What are the Best States for Doctors?

Thursday, April 7, 2016 | Larry Sobal

We now live in an era with a plethora of rankings. What used to be limited to consumer purchases, restaurants, television viewership and a handful of other things, has exploded to the point where it seems everything is being transparently rated and ranked by one website or another.

Regarding ratings of physicians, all you need to do is look at Angies List, Yelp, RateMD’s, CarePages, Dr. Score, DoctorScorecard and others. Rightly or wrongly, you’ll find ratings and consumer comments about individual physicians. How valuable this information is, and whether or not it is accurate, is a debatable topic and good fodder for a future blog.

So, what’s up with ranking which states are better for physicians to practice in? I had to find out.

So, why was I so surprised last week when WalletHub.com came out with a ranking of the best and worst states for physicians? Maybe it’s because Wallethub has primarily been known as a personal finance website that launched in early August 2013. It has since branched into producing research reports and surveys on topics with varying degrees of relevance, from personal finance, to the relationship between credit scores and car insurance premiums—and a ranking of the fattest states in the nation. Here’s a sampling of some of the other rankings WalletHub has released:

• 2015's Best & Worst States for Nurses
• 2015's Best and Worst States for Teachers
• 2015’s Best & Worst Cities to Start a Career
• 2016's Best & Worst Cities to Find a Job
• 2015's Best & Worst Entry-Level Jobs
• 2016's Best & Worst Metro Areas for STEM Professionals
• 2016's Hardest Working Cities in America
• 2014's Best & Worst States at Combating the High Cost of Lung Cancer
• The True Cost of Smoking by State
• 2016's Best and Worst Cities for an Active Lifestyle
• 2015's Most and Least Happy States in America

That’s a pretty diverse listing of research topics, don’t you think? And this is just a small subset of its numerous researched reports; however, be warned that reading them may give you more information than you want to know. So, what’s up with ranking which states are better for physicians to practice in? I had to find out.

In order to identify the best states for doctors to practice, WalletHub’s analysts compared the 50 states and the District of Columbia across two key dimensions, namely “Opportunity & Competition” and “Medical Quality.”

They compiled 11 metrics, which they considered relevant, and are listed below with their corresponding weights. Each metric was given a value between zero and 100, wherein 100 corresponds with the best state for doctors, and zero with the worst. Then, they calculated the overall score for each state—using the weighted average across all metrics—and ranked the states accordingly. On the surface, it seems like a logical approach.

Opportunity & Competition Metrics – Total Points: 70

• Physicians’ Mean Annual Wage, Adjusted for Cost of Living: Double Weight (~15.56 Points)
• Physicians’ Monthly Average Starting Salary, Adjusted for Cost of Living: Full Weight (~7.78 Points)
• Number of Hospitals per 100,000 Residents: Full Weight (~7.78 Points)
• Insured Population Rate: Full Weight (~7.78 Points)
• Medically Underserved Areas or Populations: Full Weight (~7.78 Points)
• Future Elderly Population: Full Weight (~7.78 Points)
• Current Competition: Full Weight (~7.78 Points)
• Future Competition: Full Weight (~7.78 Points)

Medical Quality Metrics – Total Points: 30

• Punitive State Medical Boards: Full Weight (~10.00 Points)
• Malpractice Award Payouts per Capita: Full Weight (~10.00 Points)
• Malpractice Liability Insurance Rate: Full Weight (~10.00 Points)

It’s a free speech country—and WalletHub can create any criteria it wants and release ratings on just about anything it wants to. But this certainly raises some thought-provoking questions about just what does make a state better to practice medicine.  

For starters, I can think of a number of things that might influence the practice environment, positively or negatively, such as whether there is a dominant commercial insurance carrier and which EHR system is most common. Are physicians mostly employed or independent? What about diversity and abundance of physicians? If I were doing a list, I probably would have chosen some other criteria, or at least, weighted some of the WalletHub choices differently. On the other hand, I respect that WalletHub made an attempt to take a subjective issue and quantify it. I just can’t figure out the intended purpose for this ranking, along with some of the other rankings it releases.

If you practice in Mississippi or Iowa, I guess congratulations are in order. And if you practice in the District of Columbia or New York, apparently you deserve our deepest sympathies, or respect—depending on whether you believe the rankings and how you feel about physicians who choose to practice in states that, at least in WalletHub’s opinion, are the least desirable for them.

For the record, when I asked one of my close friends, who is a family medicine physician, about the best state to practice in, he said (and I quote) “It’s either a state of bliss or a state of denial, depending on the day.” That tells you a lot about his state of mind.

I’d like to hear your thoughts. What criteria would you choose to develop a ranking for the best states for doctors?

 

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

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