Tuesday, May 24, 2022
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Young physicians, mid-career physicians, and later-career doctors may have very different views on what constitutes a great place to practice medicine. Market forces, including consolidation, the physician shortage, and generational priorities, are changing the way doctors select their practice locations.
Younger doctors' relocation decisions are often based more on quality-of-life considerations than economic ones. "Trailing spouse syndrome" has a profound impact on location selection as well, says Tommy Bohannon, vice-president for Merritt Hawkins, a physician recruiting firm. A study published in JAMA found physicians with highly educated spouses were 38% less likely to work in rural underserved areas. Baby boomers are working longer and reshaping what "retirement" looks like. Empty-nesters may seek out locations that offer cultural amenities and financial advantages, rather than great schools.
Our list of Best Places to Practice 2016 reflects those varying perspectives and needs. Recognizing individuals' geographic preferences, it includes selections from around the country. For more details on sources used in compiling this list, see slide 34.
State profile: Physicians are attracted to North Carolina, with its six research hospitals and 100 community hospitals. The state's popularity helps explain why average compensation last year was $273,000, roughly $15,000 below the national average. Although the cost of living in North Carolina is slightly below the national average, much of that discount is due to affordable housing—a discount movers aren't likely to enjoy in the fast-growing Raleigh-Durham area. Raleigh is a top-10 major market employment destination for young professionals and ranks 23rd (in the top quintile) on WalletHub's list of best cities to find a job. Durham places in the second quintile.
City profile: Money magazine named Apex, North Carolina, a town of just over 42,000 situated less than a half-hour west of Raleigh and south of Durham and Research Triangle, first on its "Best Place to Live" list last year. Apex is experiencing double-digit job growth and has seen its population double since 2000. Housing remains relatively affordable, with median home prices of about $243,000.
Cons: The housing and job markets are competitive.
State profile: Texas has a business-friendly environment, and physician compensation in the state averaged $282,000 last year. If you're a young physician, you're not likely to be talked out of such fast-growing metro markets as Dallas, Austin, and Houston. Collectively, those three cities saw an average annual influx of 9500 people 25-34 years of age between 2010 and 2013, according to Bloomberg News.
City profile: Austin is in the midst of a growth spurt that is projected to last for years. The Urban Institute estimates that the area's population will increase by more than 55% by 2030, and the vast majority of those new residents will be people younger than 50. Tech start-ups; big-name companies, such as Dell and Google; food trucks; music festivals—it's easy to see the appeal.
Cons: It's getting awfully crowded there.
State profile: Alabama offers excellent physician compensation—an average of $296,000 last year, which is 4.6% above the national average. Given that the state's cost of living is nearly 10% lower than the national average and the overall tax burden is 8.7%, Alabama doctors can stretch their earnings pretty far. The malpractice environment is likewise favorable, with payouts per capita last year amounting to just $4.15—the fourth lowest rate among the states. Alabama's economy is projected to continue growing, but slowly and unemployment in February was above the national average (6.2% vs 4.9%).
City profile: Birmingham is the state's economic engine, but Hoover just to the north is growing quickly too. Although independently incorporated, the city of more than 84,000 is an in-demand suburb with good schools, the largest shopping center in the Southeast, and easy access to downtown and the University of Alabama Medical Center.
Cons: Average housing costs are more than twice the state average.
State profile: Idaho offers an extremely low cost of living, average physician compensation ($289,000 last year), low malpractice payouts (just $5.17 per capita in 2015), and a middling overall tax burden of 9.3%. The three cities of Boise, Meridian, and Nampa, spreading east to west over about 30 miles, constitute the "Treasure Valley," Idaho's largest urban area. Dr Brian Crownover, 48, a family practice physician in private practice, moved to Boise several years ago after retiring from a 28-year career in the US Air Force to be near his parents. Although he grew up in the San Diego area and went to medical school in Washington, DC, Dr Crownover says he prefers "the open, spread-out" Western lifestyle. Dr Crownover, who lives in Boise, opened his own practice in nearby Meridian. "I have the flexibility to give new patients an hour-long visit and 30-minute follow-ups; for me, that is professionally satisfying. I get to practice to the full scope of my training, and I get to chart my own course."
