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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
Rating the best places to practice can be somewhat subjective. For this year's report, we took into account factors important to physicians in deciding where to work, including compensation; degree of physician burnout in the state; the health of states' residents and health systems; quality-of-life measures such as the cost of living, tax burden, and crime; the cost of malpractice premiums; and the rate of adverse actions. Will any of these locations hit your sweet spot? Are you already in one of the best states? Take a look at these rankings.
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1. Best State: Idaho
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
1. Best State: Idaho
The Gem State's natural beauty, capped by the Sawtooth Mountains, wealth of outdoor pursuits, and relatively low taxes, have made it one of the fastest-growing states in recent years. It's also regularly named one of the happiest and healthiest states. With low malpractice premiums and a low rate of lawsuits and payouts, it's no wonder that Idaho has a 63% retention rate for medical residents. It has the lowest physician density in the United States. The growing science and tech hub of Idaho Falls is attractive to families because of its low home costs, myriad job opportunities, and plentiful outdoor activities.
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2. Best State: North Dakota
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
2. Best State: North Dakota
From the Red River Valley to the Great Plains, there's much beauty to behold in the Peace Garden State, along with a reasonable cost of living with low home costs, plus low property and income taxes. The state boasts a high per capita rate of adverse actions, but malpractice filings, payouts, and premiums are among the lowest. Some 61% of those coming out of residency stay. Home to University of North Dakota, Grand Forks offers college-town culture. Depending on the season, there's plenty of biking, bird-watching, skiing, and camping.
Alicia Ault | May 18, 2023 | Contributor Information
3. Best State: Minnesota
Minnesota is attractive to physicians for many reasons: It's a happy, healthy state and has a low rate of malpractice suits, adverse actions, and premiums. Physician density is low despite 60% of residents staying in-state; Minnesota is projected to have among the least physician competition by 2028. The state has many large, well-respected healthcare systems — including the Mayo Clinic — and some 200 colleges and universities. Outdoor opportunities abound along Lake Superior and within the Boundary Waters wilderness. Saint Paul is a hip international city; more than 100 languages are spoken among its residents.
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4. Best State: Wisconsin
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
4. Best State: Wisconsin
Over the past decade, Wisconsin has had the smallest number of malpractice filings and the second lowest malpractice premiums. The Dairy State is consistently among the top 10 for doctor earnings. Few residents lack insurance. Madison has some terrific museums as well as arts and music festivals. Wisconsin falls in the middle for cost of living and tax burden, but housing prices are not insane and there's life outside — including the 1200-mile Ice Age Trail — to explore when you're not working. Madison, a college town, is safe, clean, and well educated.
Alicia Ault | May 18, 2023 | Contributor Information
5. Best State: North Carolina
The state is attracting new residents with its small-town charm, low tax burden, scenery, mild climate, natural beauty, and relatively low cost of living. It's high on Medscape's list of top-earning states. There's a low rate of malpractice actions but premiums — for specialists in particular — are high. A little more than 10% of North Carolinians are uninsured, and despite being home to some prestigious institutions, health system quality and population health are middling. US News places North Carolina high on its Best States list because of a strong education base and fiscal stability. Raleigh, nestled in the Research Triangle, is a top city for young professionals.
Alicia Ault | May 18, 2023 | Contributor Information
6. Best State: Utah
A perennial healthiest and happiest state, Utah continues to attract new residents looking to ski, paddle, climb, and hike, all while paying low taxes. Near the bottom in terms of physician density, there's still room for more doctors. Malpractice actions are few but premiums are high, and the state is at the high end regarding rate of disciplinary actions. For those looking to practice in beautiful surroundings, the growing Salt Lake City suburb of Sandy is a hotspot for good schools and accessible recreation.
Alicia Ault | May 18, 2023 | Contributor Information
7. Best State: South Dakota
Just under 1 million residents live in one of the most tax-friendly states, with no individual or payroll taxes and low sales tax. It was fourth in attracting new residents in 2022. Doctors are drawn by almost nonexistent malpractice suits and adverse actions, and among the lowest premiums. Opportunity abounds with low physician density. With beautiful waterfalls and enticing art and architecture, Sioux Falls is appealing and charming. Still, access to healthcare remains a challenge, and 9.5% of residents are uninsured.
