The most and least competitive states for physicians

By Samar Mahmoud MS
Published January 4, 2022

Key Takeaways

Physicians are among the highest-paid professionals in the US, with doctors dominating the top 20 highest paid occupation rankings according to the Bureau of Labor Statistics. However, not all states are created equal when it comes to physician salaries. According to the 2021 WalletHub ranking of the best and worst states to practice medicine, the five states with the highest annual physician salary, adjusted for cost of living, were Mississippi, Indiana, South Dakota, Wisconsin, and Kentucky. At the other end of the spectrum, Hawaii, Maryland, California, Massachusetts, and District of Columbia had the lowest average yearly wages for doctors. 

However, are the states with the highest-paid physicians also the best states to practice medicine? As it turns out, there are other factors beyond salary that physicians should consider when deciding where to set up shop. One essential metric that often correlates well with physician salaries is the competitiveness of the physician job market in each state. The 2021 WalletHub list ranked states based on 19 metrics and calculated competition scores based on the number of physicians per 1,000 residents, as well as the percentage of the population living in a primary-care Health Professional Shortage Area (HPSAs). 

Let’s look at the five least and most competitive states for doctors. 

Least competitive states 

Here are the five states with the greatest demand for physicians. 


The Yellowhammer state known for southern hospitality and college football tops the list for being the least competitive state for physicians. Alabama was ranked in the top 20 states to practice medicine overall (12th). However, in terms of medical environment, which was based on factors such as quality of the public hospital system and physician burnout, Alabama ranked 28th. 


Physicians who choose to practice medicine in Oklahoma will find sparse competition. While Oklahoma is ranked pretty highly overall (17th), it's rankings suffer from mediocre medical environment scores, coming in 26th for that category. 


Physicians practicing in Indiana are some of the best-paid doctors in the US. Combining high salaries with low competition for jobs makes this midwestern state an attractive option for physicians. Indiana was ranked 22nd overall and came in 17th for its medical environment. 


In addition to limited competition for physicians, the Hawkeye state rounded out the top 10 best states to practice medicine overall. However, Iowa did not fare as well in medical environment scores, ranking 32nd. 


While Missouri made the top five states with the least competition among physicians, it is ranked 33rd in terms of medical environment and 23rd overall among all states. 

Most Competitive States 

The following is a list of the states with the least demand for physicians. 

District of Columbia 

When thinking of best places to practice medicine, the District of Columbia is not an attractive target. Coming in at 48th overall, the US capital also comes in last place for the lowest annual salary for physicians, adjusted for cost of living. To make matters worse, the District of Columbia ranks 47th in terms of cost of annual malpractice liability insurance. Projections for 2028 place the District of Columbia in a three-way tie with New York and Rhode Island for highest competition. However, things are not all bad. One saving grace for D.C. is that it ranks 11th in terms of its medical environment for practicing doctors. 


Similar to the District of Columbia, Massachusetts scores poorly overall (46th). This is partly due to low physician wages, with Massachusetts doctors being some of the lowest-paid in the US. Massachusetts also has one of the highest malpractice award payout amounts per capita, coming in last place in a five-way tie with New York, Pennsylvania, South Dakota, and Alaska. However, there are some positives to practicing in Massachusetts, as it has the least punitive state medical boards, a metric based on the number of serious disciplinary actions taken by the board for every 1,000 physicians. Massachusetts also ranks in the top 20 states for medical environment. 


Ranked 44th overall, decreased demand for physicians makes this New England state a less-appealing location to practice medicine. However, the Connecticut medical board is ranked in the top five least punitive state medical boards, and Connecticut ranks 22nd in terms of its medical environment. 


While Utah has increased competition for physicians, it is ranked 2nd in the medical environment category and 16th overall, making it a tempting option for doctors. 


Good news for California doctors. While California is currently ranked 47th among states with the highest competition, it will rank 4th in states that have the lowest competition in 2028, according to WalletHub projections. However, this might not be enough to attract new doctors as California is ranked poorly (49th) for annual physician wages and is ranked 36th overall. 

Bottom line

The perfect state for practicing medicine might not exist. States that have low competition are often plagued with less-than ideal medical environments, and those that have high competition might not provide competitive salaries. Because of this, when deciding where to practice, doctors should use a holistic approach that takes into account which metrics matter most to each individual physician.  

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