City profile: Ringed by miles of trails, bifurcated by the Boise River, and close to world-class ski resorts, Boise is an outdoor enthusiast's dream. Forbes calls it one of the top-20 cities for working parents, and WalletHub ranked it 11th on its 2016 "Best Cites to Find a Job" list.
Cons: Two major hospital systems dominate the market.
State profile: Ohio's physician density hovers slightly above the national average (279.8 vs 265.5 per 100,000 population). The state's 9.8% tax burden is slightly less than the national average (9.9%), as were malpractice payouts per capita ($7.65 vs $11.45). Columbus is one of the 10 most affordable metro areas in the country, according to Forbes. For Dr Scott Rogers, 35, who moved to Columbus after 8 years of practicing rural medicine in Oregon and North Carolina, says that the city offered all the amenities he and his family needed. "I love rural medicine," he says, "but once we had kids, the rural dream started to morph." In Columbus, they've found everything they were looking for: great schools; ample job opportunities for his wife, a veterinarian; a diverse population; a chance to teach family medicine residents; and a small farm just 20 minutes outside the city.
City profile: Columbus, with a population of more than 1.8 million, ranks 12th on the AIER's Employment Destinations Index, thanks in part to favorable labor market conditions, low rents, and professional competition scores. WalletHub lists it as the 34th best city to find a job.
Cons: There are no beaches and no mountains.
State profile: Colorado is a state where physicians may have to trade dollars for lifestyle. The state ranks near the middle in terms of its cost of living and overall tax burden, and average malpractice payouts in the state last year were $8.05—making it a better than average, but not exceptional, performer. But at $269,000, average physician compensation was lower than the national average. That may be in part because a large share (36%) of Colorado physicians remain self-employed. So why does Colorado make the list? Younger generations love it. Denver, Fort Collins, and Colorado Springs all score well on AIER's Employment Destinations Index.
City profile: Denver has spent three decades focusing on diversifying its economy and is now reaping the rewards, with phenomenal growth and development and new jobs in the tech and financial services sectors. Unemployment in the city was just 3.1% in February. Many are drawn to Denver's lifestyle, which includes urban living, light rail transit, and lots of entertainment and recreational choices.
Cons: Growth has propelled property prices.
State profile: Iowa's physician density, overall tax burden, and cost of living are all below the national average, and malpractice payouts per capita were just $5.75 last year, putting the state in the lowest quintile for payouts. Average physician compensation was $298,000 last year. Iowa ranks 14th among the 50 states for overall well-being.
City profile: WalletHub calls Des Moines one of the best places in the country to find a job right now, and the AIER says that the city, with a population of roughly 660,000, is one of the best midsized metro areas for young, college-educated workers; the city offers a strong labor market, good earnings, and affordable rents. With fewer than 179 physicians per 100,000 residents, the share of doctors in Des Moines is about 14% below the national average. Des Moines scores particularly well in financial and community well-being.
Cons: Some hospitals lack Joint Commission accreditation.
State profile: By financial measures alone, California might never make the "best places" list. But many people are not objective when looking for a place to live. Jason Farr at the Medicus Firm says California was one of the top-five states for physician engagements last year. That said, it was also one of the top states for outmigration, he notes. "With California, it's a constant ebb and flow," Farr said. "At the end of the day, it comes down to the fact that California is California." At $280,000, average physician compensation is below the national average. California is among the most expensive states in the nation and has a high tax burden (11%).
City profile: Crain's Wealth ranks Fremont first on its list for empty-nesters, citing its safety, access to Bay Area attractions, golfing, parks, and abundance of senior living facilities. Median household income is roughly twice the national average.
Cons: Quality of life comes with a substantial price tag.
State profile: Boosted by strong auto sales, Michigan's economy has rebounded well. The state's unemployment rate, once the nation's worst, was the lowest in the United States in 2015 and is expected to continue improving. From a physician's perspective, the state is home to numerous universities and medical schools—a draw for those who like to train and mentor new physicians—and is known for its hassle-free licensure process.
