Best states to practice in

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cyanide12345678

cyanide12345678

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Of course everyone has talked about Texas being a great state to practice, but the larger cities are getting saturated. So what are some other great states to practice EM if family proximity and location didn't really matter and the only factors that mattered were:

1. Compensation.
2. Malpractice laws/tort reform
3. Cost of living
4. Tax burden (no state income tax is always a plus)

So what places do you get paid handsomely, while never getting sued, while living cheaply and paying minimally to Uncle Sam?
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Texas, Indiana, Arizona, Michigan, Georgia seem to be good or moderately so for malpractice
 
Commonwealth of TN is not bad. CMGs are quite prevalent but criteria 2-4 are certainly met. But I’d have to consider Nashville a MCOL city at this point due to real estate prices.


cyanide12345678 said:
Of course everyone has talked about Texas being a great state to practice, but the larger cities are getting saturated. So what are some other great states to practice EM if family proximity and location didn't really matter and the only factors that mattered were:

1. Compensation.
2. Malpractice laws/tort reform
3. Cost of living
4. Tax burden (no state income tax is always a plus)

So what places do you get paid handsomely, while never getting sued, while living cheaply and paying minimally to Uncle Sam?
Click to expand...
 
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cyanide12345678 said:
Michigan really? Was getting some pretty low ball offers when i was looking last year in Michigan.
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Yeah Michigan doesn’t really belong on that list. Malpractice climate is average and many cities are saturated driving down salaries. Many CMGs are currently offering 180/hr for full time work.
 
Kansas.

Meets all 4 of the above criteria and it’s pretty easy to get a job at the moment.

FWIW there was recently an SDG posting on EMDOCS advertising >300/hr for partners.
 
TN isn't a commonwealth. KY, VA, MA, and PA. Not that it means a whole lot.
Kansas has been high paying since I graduated residency. Because almost nobody wants to move there.
 
Michigan doesn’t pay well but low cost of living when I was there
 
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It's very difficult getting litigation started in Georgia. One has to find an emergency physician to certify that your care was grossly negligent -- not just below standard of care -- and that it directly attributed to the patient's outcome.

A friend of mine is a malpractice attorney (defense) at a large law firm. He said that most malpractice attorneys won't go after an ER doc because it's just too much time before it even gets a chance. About the only way they will pursue a case is if the patient/family pays for their time invested in researching it, securing an expert witness, filing, etc. He said most emergency litigation in Georgia costs about $15-25,000 before the papers get handed to the defendants. It's rare to see a plaintiff attorney work on contingency for emergency cases (not limited to emergency medicine; also includes specialists providing care to emergent patients).
 
Dr.McNinja said:
research.zippia.com

This Interactive Map Shows Which States Sue Doctors The Most

We mapped the one downside to a career in healthcare -- how many times medical practitioners get sued.
research.zippia.com research.zippia.com
Click to expand...

I got my misleading info from here:
www.beckershospitalreview.com

A state-by-state breakdown of medical malpractice suits - Becker's Hospital Review | Healthcare News & Analysis

A state-by-state breakdown of medical malpractice suits
www.beckershospitalreview.com www.beckershospitalreview.com

A good comment at the bottom addresses TN's standing. Apparently the medmal environment IS good in TN.
 
carbonizedeyesockets said:
I got my misleading info from here:
www.beckershospitalreview.com

A state-by-state breakdown of medical malpractice suits - Becker's Hospital Review | Healthcare News & Analysis

A state-by-state breakdown of medical malpractice suits
www.beckershospitalreview.com www.beckershospitalreview.com

A good comment at the bottom addresses TN's standing. Apparently the medmal environment IS good in TN.
Click to expand...
Sure, that quote is as believable as the article itself. Which is to say, no primary data.
I don't know who to believe.
 
So much local variability that state by state comparison is of limited utility. There are cities on both coasts paying $3-400/hr for full partners plus health profit sharing bonuses. You can also get $125/hr at a slow rural site in middle america. Housing costs are a choice, though some places are certainly more expensive than others. State income taxes can also take a bite, but picking a group with good tax sheltered accounts can help you put away well over 100k per year pre tax and limit that exposure as well making overall compensation and your enjoyment with location and practice site so much more important.
 
alpinism said:
Yeah Michigan doesn’t really belong on that list. Malpractice climate is average and many cities are saturated driving down salaries. Many CMGs are currently offering 180/hr for full time work.
Click to expand...

The headache of EM just isn't worth it for less than $200 an hour IMHO. Even government work pays better than $180.
 
