Physician Friendly States - Consider Them in Your Job Search

Where are you going to practice? States actually are quite different when it comes to being "Physician Friendly". Massachusetts for example deters physicians with high cost of living and one of the lowest reimbursements in addition to unusually restrictive state rules, such as being forced to carry malpractice insurance as a condition to licensing, prohibition of balance billing and other unsavory goodies, which for my own good I cannot mention here. But then of corse, everybody just cannot explain why, oh why there is a primary care physician shortage in Massachusetts! I don't know either, can't figure it out.
This article by an editor of "Physician Practice" is worth reading. I am quoting an abreviated version with gracious permission from the author - Thank you!


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The Best States to Practice: America's Physician-Friendliest States
By Bob Keaveney, executive editor of "Physicians Practice"

Kansas, South Dakota, Oklahoma, Indiana and Texas are the most physician-friendly in the country, according to Physicians Practice's biannual analysis. We examined factors that affect a doctor's ability to work relatively hassle-free while still making a nice living, and found that the big flat, open spaces of America's Midwest outshine the glitzier coastal states as attractive places to practice medicine.

We emphasized factors such as malpractice climate, reimbursement, and cost-of-living — not so-called "quality-of-life" issues, we find that the simple-life states tend to fare best. Places like Hawaii, New York, and California may be terrific places to live, but the cost of living is just too high. Also, densely populated states tend to be similarly thick with physicians.

Our methodology
We didn't consider the subjective, so-called "lifestyle factors", the main ingredients of the "best places to live" rankings, Since there is no particular "lifestyle" that most physicians would agree is ideal. For those rankings, see Money magazine's, found at www.money.cnn.com/best/bplive, and Sperling's BestPlaces, www.bestplaces.net. As for Physicians Practice, we sought to identify the best places for a physician to work.

We considered the following:

Malpractice climate — We disqualified any state considered "in crisis" by the American Medical Association.
Physician-patient ratios — In our analysis, a lower ratio is better. Using an examination conducted last year by the New York Center for Health Workforce Studies (based on 2004 data by the U.S. Census Bureau, the AMA, and the American Osteopathic Association), physician-patient ratios affect a range of factors, from physician salaries to contract flexibility. The consolidation of commercial payers is putting a squeeze on practices. Having fewer physicians in your area increases your leverage.
Cost of living — Using data from the second quarter of 2006, the U.S. Bureau of Economic Analysis indexes the states against one another, with a median score of 100; the higher a state's score, the higher its cost of living. Thus, a lower score is better. For example, Hawaii scored 161.3; Oklahoma, 88.5.
Reimbursement — Medicare uses a similar indexing system for its Geographic Adjustment Factor. Hawaii's adjustment factor in 2006 was 1.044; Oklahoma's, 0.913. Commercial payers often tie their reimbursement rates to Medicare. For our analysis, the higher the score, the better.
Cost of living/reimbursement margin — These measures are closely linked; neither can be examined in a vacuum. Some states have costs of living that are relatively high or low in comparison to reimbursement rates. We evaluated and contrasted both of these indices to gain a sense of which states actually fared best.

Selecting America's most physician-friendly states is a subjective task. We recognize that factors affecting your particular quality of practice and life will include many additional variables.

Texas: A new law, passed with the assistance of the Texas Medical Association (TMA), established caps on noneconomic damages — money for pain and suffering — that plaintiffs can win in a malpractice suit. "I think the liability climate is one of the best, especially for physicians," says Ledon W. Homer, the TMA's president.

"We've found that a lot of doctors who relocate and never go back have gone from California to Texas," says Mosley. He made this exact move himself 15 years ago, and he found the stories of a unique Texas culture to be accurate. "One of the first things I saw was a bumper sticker that said, 'I'm from Texas. What country are you from?' And it really is like its own country."

Indiana is one of only two states to appear on our list all three times we've conducted this analysis. Its malpractice climate is "currently OK,", its cost of living is the 12th-lowest in the nation, and for every 100,000 residents, it has 180-200 physicians. "One thing that's kind of unique about Indiana that a lot of people don't really know about is that it really has a lot of great universities," he says. "Notre Dame, Purdue, Indiana University, Valparaiso, Ball State. People don't really think of Indiana as an academic university kind of place, but it is."

Oklahoma offers rock-bottom cost of living and comparatively low physician density (150 physicians per 100,000 residents)- combined with good reimbursements and generally higher incomes.

Kansas has the seventh-lowest cost-of-living, low physician density, and good reimbursement. were the deciding factors. Several physicians report that the biggest advantage is the people. Heartland folks just seem nicer. There's more respect for physicians. There's a greater willingness to trust."
Good economics make Kansas a great place to be a doctor. You can get a really nice home for a lot less than you'd pay in California. Kansas does have a $250,000 cap on noneconomic damages.

South Dakota has a friendly malpractice climate, they have the [noneconomic damages] cap. But it's also supply and demand, the supply of physicians is fairly low. The Plains state remains one of America's least-dense with doctors per capita. It also has the ninth-lowest cost of living.


Consider what matters - Don't get us wrong. We're not suggesting you pack your bags and move to Topeka or South Bend. We do suggest, however, that if you're ready to move — and more of you than ever, it seems, are — start your search by asking yourself what you're looking for in a practice setting and lifestyle, and then look for areas that meet those needs. Many physicians start with a place in mind, and then hope for the best, which is exactly the wrong way to proceed.

You may have familial or some other personal connection to a particular area; that's fine. But if you're just trying to indulge a fantasy by, say, insisting on practicing in Hawaii, then you're possibly setting yourself up for disappointment.

Consider the practice's size, compensation model, call-coverage policies, opportunities for partnership, and culture. Think also about how well-run the practice seems. For example, ask about average patient wait times (more efficient practices tend to have shorter waits) and about its use of information technology.

Bob Keaveney is the executive editor of Physicians Practice . He can be reached at bkeaveney@physicianspractice.com.

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