City profile: Over the past decade, the Grand Rapids-Wyoming region has diversified its business base and strengthened its education base; it has strong healthcare and manufacturing industries, and a rapidly growing IT industry. Although the city has a healthy economy, it could use more doctors. Grand Rapids places 10th among large communities on the Gallup-Healthways Well-Being Index, in part because 96.1% of respondents surveyed said that they have the necessary access to medicine. The Grand Rapids Hospital Statistical Area has 11% fewer primary care physicians and 13% fewer doctors overall than the national average.
Cons: Physician compensation in Michigan ranked in the bottom 10th percentile of all states last year, and physician density statewide is higher than the national average.
State profile: Average physician compensation last year in Indiana was $304,000, and the state has the second lowest cost of living in the nation. When Dr Samir Ginde, a hospitalist, and his wife, who practices pediatrics and internal medicine, moved to Indianapolis as young residents, they were thrilled to learn they could afford a three-bedroom house on a half-acre in a nice suburb with good schools. For Dr Ginde, a New Jersey native, that combination is a huge perk. "There's no way we could have bought a house as residents in New Jersey. No way."
City profile: Forbes ranked Indianapolis the fourth most affordable city in the United States in 2014. It offers "all the benefits of a big city without the headaches," Dr Ginde says. He also feels people in the area "have a lot of respect for physicians. I feel like patients appreciate us, and those are the little benefits you feel on a day-to-day basis."
Cons: Dr Ginde says he misses easy access to East Coast ski slopes.
State profile: Nearly one half of Georgia's population lives in the sprawling and rapidly growing Atlanta area, so it's no surprise that physicians gravitate to the metropolis. In addition to mild winters and abundant outdoor activities, Georgia affords the lowest cost of living on the East Coast, high physician wages (an average of $286,000 last year—about $2000 above the national average), and a tempered malpractice environment (payouts per capita last year were about 5% below the national average).
City profile: Launched as a planned community by Georgia Tech graduates in the 1980s, Johns Creek has experienced tremendous growth during the past 20 years and was incorporated in 2006. Located about 30 miles northeast of Atlanta, Johns Creek offers excellent schools and amenities and upscale housing.
Cons: Growth has propelled housing costs and snarled traffic in the region.
State profile: Kentucky offers above-average physician compensation—an average of $298,000 last year, which is roughly $15,000 above the national average—and the cost of living statewide is 10% below the national average. Taxes and malpractice payouts per capita are both lower than the national average. Physicians have their hands full: Kentucky is one of the least healthy states with high rates of smoking, obesity, and physical inactivity. In 2013, Kentucky expanded Medicaid and established a state-based exchange, providing more than half a million Kentuckians with health coverage; however, the state's newly elected governor has vowed to dismantle the exchange and scale back on the expansion, which may create access problems once again for many Kentuckians.
City profile: Kentucky's two largest metro areas, Louisville and Lexington, account for 47% of the state's job growth since the recession, thanks in large part to growth in professional services, education, and healthcare. In Lexington, which Forbes named a top-10 city for working parents, Baptist Health recently opened a $240 million expansion and the University of Kentucky hospital complex continues to grow.
Cons: The state scores poorly on health and well-being metrics, and the insurance climate is uncertain.
State profile: Wisconsin physicians earned an average $302,000 last year—more than $14,000 above the national average—but they had to pay a hefty 11% overall tax burden. At just $2.46 per capita, malpractice payouts were the lowest in the nation.
City profile: Madison offers first-class healthcare, a high-performing school system, and strong economy. As home to the state capital and the University of Wisconsin, Madison offers an abundance of cultural attractions, and the city scores well on both economic and livability measures. It made WalletHub's top-10 best cities to find a job in 2016, ranked in the top half of the metro areas on the Gallup-Healthways Well-Being Index, and was the Milken Institute's pick as the best large metro in the nation for successful aging—thanks in large part to great healthcare, a strong economy, and opportunities for educational and intellectual engagement.
Cons: Wisconsin's tax burden is the highest in the Midwest.