My votes (not including QOL or weather) would be, in no particular order:
Indiana- good $, minimal medmal, but high CMG penetration. Strong state medical board.
Georgia- good $ and medmal
Kansas
New Mexico has great salaries in smaller areas
 
miacomet said:
My votes (not including QOL or weather) would be, in no particular order:
Indiana- good $, minimal medmal, but high CMG penetration. Strong state medical board.
Georgia- good $ and medmal
Kansas
New Mexico has great salaries in smaller areas
Click to expand...

Keep in mind that just focusing on a state can be misleading. As for Indiana, the county where I actually live has not had a successful malpractice suit since before World War II (so I am told); granted there are probably less than 20 physicians who actually practice in the county. On the other hand, Gary and Indianapolis tend to have juries and judges much more sympathetic to plaintiffs. One state, different outcomes depending on location.
 
Vandalia said:
Keep in mind that just focusing on a state can be misleading. As for Indiana, the county where I actually live has not had a successful malpractice suit since before World War II (so I am told); granted there are probably less than 20 physicians who actually practice in the county. On the other hand, Gary and Indianapolis tend to have juries and judges much more sympathetic to plaintiffs. One state, different outcomes depending on location.
Click to expand...

I'm told that PA is the same way. You get out of the blast rings with Philadelphia at the atomic epicenter, and you can breathe the air without radiation sickness.
 
Here is the last ACEP EM Report Card, published before ACEP decided to be a total lapdog to their CMG masters.
Granted, some of the data may be outdated (it was five years ago, after all), but the fact that this data is no longer published by ACEP gives all the more weight to have them suffocate via attrition.
 

Attachments

Wow. Why would ACEP stop doing this? It's actually super helpful. Oh wait...

Btw @RustedFox I've heard you work in Florida. I'm considering going there. Feel free to PM me but I'm curious why/why not move.
 
So really... The only places most people agree on are Texas, Indiana, georgia and maybe questionably Tennessee?

What about South dakota, north dakota, iowa? They Seem malpractice friendly with reasonable salaries. Any thoughts on that anyone?
 
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cyanide12345678 said:
So really... The only places most people agree on are Texas, Indiana, georgia and maybe questionably Tennessee?

What about South dakota, north dakota, iowa? They Seem malpractice friendly with reasonable salaries. Any thoughts on that anyone?
Click to expand...

Been to S.Dakota last year. There are two small cities (Sioux Falls, Rapid City) - one in each half of the state. There is NOTHING between them but endless prairie (and the Badlands, which are pretty cool). We loved the nature tourism of the area, but I wouldn't want healthcare anywhere around there. My own veterinarian just got back from a trip to the Black Hills and said "I had a seizure while I was there; I've had them before... but... man.... it was like these people didn't know what to do with anyone who had a convulsive episode."

N.Dakota.... Never been there myself, but my best buddy since high-school just moved the hell out of there saying: "The oil boom was cool [economically speaking] and all, but its a post-boom wild west now. I wouldn't bring a woman or a child to Dickinson or any of those places in the Bakken. Nothing but "Rig Pigs" who are only interested in something if they can (1) drink it, (2) sleep under it, or (3) f*ck it. The oil fields have stopped because now "we have enough... thanks" and its a drifter wasteland of out-of-work people who followed the black gold rush.

Iowa?
No idea; but there was a poster on here called @OldMil that worked in Iowa for awhile. He had a post or two about bad jobs in the state. He left medicine altogether for awhile, but (I guess, according to what I can gather) is now involved on the fringe for his own reasons.
 
RustedFox said:
Been to S.Dakota last year. There are two small cities (Sioux Falls, Rapid City) - one in each half of the state. There is NOTHING between them but endless prairie (and the Badlands, which are pretty cool). We loved the nature tourism of the area, but I wouldn't want healthcare anywhere around there. My own veterinarian just got back from a trip to the Black Hills and said "I had a seizure while I was there; I've had them before... but... man.... it was like these people didn't know what to do with anyone who had a convulsive episode."
Click to expand...
A guy I work with worked for the Indian Health Service of the PHS, after he was on a health professions scholarship. This was more than 20 years ago, but he was posted there. He said that, at that time, the reservation was "X" sized, but, now, have bought so much land, that they are (or seem) to be 5X or 10X sized. He told me that, soon, they will own all land that is not state or federal government land.
 
Vandalia said:
Keep in mind that just focusing on a state can be misleading. As for Indiana, the county where I actually live has not had a successful malpractice suit since before World War II (so I am told); granted there are probably less than 20 physicians who actually practice in the county. On the other hand, Gary and Indianapolis tend to have juries and judges much more sympathetic to plaintiffs. One state, different outcomes depending on location.
Click to expand...