Alicia Ault | May 18, 2023 | Contributor Information
8: Best State: Virginia
Covering 42,000 square miles from the Atlantic to the Blue Ridge mountains, from Washington, DC, to North Carolina, Virginia has fewer than 9 million residents. Its doctor density is on par with smaller South Carolina's, which may contribute to a 58% burnout rate. Malpractice actions are few and premiums are low for internists and some specialists. Virginia ranks seventh on US News' Best States, getting high marks for health, education, and its economy. The cost of living can be a challenge close to the nation's capital, but the racially diverse city of Chesapeake offers low home prices and a good quality of life. There are lots of parks and the city is considered great for families.
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9. Best State: Nebraska
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
9. Best State: Nebraska
Cattle outnumber humans, but Nebraska is still drawing doctors who are attracted by the great outdoors, the least expensive malpractice premiums in the country, and a low rate of lawsuits. US News rates it sixth on its Best States list, primarily for good roads, renewable energy use, and economic opportunity. Although doctors earn less here than elsewhere, the low cost of living and very low burnout rates soften the blow. Lincoln is the state capital and a cultural center, and residents are among the least stressed in the nation.
Alicia Ault | May 18, 2023 | Contributor Information
10. Best State: New Hampshire
This New England gem has often been a best state for physicians, with low rates of malpractice actions and payouts, low individual taxes, no sales tax, a well-insured population, and good access to care. The cost of living and rising malpractice premiums are taking some of the shine off, but it's safe and naturally beautiful, from the White Mountains to Lake Winnipesaukee. Nashua, a bedroom community for Boston, is known for its art and theater scene, outdoor recreation, and concentration of young professionals.
Alicia Ault | May 18, 2023 | Contributor Information
11. Best State: Washington
About two thirds of medical residents stay in Washington, which was US News' #1 state in 2022, in part for its highly ranked health quality and access, and a booming, innovative economy. All that opportunity helps drive up the cost of living, however. Physician density is fairly low, as are malpractice actions. Many are willing to make the trade-off for a chance to live in such a beautiful state. Scenery includes Mount Rainier and a booming job market. Bellingham, nestled between Mount Baker and Bellingham Bay, is quintessential Northwest.
Alicia Ault | May 18, 2023 | Contributor Information
12. Best State: Florida
Remote work and a good climate helped attract a record number of new residents to Florida in 2022. No income or payroll tax is also alluring. Physicians are well paid and 64% of medical residents stay in-state. It's not all sunshine, though: Malpractice is a big industry, and payouts and premiums are high. The state also has among the highest number of uninsured residents. With good public schools, diverse Fort Lauderdale has been rated a top place to raise a family. Beach and outdoor activities are endless, as are art and cultural festivals, nightlife, and excellent restaurants.
Alicia Ault | May 18, 2023 | Contributor Information
13. Best State: Oregon
Pay is a big draw, and Oregon ranks high among states in Medscape's physician compensation reports. But the state has a high tax burden, and while malpractice actions are relatively low, payouts were large last year. Still, medical residents stay put, in part for the high-quality healthcare and smorgasbord of outdoor activities. A frequent best place to live, Eugene — home of the University of Oregon — is a perfect combination of youthful energy and a strong economy. It's an entrepreneurial state; many well-known brands started in Oregon.
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14. Best State: Iowa
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
14. Best State: Iowa
Frequently dubbed a best state to practice, in part because of its good compensation and low rate of malpractice, Iowa also has a low cost of living, and it's one of the least costly states in which to buy a house. The state boasts good healthcare and a healthy population with few uninsured. The low physician density and high burnout rate suggests a need for more doctors. Iowans enjoy a good quality of life and below-average crime rate. Cedar Rapids attracts younger talent to its manufacturing, technology, and healthcare sectors.
Alicia Ault | May 18, 2023 | Contributor Information
15. Best State: Maine
With burnout rates on the lower side and good-quality healthcare, Maine physicians seem to enjoy practicing. Some 60% of medical residents stay. Only a small percentage of Mainers are uninsured. The state gets high marks for its primary education and low crime. Maine's 3000 miles of shoreline and thousands of acres of wilderness keep outdoors enthusiasts busy. If you're looking for small-town life, Bangor, where Eastern Maine Medical Center is the largest employer, might be the place.
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16. Best State: Tennessee
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
16. Best State: Tennessee
Volunteer State physicians have high earnings, no individual income tax, and few malpractice actions. Tennessee also has the tenth lowest cost of living, reflected in lower home prices. Still, a considerable percentage of state residents do not have health insurance. The economy, however, is growing and stable. The Knoxville suburb of Oak Ridge has good public schools and a diverse and educated population, thanks to the Oak Ridge National Laboratory.
