Worst states to practice medicine: An MDLinx analysis

By John Murphy, MDLinx
Published June 27, 2018

Key Takeaways

It's not where you live, but how you live that matters. Or, as author John Milton put it more poetically: "The mind is its own place, and in itself can make a heaven of hell, a hell of heaven." That's good advice to keep in mind as you read our ranking of the worst states to practice medicine. What we found to be the worst could be your heaven, of course, and our best location could be your hell. (Click here to see our analysis of "Best States to Practice Medicine.")

Yet, even though your mind is its own place, where you live and work still matters. So, where did your state rank? Read on to find out.

But first, a few words of explanation. This analysis considered several factors, all of which were given equal weight:

  • Salary—data from the Bureau of Labor Statistics' May 2017 State Occupational Employment and Wage Estimates
  • Cost of living—based on data from the Council for Community and Economic Research
  • Physician density—from Association of American Medical Colleges 2017 State Physician Workforce Data Report
  • Health care access and quality—from US News & World Report's Best States for Health Care rankings
  • Cost of medical malpractice insurance—the industry average yearly costs of medical malpractice insurance for physicians in solo and group practices, from Capson Physicians Insurance Company
  • Family friendliness—from WalletHub.com's 2018's Best & Worst States to Raise a Family
  • Quality of life—from US News & World Report's Quality of Life rankings

Each category ranks all states from first (#1) to worst (#50). The average of these scores generated our overall ranking. Data were not available for the District of Columbia and Puerto Rico.

Using these factors as a basis, it's not difficult to see how some states ranked high in our analysis, and how some states ranked low. High-ranking states scored well in terms of physician salary and health care, and low in numbers of physicians per population. They're also well-regarded places to raise a family and enjoy a high quality of life.

Now without further ado, here are MDLinx's 10 worst places to practice.

10. California

2nd highest cost of living in the nation

Say what you will about the Golden State—sun-kissed beaches, world-class vineyards, giant redwoods, an NBA championship basketball team—it's not one of the greatest places for physicians. Cost of living is almost the highest in the nation (#49 out of 50 states), while physician wages are in the bottom half (#34). And it comes in dead last in terms of quality of life (#50), which is defined as social connectedness (think tight-knit communities) in a healthy environment (think clean air).

9. South Carolina

Ranks in the bottom 10 in the US for both health care and where to raise a family

The Palmetto State is one of the best states to enjoy Southern cooking, and also one of the top states for diabetes and hypertension. South Carolina ranks poorly in health care quality and access (#41) and as a place to raise a family (#44)—although well-heeled towns such as Charleston may be an exception to the rule.

8. Illinois

Low physician salary coupled with high medical malpractice costs

Illinois is known for some great things—the world's first skyscraper—and some not-so-great things—the invention of the Twinkie. But the Prairie State ranks low for physician pay (#42), quality of life (#47), and near the bottom (ie, higher cost) for medical malpractice insurance (#47).

7. New Jersey

High family friendliness score countered by low quality of life

The Garden State ranked in the bottom 10 in several categories for its high physician density (#40), high medical malpractice insurance (#46), high cost of living (#41), low quality of life (#49), and lower physician pay (#38). However, it does score high (#12) for both health care and family friendliness.

6. Hawaii

Shockingly high cost of living, coming in at #1 in the US

Besides erupting volcanoes, what could possibly be wrong with working in Hawaii? Cost of living, for one. The Aloha State has the highest cost of living of any of state (#50). Not surprisingly, it's one of the states with the highest physician density (#41). And the pay ain't that great, either (#32). On the upside, Hawaii ranks #1 for health care access and quality.

5. West Virginia

Beautiful scenery takes a back seat to being the worst state for business

Country roads can take you home to West Virginia, to paraphrase John Denver. Indeed, the Mountain State is considered one of the most scenic states in the nation. Unfortunately, West Virginia was recently named the worst state for business in 2017. For physicians, the Mountain State ranks low for health care (#44), quality of life (#45), and raising a family (#47). One silver lining: West Virginia ranks #13 for physician wages.

4. New York

Last place for physician salary

The state of New York is great for many reasons (America's first pizzeria!), but physician pay isn't one of them. New York ranks dead last (#50), with an annual average physician wage of $184,833. This may be exacerbated by the state's high cost of living (the fourth highest in the country), and the high physician density (the third highest). New York is also the state with the highest average cost of medical malpractice coverage.

3. Louisiana

Low malpractice costs overshadowed by low quality of life

Louisiana is famous for more than just jambalaya, 'gators, and bayous. But if you're looking to practice there, then you should know that the Pelican State is also ranked low for quality of life (#42), family friendliness (#46), and health care (#47). It does have the nation's third-lowest medical malpractice cost, though.

2. Pennsylvania

Consistently ranks in the bottom 10 across 4 of 7 criteria

Pennsylvania—the cradle of liberty and home to the nation's first hospital—is also one of the worst states for doctors, according to our rankings. The Keystone State ranks among the bottom 10 states in several categories, including high cost of malpractice insurance (#42), high physician density (#43), quality of life (#44), and physician pay (#47). If you're one of the many physicians already planted in Pennsylvania, then at least you can take comfort knowing that it's one of the top 20 states to raise a family (#18).

And the number 1 worst state to practice medicine is…Maryland!

High cost of living plus low pay make for poor bedfellows

There are many wonderful things about Maryland—the lip-smacking Chesapeake blue crabs, for one. But for physicians, there are many things not to like. Maryland has some of the worst rankings in terms of cost of living (#44), physician pay (#46), and physician density (#49). And it doesn't score well in most of the other qualities, either—although it ranked #16 for health care quality and access. Perhaps that's one benefit of living in a state with so many good physicians and hospitals in it.

Again, one doctor's hell may be another doctor's heaven—it all depends, as Milton indicated, on your mindset.

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