This is spot on.

I used to work in a rural county with very few doctors in an overall bad med-mal state. Nobody sued.

Unless something egregious occurs nobody living rural wants to sue their doctors for fear they'll move away, ie the John Edwards effect. And the rural folks on a jury are even less interested in letting the plaintiff succeed.
 
miacomet said:
My votes (not including QOL or weather) would be, in no particular order:
Indiana- good $, minimal medmal, but high CMG penetration. Strong state medical board.
Georgia- good $ and medmal
Kansas
New Mexico has great salaries in smaller areas
Click to expand...

Indiana is great. I wouldn't say high CMG penetration. Indianapolis has 4-5 democratic groups. Richmond has a democratic group. Columbus (south of Indianapolis) has a democratic group. South Bend I believe has a democratic group. Fort Wayne I believe has two democratic groups. Envision is around on the outskirts of Indy and in the rural sites but they pay decent since no one wants to work rural out here. They also have some free standing EDs around Indy, but they can't seem to keep them staffed and I think none of them are doing well. IU Physicians group is essentially an academic CMG but they staff most of the IU hospitals around central Indiana. Malpractice is good. We have caps (at least for now) and the review panel is nice. The amount of suits have gone up but actual payouts I think has remained low. COL is low for the most part. Good school districts round Indy will be more expensive but nothing like Chicago or the coasts. Airport is regularly ranked as one of the best in the country. Traffic has been bad this summer due to road construction but usually "bad traffic' entails leaving about 10 min early for a shift. Overall, it is a nice midwest area to live that pays well above the national EM avg. Some jobs are top 5% and democratic, so things could be much worse.
 
Upstate NY is actually a nice place to practice with a plethora of academic centers. The COL is surprisingly low if you look at areas like Rochester, Buffalo, Syracuse, and Albany. Everyone always forgets there's more to NY than NYC. The pay is above average and ppl don't realize how cheap it is to live in upstate! Lots of medical schools and teaching opportunities as well. Just gotta like snow!
 
KeikoTanaka said:
Upstate NY is actually a nice place to practice with a plethora of academic centers. The COL is surprisingly low if you look at areas like Rochester, Buffalo, Syracuse, and Albany. Everyone always forgets there's more to NY than NYC. The pay is above average and ppl don't realize how cheap it is to live in upstate! Lots of medical schools and teaching opportunities as well. Just gotta like snow!
Click to expand...

From a medicolegal standpoint, unless there's been meaningful reform in the last few years I don't know about, NY is not a good place to practice. Can get similarly above average pay and decent CoL in a bunch of other places which are also better in other ways.
 
KeikoTanaka said:
Upstate NY is actually a nice place to practice with a plethora of academic centers. The COL is surprisingly low if you look at areas like Rochester, Buffalo, Syracuse, and Albany. Everyone always forgets there's more to NY than NYC. The pay is above average and ppl don't realize how cheap it is to live in upstate! Lots of medical schools and teaching opportunities as well. Just gotta like snow!
Click to expand...

Except that 6.85% tax rate will get you. $20,000 per year for the "privilege" of living Buffalo or Rochester......

I lived in Indiana for 6 years. If you have to live in the Midwest it's one of the better places. Short drive to Chicaco and really nice airport. Medical Centers downtown are pretty amazing. Weather is horrendous with snow for 6 months of the year and rainy/humid Summers. Pay is a big higher than normal, but still not what it is in TX, FL or other states.

I worked locums for 2 years in SD. Sioux Falls is the only "real city". They actually have two huge academic tertiary referral centers that provide amazing care. Unfortunately this was the place where I was a hospital employee, the midlevels were incredibly lazy (as we had no authority over them), and they were wantonly committing EMTALA violations with their rural-hospital ICU to ER transfers. Pay was $250/hr non-negotiable with no state income tax.
 
GeneralVeers said:
Except that 6.85% tax rate will get you. $20,000 per year for the "privilege" of living Buffalo or Rochester......

I lived in Indiana for 6 years. If you have to live in the Midwest it's one of the better places. Short drive to Chicaco and really nice airport. Medical Centers downtown are pretty amazing. Weather is horrendous with snow for 6 months of the year and rainy/humid Summers. Pay is a big higher than normal, but still not what it is in TX, FL or other states.