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17. Best State: California
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
17. Best State: California
Almost 80% of medical residents stay in the Golden State, drawn by economic opportunity, a wide choice of communities, and the endless variety of natural environments. It's tax-friendly for the middle class but not for higher earners. Malpractice premiums are relatively low, however. Californians are mostly healthy and happy despite the high cost of living. At the foot of the San Bernardino Mountains, Redlands is one of the more affordable places to live and is rated a good place for families, with a lively downtown area.
Alicia Ault | May 18, 2023 | Contributor Information
18. Best State: Texas
Texas drew many new residents in 2022, with its lack of income taxes; low cost of living; and choice of urban, suburban, and rural locales. Malpractice filings and premiums are low, and Texas doctors are top earners. But they are also spread pretty thin, especially in rural areas, and Texas has the highest number of people without insurance in the United States. Founded in 1848, the Dallas suburb of McKinney offers a small-town feel in a big city. There's a great job market and plenty of parks, galleries, and shops.
Alicia Ault | May 18, 2023 | Contributor Information
19. Best State: Indiana
The low cost of living — it's one of the least expensive states in which to buy a house — is a big draw for this still largely agricultural state. Coupled with low rates of adverse and malpractice actions and a top 5 median income, Indiana is a fine place to practice. Corporate and individual taxes are low. Almost two thirds of medical residents stay in-state. The Indianapolis exurb of Fishers was #7 on Livability's best places to live in 2022. There are 24 parks with over 104 miles of multiuse nature trails.
Alicia Ault | May 18, 2023 | Contributor Information
20. Best State: Georgia
The fifth least costly state in the country, Georgia was #10 in net in-migration in 2022, despite a high tax burden. Georgia had the second highest number of malpractice actions filed in the past decade, but the rate dropped in 2022 and adverse actions are low. Median salaries are in the top 10. The state has some of the best health institutions in the nation. The growing Atlanta bedroom community of Alpharetta is one of the best family-friendly places, according to WalletHub. There are great schools, shops, and parks.
Alicia Ault | May 18, 2023 | Contributor Information
21. Best State: Colorado
High living costs have not dissuaded people from wanting to be close to Colorado's bountiful nature and top-notch ski areas. Two thirds of medical residents stay in-state, where the low density of physicians presents opportunity. Although malpractice premiums are expensive, the rate of actions was relatively low in 2022. The state gets high marks for its healthcare and is always rated a healthiest state. A thriving bioscience and clean-energy industry are driving employment opportunities in Fort Collins.
Alicia Ault | May 18, 2023 | Contributor Information
22. Best State: South Carolina
South Carolina was third in attracting new residents in 2022. It is the 20th least expensive state, despite having high taxes, and boasts a good year-round climate. Physicians pay among the lowest malpractice premiums in the United States and enjoy good earnings and low malpractice actions. About 10% of residents are uninsured. Art, history, culture, accessible healthcare, and a diverse population are attracting professionals and retirees to Charleston. Many visit Charleston for the architecture and excellent restaurants.
Alicia Ault | May 18, 2023 | Contributor Information
23. Best State: Alabama
Alabama pays top dollar to its doctors, who can take advantage of the fourth lowest cost of living in the country. Just under half of medical residents stay in state, perhaps partly because of the challenges of treating a less healthy, less insured population. With well-respected schools and corporations in Birmingham and Huntsville, the state is becoming a biomedical and engineering research powerhouse. Huntsville is #1 on US News' top places to live and is also considered very livable because of its diversity, educated population, and low housing costs.
Alicia Ault | May 18, 2023 | Contributor Information
24. Best State: Delaware
The First State attracted a large number of new residents in 2022. Retirees are flocking to "slower, lower Delaware" to enjoy a beach lifestyle with no sales tax, low property taxes, and no tax on Social Security earnings. Malpractice rates are fairly low, but premiums are high. Competition is fiercer in the Wilmington area, a bedroom community for Philadelphia. But the boom in the South makes Lewes attractive for those looking for new opportunities. Lewes has beautiful beaches and many museums.
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5 Worst States
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
5 Worst States
Where to establish your practice is a deeply personal decision, but the following states offer lower compensation, higher tax burdens, higher living costs, or higher malpractice payouts than Medscape's "best" states.
