Top 3 Worst (and Best) States to Practice Medicine

Where to settle down after residency or fellowship is probably the biggest question most doctors and doctor spouses ask themselves as their time in training runs down. After essentially having your location chosen for you throughout medical school, intern year, residency, and fellowship, determining the best place to practice can feel overwhelming. After all, physicians are needed everywhere! 

There are a number of factors which influence these post-training decisions, from quality of life factors, proximity to family, cultural preferences, and beyond! Because of all of these deeply personal “x” factors, no singular list can tell you which state is the right fit for your family’s personal medical journey. However, there’s plenty of data out there about burnout, malpractice rates, salary offerings, and physician competition. While these factors alone may not sway your decision, it’s worth taking them into consideration, since they will heavily impact your post-training experience. 

Based on the factors listed above (all considered equally), here’s our list of the worst and best states to practice medicine. 

Worst

1. New York 

It didn’t take a lot of debate to determine New York is the worst state to practice medicine. It pretty much swept every negative category. Physicians practicing in New York take a one-two punch of sky-high malpractice rates and extremely low compensation. To make matters worse, New York has extremely high taxes, which cuts deeper into physicians’ bottom lines. Quality of life also takes a hit in New York, largely due to an extremely high cost of living, and a lot of physician density (read: big competition). All those negative factors lead to high rates of physician burnout and dissatisfaction. But at least it’s pretty in the fall? 

2. Maryland

Maryland is a fiscal disaster for physicians. On top of being one of the worst states for physician compensation, the cost of living is high, and the tax structure isn’t exactly friendly to practicing doctors. Although Maryland does boast some big names in medical education (Heard of Johns Hopkins, anyone?), the state is less kind to physicians after they’re finished with training. 

3. Massachusetts 

Massachusetts is doing a lot right in terms of education (Harvard Medical School) and well-performing hospitals (Massachusettes General and Brigham), but for as much as the state offers to its patients, it’s not so kind to its doctors. Massachusetts is known for its astronomical cost of living expenses, which of course, is not only impacting physicians. However, couple the sky-high cost of… well… everything in Massachusetts with high physician density, low starting salaries, and big malpractice costs, the state becomes a less attractive place to practice medicine.  

Best

1. North Dakota

While the midwest may not be everyone’s cup of tea, North Dakota has a lot to offer physician families. Looking to make a dent in those student loans? North Dakota boasts the highest physician salaries of any state, which may be the reason physicians in the “Peace Garden” state report high quality of life and a strong sense of community support. Large income, low cost of living, and friendly neighbors sound good to you? North Dakota may be worth a second look. 

2. Iowa

While we ultimately ranked Iowa behind North Dakota, it was a neck-and-neck race. The midwest seems to know how to treat its physicians! Iowa scores well across the board for physicians, offering competitive wages, low cost of living, and great quality of life. One of the biggest benefits of practicing in Iowa is less competition between physicians, due to a relatively low number of physicians relative to the population. This well-rounded state scores highly in both career and quality of life factors. 

3. Minnesota

Minnesota tends to conjure images of snow piles as big as houses, and there’s no doubt the long winters can be daunting. Still, physicians might reconsider getting out their gloves, boots, and shovels, as Minnesota is consistently ranked as one of the best places to practice medicine. So what makes this state so alluring to physicians? In addition to providing its physicians with great quality of life, Minnesota has one of the lowest malpractice award payouts, and one of the highest rates of employer insurance. Yay for healthy, satisfied patients!