State profile: New Hampshire is the only Northeastern state to make Medscape's top-10 in terms of compensation. New Hampshire physicians reported average compensation of $322,000 last year, second only to North Dakota. The state has the second-lowest cost of living and the lowest physician density in the Northeast. Its 7.9% overall tax burden is a bargain compared with the double-digit rates charged by the other states in the region. Dr Mary Cullen, a family medicine physician and New Hampshire native who works in a Manchester Federally Qualified Health Center, says she enjoys a full scope of practice and delivers about 40 babies a year—something she says she probably wouldn't be able to do if she practiced in a large metro area, such as Boston. She also likes living within an hour's drive of the city, the beach, and the ski slopes.
City profile: The Manchester-Nashua metropolitan area, located about an hour from Boston, is home to nearly one third of the state's population. Residents of southeastern New Hampshire tend to be younger and more educated and have a higher per capita income than those in the northern part of the state. The cities rank well on AIER's list of small metro employment destinations, thanks to high ratings in labor market conditions, affordable rents, and plenty of restaurants and bars. Crain's Wealth calls the Manchester-Nashua area a top-10 city for empty-nesters over 50.
Cons: New Hampshire does a poor job of retaining medical residents who train there.
State profile: Minnesota offers excellent physician compensation: an average of $296,000 last year. That's 4.6% above the national average and $8000 more than physicians reported in 2014. The cost of living in Minnesota runs slightly higher than the national average (consumer price index, 101.5). Minnesota, like its neighbor Wisconsin, is a high-tax state, with an overall tax burden of 10.8%. Statewide malpractice payouts per capita were more than 23% lower than the national average. Minnesota is at or near full employment, and thanks to its diverse economic base—which includes health industry employers, such as the Mayo Clinic, UnitedHealth Group, and St Jude Medical—its economic expansion is expected to continue, albeit at a slower pace.
City profile: Minneapolis-St Paul had 3.9% unemployment rate in February, and AIER named it a top-10 employment destination among the major metro areas.
Cons: The physician job market is competitive, and the winters are hard.
State profile: Tennessee is aggressively recruiting physicians, particularly in rural areas, says Jason Farr. The state has a very low cost of living, low tax burden, and low malpractice payouts. Physician compensation is close to the national average. Whereas Nashville, home to Vanderbilt University Medical Center, is swarming with doctors, physicians can find great opportunities if they are willing to look outside the city in such areas as Murfreesboro, an economically progressive community located about 35 miles southeast of the city.
City profile: Home values, educational levels, and income levels are higher in Murfreesboro than in Tennessee as a whole, and the population of Rutherford County, where Murfreesboro is located, is expected to grow by nearly 21% over the next decade. Relocating families will appreciate the quality of Murfreesboro's schools, but singles may find the community a challenge: Only 29% of Murfreesboro residents are single, compared with 43% in nearby Nashville, according to the real estate website Trulia.
Cons: Murfreesboro has grown tremendously in the past decade, propelling home prices.
State profile: Nebraska physicians earn terrific compensation: an average of $317,000 last year, 12% above the national average. The cost of living and malpractice payouts per capita are well below the national average, and the overall tax burden is slightly lower than the national average.
City profile: Omaha, home to five Fortune 500 companies, appeals to people at every life stage. It makes AIER's top-10 list of midsized metro employment destinations for young professionals, WalletHub's "Best Cities to Find a Job" list (a draw for dual-income families), and the Milken Institute's list of top metro areas for successful aging, thanks in part to plentiful healthcare facilities hospitals affiliated with medical schools. Primary care physician density is 69.8 per 100,000 residents in the city, whereas overall physician density in Nebraska is 202.9 per 100,000, slightly below the national average. Omaha ranks in the second quintile on the Gallup-Healthways Well-Being Index.
Cons: The beach is a plane ride away.
State profile: Florida physicians earned a middling $284,000—a tick below the average for physicians in the Southeast, but on par with the national average. Dr Rachel Eyma, a family medicine physician from Long Island who practices in Orlando, says she chose to stay in Florida after completing her residency in 2006 because she liked the weather; the lifestyle; and the collaborative, team-oriented approach to medicine she found in the state. As a single woman accustomed to the culture and amenities of New York, "it was important to me to have a life outside of medicine," she says.
