Best and Worst States, Cities for Physicians to Thrive: Survey

Marcia Frellick

May 10, 2019

Minnesota moved from eighth place last year to first in Medscape's Best & Worst Places to Practice 2019.

Medscape ranked states on the basis of 14 key criteria, including measures of happiness inside and outside work, livability, average income, regulatory climate, and performance of the state's healthcare system. A full list of criteria is available at the end of the report.

The number one state last year, North Dakota, dropped to 11th this year.

Minnesota shares with Alaska the lowest burnout rate in the country (36% vs the national physician average of 44%). Minnesota also scored high in culture, affordability, and livability, for which it ranked second among all states. Average physician compensation was $322,000.

The report highlighted Woodbury in Washington County, Minnesota, as a particularly desirable suburb in the state and nation. Money magazine named it among the top 10 places to live in the United States last year, and according to US News and World Report and the Aetna Foundation, it is the country's 15th healthiest community.

Iowa was the only state that ranked higher than Minnesota in livability. It was number two in the overall rankings. It has the lowest unemployment rate in the nation (2.4%), and the Medicaid expansion state has the second-lowest percentage of uninsured people, at 4.7%.

Iowa was described in the report as having an "easier pace of life" and a focus on family.

Rounding out the top 10 this year were, in order, Wisconsin, Utah, Hawaii, Washington, Nebraska, South Dakota, Massachusetts, and Vermont.

Hawaii ranks highest in access and affordability of healthcare. However, because it also ranks highest in cost of living, physician income doesn't stretch as far.

In Washington, physicians were almost six times as likely to say they were happy outside work than to say they were not happy. The burnout rate is slightly below the national average.

Nebraska has among the lowest unemployment levels in the nation, at 2.8%. An average physician income of $324,000 is particularly attractive with the low cost of living in the state.

Vermont was a study in contrasts: Although the state had the highest percentage of outside-work happiness (78%), 64% reported they were burned out at work.

The top 10 had some newcomers or return standouts from years past, and some dropped off from last year's list. In 2018, after North Dakota, the top 10, in order, were Hawaii, Nebraska, Vermont, Iowa, New Hampshire, Colorado, Minnesota, Utah, and Connecticut.

Kentucky Ranks Lowest

At the other end of the spectrum, Kentucky ranked lowest.

Although most doctors in Kentucky reported that they were happy outside work, half of them reported that they were burned out in their profession. About 1 in 5 said they were happy at work, but about the same percentage said they were not.

Fiscal instability, high unemployment, and a challenging business environment brought down livability scores.

Also, malpractice payouts were above the national average, and the state's health system performance was in the lowest 20% nationally.

West Virginia was second lowest in the rankings. It was ranked lowest last year. A positive development, however, is that the Commonwealth Fund named it one of the states that showed the most improvement in healthcare in 2018.

In West Virginia, malpractice payouts per capita were 75% higher than the national average. The state's unemployment rate (5.2%) was second highest, behind only Alaska. It ranked 47th in the Commonwealth Fund's ranking of states' health systems in 2018.

Rounding out the worst five were Louisiana, Nevada, and Oklahoma.

Louisiana ranked lowest among all states in livability. Nevada scored lowest in prevention and treatment and near the bottom for access and affordability. Oklahoma's health system was ranked in the lowest 20% of all five categories in the Commonwealth Fund's 2018 rankings.

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