Alicia Ault | May 18, 2023 | Contributor Information
Worst State/District: Washington, DC
The District's stratospheric malpractice premiums — highest in the country — and equally high housing costs, along with low salaries, make it a worst place, even as health quality and access are top ranked. Still, the negatives have not stopped doctors from coming to the area, which means lots of competition. The city is cosmopolitan, internationally diverse, and offers a plethora of cultural and recreational pursuits. Shepherd Park is highly rated for families and near a huge retail, housing, arts, and entertainment complex under construction at the old Walter Reed military installation.
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Worst State: Maryland
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Best & Worst Places to Practice 2023
Alicia Ault | May 18, 2023 | Contributor Information
Worst State: Maryland
Like its neighbor, Maryland is known for its tax burden and, close to DC, outsized housing prices. But Wallet Hub says it's the second-happiest state. Maybe it's the proximity to the ocean, mountains, or Chesapeake Bay; the diversity; or the good job opportunities. Doctors pay high malpractice premiums and face one of the most punitive boards. Halfway between Baltimore and Washington, the planned community of Columbia has long been popular with professionals and families.
Alicia Ault | May 18, 2023 | Contributor Information
Worst State: Connecticut
Connecticut is near the top for malpractice premiums and cost of payout per action, and it sees a fair number of filings. Despite an uptick in compensation in 2022, it has typically been in the bottom five for wages — tough when you're living in the ninth most expensive state with the fourth highest tax burden. A lot of doctors are packed into Connecticut's 5543 square miles; 61% report burnout. Health quality and the health of the state's population rank in the top 10 and just 5% of residents lack insurance. The Hartford suburb of Avon is safe, has relatively low home prices, and oozes New England charm.
Alicia Ault | May 18, 2023 | Contributor Information
Worst State: New Mexico
New Mexico doctors face the highest per capita number of malpractice filings and among the most expensive premiums, a burden lessened by its relatively low cost of living (it's the 19th least expensive state to live in). With the third highest poverty rate, few job opportunities, and 10% of residents lacking insurance, New Mexico presents a challenging practice environment. Its rich Native American and Hispanic history and culture, and beautiful desert and mountains, are draws, however. Perhaps best known for the Manhattan Project, Los Alamos is a magnet for educated professionals.
Alicia Ault | May 18, 2023 | Contributor Information
Worst State: West Virginia
Despite being near the bottom for health, West Virginia has increased the number of residents who have insurance. Physicians can expect to pay malpractice premiums on par with the most expensive states, although in 2022 there was a reduction in rate filings. Struggling with high poverty and reliance on fading coal-mining and mineral-extraction industries, West Virginia is still one of the most affordable states and is known for its beautiful scenery. The riverfront capital of Charleston has a diverse economy based on manufacturing, government, and healthcare.
Travel is on the upswing, and doctors are looking to get out and visit new places. Here are 25 great suggestions.Medscape Features Slideshows, Jun 2022
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Alicia Ault
Freelance journalist, Saint Petersburg, Florida
Disclosure: Alicia Ault has disclosed no relevant financial relationships.
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Data Sources and Criteria
Economics
Compensation: Data provided by Medscape, based on annual compensation surveys, and Physicians Thrive 2022 Compensation Report.
Cost of living: Adjustments were made on the basis of the Missouri Economic Research and Information Center (MERIC) 2022 Cost of Living Data Series.
Tax burden: Total state tax burden includes property taxes, individual income tax, and sales and excise taxes. Information compiled from WalletHub, the Tax Foundation, and Kiplinger.
Adverse actions against physicians: Adverse actions against physicians in 2022 (excluding reinstatement and restorations) were calculated using the National Practitioner Data Bank data analysis tool.
Professionally active physicians: As of January 2023, per Kaiser Family Foundation State Health Facts.
Physician retention in state of residency training: From AAMC 2022 Report on Residents.
Livability: U.S. News & World Report Best States Rankings, which include 70 metrics based on healthcare, education, the economy, infrastructure, opportunity, fiscal stability, crime and corrections, and the natural environment. Additional information from Kiplinger, The Discoverer, National Association of Realtors, Homebuyer.com, Thrillist, and WalletHub.
Additional Sources:
Suggested cities were identified according to ratings and recommendations from US News & World Report, Kiplinger, The Discoverer, Niche.com, BestPlaces.net, Livability.com, Greatschools.org, and Scholaroo.com.
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