City profile: Orlando has made strides in diversifying its tourism-intensive economy and adding higher-wage technology and healthcare jobs. From 2004 to 2014, the region saw its science, tech, engineering, and math job sectors grow from about 4.5% of the market to almost 8%, according to the Orland Sentinel. Health-related jobs grew to about 12.6% of the workforce, up from 8.6%, but physician density remains below the national average. The city's unemployment rate was 4.4% in February. Orlando's ballet, philharmonic, restaurants, and cultural diversity fit the bill, and Yankees spring training is only an hour away.
Cons: Florida has the second-lowest rate of employer-provided insurance (just 39%).
State profile: The Kansas City metro area, which includes Overland Park, spans both Kansas and Missouri. Average physician compensation in Kansas in 2015 was $281,000; in neighboring Missouri, it was $292,000. The cost of living is low and taxes are moderate in both states, as were average malpractice payouts last year.
City profile: Whereas singles may prefer downtown Kansas City, families will likely look to the 'burbs. Overland Park, a growing suburban city of more than 185,000 residents located 20 minutes south of Kansas City in Johnson County, has made Livability.com's top-100 list 3 years in a row, ranking 14th this year. Often cited as a great place for families and kids—owing to its low crime rate, stable economy, and schools that earn high marks—the town offers lots of dining, shopping, and recreational opportunities. Residents are better educated and have a median household income roughly 35% higher than the national average. Johnson County ranks highest in the state for health outcomes, quality of life, healthy behaviors, and clinical care.
Cons: The winters are tough, and the summers are hot and humid.
State profile: Pennsylvania ranks 33rd among the states in terms of cost of living; average physician compensation is $274,000, roughly $15,000 below the US average; and physician density is above average. The state has been chipping away at the issue of tort reform for years and has made a lot of progress: The number of malpractice cases filed fell by nearly 45% between 2000 and 2014. Still, malpractice payouts per capita are high—more than three times the national average last year. So why is Pennsylvania on the best list? Dr Kevin Wong, a family medicine physician who grew up in Boston, says it has Pittsburgh.
City profile: "Pittsburgh is probably the best-kept secret for a big city," says Dr Wong, who moved there 35 years ago and stayed to raise his family there. "I can be in town for major sporting events or museum and arts and science events; there are breathtaking views; you don't have to deal with the traffic the way you do in Boston; and the cost of living is so much more reasonable." At $950 per month, the median rent for 22- to 35-year-olds with a college degree is only about one half that of DC or San Francisco, according to the AIER. Physicians closer to retirement will appreciate the fact that Social Security benefits and distributions from retirement accounts and pensions are tax-exempt.
Cons: Quirky state regulations make liability reform a challenge.
State profile: Oregon physicians earned very close to the national average last year, with an average compensation of $287,000. But given the high cost of living and taxes—Oregon ranks in the most expensive quintile among the states for both—they had a harder time hanging on to their money than physicians in the nation's midsection. What did their money buy them? Quality of life. Oregon's economy has grown nearly three times faster than the national economy since 2001, and the Portland metro area, which accounts for three quarters of the state's economy, is the main driver.
City profile: Sometimes dubbed "Silicon Forest," progressive, antisprawl Portland has become an important center for the knowledge economy. The city's unemployment rate was 4.9% in February. If the words "locally grown," "artisanal," and "walkable" are an important part of your vocabulary, Portland is for you.
Cons: High taxes, high cost of living, and a youth-oriented culture may not appeal to a more mature demographic.
State profile: Compensation in Utah is in line with the national average ($288,000), but the state has a low cost of living and the 9.6% overall tax burden is slightly lower than the national average of 9.9%. Malpractice payouts per capita last year were just $5.49. Physician density statewide is well below the national average, but substantially higher in the Salt Lake City hospital service area. Young physicians and their more mature colleagues are likely to find Salt Lake City equally appealing, particularly if they enjoy skiing and the outdoors.
City profile: Salt Lake City ranks fifth on WalletHub's list of best cities for jobs and claims the same spot on the Milken Institute's "Best Cities for Successful Aging" list. It scores high points in terms of livability and overall community well-being as well. The city has low unemployment and a solid financial infrastructure.
Cons: Physician density in the city is high, and housing, particularly starter homes, is hard to find.
