MD Cents: Food for Thought on Your Career’s Location

An interesting article was released a few weeks ago regarding the “best” and “worst” states in which to practice medicine. I’m pretty happy practicing where I do and I hope you can say the same, regardless, I was curious. You may wonder (as I did) where does your state rank for physicians and what makes a state a good place to practice?

We each have our own criteria when looking at jobs after fellowship. Some will favor compensation, some location, and some reputation of the institution. This article looks at some of those factors but also considers many items that most PEM physicians don’t count at all in their decision process.

Here is a link to the article: Best States

Surprisingly, the top three “states” are: Iowa, Minnesota, Idaho and the worst “states” are: New Jersey, DC, and New York.

In order to explain why they make these determinations let’s dig a bit into the methodology of the report and also why some of the factors they consider should be on the radar of PEM physicians when deciding where to practice.

In their methodology they give a score to several factors:

  1. Physicians average annual wages
  2. Physicians average annual starting monthly wage
  3. Hospitals per capita
  4. Insured population rate
  5. Primary care provider shortage
  6. Projected elderly share of the population
  7. Current physician competition
  8. Projected physician competition
  9. Number of CME credits required
  10. Presence of interstate medical licensure compact law
  11. Quality of public hospital systems
  12. Punitiveness of the state medical board
  13. Malpractice award payout per capita
  14. Annual malpractice liability insurance rate

As you can see they take many factors into consideration. Some of them we often think of like salary and the quality of the health system we are joining but many are unique (and some don’t apply to the PEM physician at all like the elderly population rate). For instance, I did not consider the insured population rate, the presence or lack of a primary care physician shortage, or the punitiveness of the state medical board in my decision to practice in Indiana. Many of these are directly related to your finances, hence the examination of this article on this blog.

Let’s dive in a bit. The factors that arguably can make your job help or a hinder your financial future include factors that directly affect your compensation and factors that effect the chance you will get sued potentially taking away financial resources.

The authors assign a 0-100 score to each state based on the 14 factors listed above. The first 10 make up the opportunity and compensation factors where a state can score up to 70 points and the last 4 make up the medical environment factor where a state can score up to 30 points.

As you would imagine, several different states lead in different categories and none is all “good” or “bad.” For instance, Indiana ranks #1 in physician compensation and in the top 5 for malpractice insurance premiums, whereas New York is in the bottom 5 for annual wage, competition, malpractice awards and insurance rates. Given this it isn’t hard to see why some states ranked lower than others.

One important caveat is that compensation rankings in this article were adjusted for cost of living. This makes it easy to see why a relatively high wage would be ranked higher in a place like Indiana than say, California or New York as the cost of living is much more on the coasts. Also, more desirable locations attract people, physicians included so this inevitably leads to more competition (and higher physician density) decreasing the score for some of the same locales that have lower adjusted compensation for the cost of living. This proves a double whammy to certain states.

Other important factors that have nothing to do with physician density are the punitiveness of medical boards (sorry New Mexico, Ohio, Delaware, Louisiana and Wyoming), the amount of malpractice awards (lowest in North Dakota, Minnesota, Wisconsin, Texas and North Carolina), and the cost of malpractice insurance (condolences New York, DC, Michigan, Illinois, West Virginia). Malpractice insurance is cheaper where malpractice awards are relatively lower and this is often partly due to the presence of tort reform laws. These awards also cause a double hit to certain states, as it seems that many states with high desirability, geographically speaking, also have more punitive environments for physicians and any mistakes they might make.

Overall, I found this article interesting and it raised a couple of points that I think are pertinent to PEM physicians looking for a new/first job. Namely, the state practice environment depends on more than just whether there is an ocean/good climate/mountains present and that a PEM job seeker should consider physician density, the state medical board, and the malpractice climate along with more traditional considerations like salary when they make their decisions.

What do you think about the article? Did you consider the malpractice environment in your future practice site when thinking about your current job? Do you think the score is faulty or how would you change the scoring system to rank states in your opinion?

Brian Wagers

Brian Wagers

Assistant Professor of Emergency Medicine at Indiana University
Brian's academic interests include injury prevention, quality improvement, and global health. He is from Cincinnati, Ohio (go Reds and Bengals). Brian loves to travel, run, and is interested in the intersection of business, medicine, and health policy.
Brian Wagers
Brian Wagers

Brian Wagers

Brian's academic interests include injury prevention, quality improvement, and global health. He is from Cincinnati, Ohio (go Reds and Bengals). Brian loves to travel, run, and is interested in the intersection of business, medicine, and health policy.