginia ranks in the lowest quintile in terms of livability, population health, and the quality of the overall health system. West Virginia doctors were more likely to say they were burned out and unhappy outside of work than the national average. Still, it ranked in the top 20% of states taking aggressive action to contain COVID-19.
More than 17,000 physicians told us about their salary, incentive bonus, and denied claims, and how they feel about their career in medicine.Medscape Features Slideshow, May 2020
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Contributor Information
Shelly M. Reese
Freelance writer
Cincinnati, Ohio
Disclosure: Shelly M. Reese has disclosed no relevant financial relationships.
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Data Sources
States were assessed using the following metrics and sources.
Adverse actions against physicians in 2019 (excluding reinstatement and restorations) by state. National Practitioner Data Bank: Adverse Action and Medical Malpractice Reports (1990-2019), Data Analysis Tool. (Data accessed February 21, 2020)
Compared with the number of currently active allopathic physicians (MDs) and osteopathic physicians (DOs) as of March 2019. Kaiser Family Foundation State Health Facts. (Data accessed February 21, 2020)
Health System Performance, Health Status, Livability
Livability: US News & World Report Best States Rankings: 70+ metrics used to assess states' healthcare, education, economy, infrastructure, opportunity, fiscal stability, crime, corrections, and the natural environment (Data accessed May 6, 2020)
Effectiveness of social distancing: Unacast Social Distancing Scorecard. Built off smartphone data from up to 15% of people in every county of the United States, the scorecard uses three metrics: change in average mobility (based on distance traveled), change in nonessential visits, and difference in encounter density. (Data accessed May 12, 2020)
Other sources:
Livability.com, Money.com, New York Times.com, AAMC Report of Residents, National Rural Health Association, Kaiser Health Network
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