State profile: Given the hefty cost of living and 11% overall tax burden, California is probably a destination for two-income households, particularly if one spouse works in the IT industry. If that's the case, the sprawling Bay Area is booming. Major health systems in the state are offering big upfront financial incentives, but 42% of physicians in the state remain self-employed—the third highest rate in the country, according to the Medscape Physician Compensation Report.
City profile: The Silicon Valley community of San Jose-Sunnyvale-Santa Clara is the fourth-ranked major metro area for employment options for young, educated workers, and it ranks in the top 10% on the Gallup-Healthways Well-Being Index. But be forewarned: The market has more than its fair share of doctors.
Cons: The cost of living is high, job competition is stiff, and a single health system dominates the market.
State profile: Arizona offers middling physician compensation—an average of $279,000 last year, or about $4000 less than the national average—and the cost of living in the state is just a hair under the national average. The tax burden is a manageable 8.8%, and malpractice payouts per capita were slightly below the national average last year. Although the state retains one half of the students who receive their graduate medical training, overall physician density is just 234.0 per 100,000 residents—well below the national average of 265.5. The vast majority of those physicians are clustered in the state's handful of metro areas.
City profile: Numerous Medscape readers recommend Scottsdale as a practice location, citing the weather and beautiful golf courses, and the Phoenix-Scottsdale area has above-average scores for every indicator of well-being on the Gallup-Healthways Well-Being Index. Scottsdale just missed the cut for making Forbes' top-10 list for working parents, coming in 11th, but it is one of the top-five choices for empty-nesters over 50, according to Crain's Wealth.
Cons: Physician density in the Scottsdale area is high.
State profile: Texas was one of the hottest destinations for physicians last year, says Jason Farr. Physicians seeking to avoid the growing pains associated with rapidly growing metro areas (eg, expensive housing, heavy traffic, and professional competition) should consider smaller markets, such as Tyler, Midland, Odessa, and El Paso, he says.
City profile: Dr Janet Hurley, a family medicine physician, moved to conservative Tyler from Dallas for residency and decided to stay. "It's small enough that you don't have the crime, traffic, and smog of a big city, but large enough to have variety in restaurants and stores." She says that upscale senior living communities are making Tyler a draw for retirees and notes that several of the physicians who have interviewed with her practice in recent years have been empty-nesters looking to relocate in the area. The Milken Institute calls Tyler a top-50 small metro area for successful aging, thanks in part to its hospitals and rehabilitation services.
Cons: Dallas is 100 miles away. If you need a daily fix of big-city culture, Tyler isn't the place. Seventeen percent of Texans are uninsured.
State profile: The economics of practicing medicine in New Mexico are challenging. New Mexico ranks in the bottom quintile among the states for compensation. Integrated health systems dominate the state: Only 19% of physicians in New Mexico surveyed by Medscape said that they were self-employed, compared with about 30% nationwide, and only five states had higher average malpractice payouts per capita last year. Only 37% of New Mexico residents have employer-provided health insurance—the lowest rate in the nation. New Mexico expanded Medicaid and now faces a huge Medicaid deficit, and proposed provider cuts by the state may exacerbate healthcare access issues.
City profile: In Albuquerque, the unemployment rate in February was 5.7%—well above the rate of regional competitors, such as Denver and Phoenix, and above the national average (4.9%).
State profile: West Virginia is a naturally beautiful state and physicians are well compensated, earning more than $10,000 above the national average. However, the state is plagued by problems that may outweigh the benefits of practicing there. West Virginia has scored lowest among all the states on the Gallup-Healthways Well-Being Index for the past 7 years. The state ranks last in four out of five of the categories used to assess well-being: purpose, social, community, and physical. Historically, West Virginia's mining industry enabled uneducated workers to get relatively high-paying jobs, but with coal in rapid decline, inadequate education is contributing to a cycle of poverty.
City profile: In Charleston, an estimated 19% of the population lives in poverty, according to the US Census, and the unemployment rate is high—7.3% in February, and rising. The number of nonfarm jobs decreased by 1.6% over the 6 months ending in February. Although most of those jobs are in the mining and construction sector, employment in the professional and business services and health and education sectors have likewise tumbled.
