Phil WestBy Phil West, WCI Contributor

If you’re a doctor who has the flexibility to move to a different state to start a practice (or to get a fresh start), you might be curious about the best states for doctors. Similarly, you might want to know the worst states for doctors so you can know where to avoid or, if you’re currently in a bad spot, think about maybe trying somewhere else. 

In determining the best and worst states, a few different factors come into play, including compensation and the cost of living. Let’s look at some of the factors that might weigh into your determination for the best states for doctors—and, crucially, the best states for you.


The Highest-Paying States for Physicians

Based on a survey from Doximity and Curative assessing physician compensation for 2023, two of the top 10 highest-paying metro areas are in northern California, and despite what you might have heard about the Bay Area, it’s not offset by cost of living as you might expect. In fact, San Jose was the fourth-highest metro area in compensation, at $418,600, with neighboring San Francisco sixth in the Lowest Adjusted Cost of Living Category. 

Topping the list in compensation was, perhaps surprisingly, Charlotte, North Carolina, at $430,890, with St. Louis right behind at $426,370 and with Oklahoma City, thanks to a substantial increase from the previous year of the survey, in third at $425,096. Of course, one factor that needs to be weighed when considering compensation is how state income tax figures in. 

Anywhere between 7-9 states, depending on how you slice it, don’t levy a state income tax. Seven states—Alaska, Florida, Nevada, South Dakota, Tennessee, Texas, and Wyoming—have no state income tax whatsoever, while Washington levies an income tax on investment income and capital gains at high-income levels and New Hampshire is phasing out regulations on investment and interest income. 

None of the top 10 best-paying metro areas are in a state without income tax. 

More information here:

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The Lowest Paying States for Physicians

best states for doctors

The survey cautioned, however, that US physician incomes decreased slightly from 2021 to 2022, dropping 2.4% overall. As the survey noted:

“Physicians in Oklahoma City experienced the largest increase in compensation with an annual growth rate of 6.3%. Charlotte and St. Louis retained their positions as the top two metropolitan areas with the highest physician compensation in the US in 2022. Still, with a peak inflation rate of 9.1% in 2022, physicians across the country, on average, experienced a substantial decrease in real income.” 

The survey also revealed that some of the cities with the lowest compensations were also among the lowest in adjusted cost of living. Washington, DC, for example, was deemed the metro area with the lowest compensation at $342,139, but it was also the metro area with the lowest adjusted cost of living. Boston, third-lowest for compensation, was second-lowest in adjusted cost of living. 

Three of the top 10 lowest metro areas are in the Northeast, with New York and Providence joining Boston. Baltimore and Virginia Beach join Washington DC on the bottom 10 list to represent the Mid-Atlantic. San Antonio comes in at fourth-lowest, but remember that Texas doesn't have a state income tax. 


Best States for Doctors to Retire

Medscape made a list of the 20 best places for doctors to retire, and it found a quite varied list of cities. In fact, of the 20, two were in the same state: Florida, which had Tampa No. 1 and Melbourne No. 5 with no state income tax. California also had two cities on the list, with Visalia and Palm Desert making it. The metrics for the best places to retire included median home income, sunny days, and hospitals within 25 miles of the city in question.

More information here:

How Much Money Does a Doctor Need to Retire?


Other Factors to Consider

Malpractice (and malpractice insurance) is another facet of a physician’s practice that factors into the equation for best and worst states. By just looking at one element of that—medical malpractice payouts by state over a full decade—New York, Pennsylvania, Florida, and New Jersey have the highest payouts total. Meanwhile, North Dakota, South Dakota, Vermont, Wyoming, and Alaska are among the lowest. 


Another Assessment to Help Guide You

What makes a state best or worst for doctors varies greatly, and it depends on what factors you consider most important. WalletHub created a rating system that considered “the average annual wage of physicians to hospitals per capita to the quality of the public hospital system.” 

From that, it concluded that Montana was best by a considerable margin; with South Dakota and Idaho close to each other; and Wisconsin, Minnesota, and Louisiana right behind. Conversely, Hawaii was deemed the worst, with Rhode Island, Alaska, and New Jersey not much further ahead. 

That said, your metrics for what you value might differ from those. If you’re in a specific type of practice that a state needs and you land in a metro area that you like, your experience living in that state might be much different from a doctor in a saturated field with a less robust infrastructure. As with all determinations of what’s best or worst, you need to determine what’s most important to you and do the research. 

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