Profile: Although not its own state, Washington, DC, is a cherry blossom–bedecked jewel and a magnet for young professionals seeking career opportunities. For doctors, however, the city presents a few problems. The region suffers from a very high density of physicians per resident; for comparison's sake, the physician-per-population ratio is 6% higher than in the Boston hospital referral region. DC physicians last year reported lower compensation than those in any of the 50 states except Rhode Island. At $226,000, average physician compensation was about 20% below the national average, while the cost of living is higher than in any of the states except Hawaii.
State profile: Roughly one half of the residents who train in Mississippi go on to practice in the state—a much higher retention rate than many other states enjoy. What's more, doctors in Mississippi are well-compensated, earning an average of $302,000. Still, that generous compensation comes at a price. The state scores poorly on many quality-of-life indicators. The Organisation for Economic Co-operation and Development ranks Mississippi last among the states in terms of access to services—only 51% of households had access to broadband Internet in 2013—and health. It ranked third to last in education and income and fourth to last in safety.
City profile: Jackson, a city of just over 172,000, reported a nearly 30% increase in murders last year, according to an FBI Uniform Crime Report. Nearly one quarter (23%) of adults in Hinds County, where Jackson is predominately located, report their health as poor to fair—more than double the percentage of top US performers—and nearly three times as many children live in poverty, according to County Health Rankings.
State profile: To be fair, Rhode Island suffers from many of the same problems that characterize the other New England states: too many doctors, steep taxes, and a high cost of living. Unfortunately, Rhode Island doctors also have the lowest compensation of physicians in any state—fully $23,000 less than their peers in adjacent Massachusetts and 22% below the national average. Rhode Island's slow recovery from the Great Recession is forecast to continue over the next 3 years, according to the latest economic outlook produced for the New England Economic Partnership. The state's unemployment rate, which stood at 5.4% in February 2016, is expected to drop to 5.3% by 2018 but remains the highest in New England. Rhode Island's real gross domestic product is forecast to grow at an annualized rate of 1.8%; New England's, at 2.0%; and the United States', at 2.3%. Demographic trends remain "a source of concern," the report states: "While population has been stagnant, there is evidence that qualified individuals are leaving the state, which reduces the pool of qualified labor." A Brooking Brief notes that "no state lost advanced industry jobs faster over the last two decades."
City profile: Forbes named Providence the fifth worst city for finding a job in 2016.
The factors that appeal to each person can differ greatly. For some, proximity to family trumps all other consideration. Others have different requirements, depending on their stage of life and interests. If you are considering a new venue to get a job or set up your own practice, make sure to take all of the factors important to you into account. Your happiness and adjustment to a city or state is more likely to be based on emotional and lifestyle issues first, and compensation second.
Now we want to know which state you like practicing in the most. We are planning to feature some of the responses on Medscape and will contact you if your response is chosen.
In selecting this year's "best places," we took many diverse factors into consideration. We analyzed all 50 states using cost-of-living data from the Missouri Economic Research and Information Center, information on malpractice payouts per capita from Diederich Healthcare, physician density figures from the Association of American Medical Colleges, overall state and local tax burden data from the Tax Foundation, and compensation information from the Medscape Physician Compensation Report 2016 to understand statewide practice conditions.
We then considered individual markets in light of current economic conditions, physician density, overall health, and quality-of-life considerations using data from the US Census Bureau, the Bureau of Labor Statistics, the Dartmouth Atlas of Health Care, the Gallup-Healthways Well-Being Index, the Robert Wood Johnson Foundation's County Health Rankings, and other sources.
To guide our selections, we turned to the American Institute for Economic Research's (AIER's) Employment Destinations Index, which ranks metro areas on the basis of eight economic and quality-of-life factors that attract young, educated millennials. We used WalletHub's 2016 Best & Worst Cities to Find a Job, Forbes' Best Cities for Working Parents, and Livability.com's 100 Best Places to Live lists to assess conditions from a dual-income householder or working parent's perspective. Recognizing that more mature physicians may relocate with an eye for the long-term and eventual retirement, we used the Milken Institute's Best Cities for Successful Aging list to identify cities that provide the economic opportunities and lifestyle amenities that might be important to physicians considering a late-career shift.
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