I worked locums for 2 years in SD. Sioux Falls is the only "real city". They actually have two huge academic tertiary referral centers that provide amazing care. Unfortunately this was the place where I was a hospital employee, the midlevels were incredibly lazy (as we had no authority over them), and they were wantonly committing EMTALA violations with their rural-hospital ICU to ER transfers. Pay was $250/hr non-negotiable with no state income tax.
Click to expand...

I have a *Best buddy* that worked at what I'm sure is the shop that you're referring to.

He left for the exact same reasons.
 
Oh I'm definitely not saying NY is better to practice overall compared to other states - but Upstate NY is definitely a great QOL with a much lower COL when compared to the astronomical costs of NYC and Downstate areas. Yeah the state taxes suck but the remaining of everything else outside of the city is actually quite cheap, in terms of land, groceries, and other extraneous costs. Also there's Wegmans. I feel like people definitely forget about the remaining 85% of NY
 
KeikoTanaka said:
Upstate NY is actually a nice place to practice with a plethora of academic centers. The COL is surprisingly low if you look at areas like Rochester, Buffalo, Syracuse, and Albany. Everyone always forgets there's more to NY than NYC. The pay is above average and ppl don't realize how cheap it is to live in upstate! Lots of medical schools and teaching opportunities as well. Just gotta like snow!
Click to expand...

Terrible weather, high taxes, hideous medmal, Lyme disease- I'm not seeing it, although the Hudson Valley is beautiful. Last job I say in upstate NY was under $200 an hour after they negotiated a huge raise. Where are these well-paying jobs, and what do they pay?
 
miacomet said:
Terrible weather, high taxes, hideous medmal, Lyme disease- I'm not seeing it, although the Hudson Valley is beautiful. Last job I say in upstate NY was under $200 an hour after they negotiated a huge raise. Where are these well-paying jobs, and what do they pay?
Click to expand...

So Hudson Valley definitely isn't upstate for us actual Upstaters haha. The problem with the Hudson Valley is it is artificially inflated by its proximity to NYC despite being so rural. Rochester has a really amazing healthcare system with great paying jobs, and a low cost housing market. The problem is its a hard system to break into if you're an outsider. A home that would be 3 mil in Cali might only be 600k in Rochester, hell, even less. Weather is definitely dependent on what your preferences are.. I love the snow and dream of living in NH or ME.
 
Also I've pulled 3 ixodes ticks off my legs in the last year, never got Lymes. It needs to stay burrowed in you for quite a while actually. You get used to tick-checking, it's not really a problem at all 😛.
 
Yes...but depressed local economy, small airport, HIGH taxes, poor infrastructure, six months of snow with no decent skiing, gray skies (there are places that are sunny and have snow AND mountains), lots of social issues (meth) etc. And terrible medmal as others have noted.

I'd be curious, though, if the salaries do make up for this. Are they really paying a ton? Plattsburgh, Buffalo and Syracuse always seem to have jobs, and they haven't offered much IME.
 
cyanide12345678 said:
Of course everyone has talked about Texas being a great state to practice, but the larger cities are getting saturated. So what are some other great states to practice EM if family proximity and location didn't really matter and the only factors that mattered were:

1. Compensation.
2. Malpractice laws/tort reform
3. Cost of living
4. Tax burden (no state income tax is always a plus)

So what places do you get paid handsomely, while never getting sued, while living cheaply and paying minimally to Uncle Sam?
Click to expand...

There are a handful of states with no state income tax: Florida, Tennessee, Texas, Nevada, Wyoming, South Dakota, and Washington.

Of these, Florida, Wyoming, and Washington all have poor malpractice/tort environments.

The Texas market is saturated.

South Dakota and Tennessee both offer the combination of a decent practice environment, decent pay, and reasonable costs of living.
 
Last edited:
cyanide12345678 said:
So really... The only places most people agree on are Texas, Indiana, georgia and maybe questionably Tennessee?

What about South dakota, north dakota, iowa? They Seem malpractice friendly with reasonable salaries. Any thoughts on that anyone?
Click to expand...

South Dakota has no state income tax. Iowa’s state income tax is absurdly high and with the loss of the SALT deduction that is really a major factor that people need to take into account...unless you like cutting your state government a check for 1000-2000 a month just for the privilege of living there. North Dakota? Go to Alaska.
 
Old_Mil said:
South Dakota has no state income tax. Iowa’s state income tax is absurdly high and with the loss of the SALT deduction that is really a major factor that people need to take into account...unless you like cutting your state government a check for 1000-2000 a month just for the privilege of living there. North Dakota? Go to Alaska.
Click to expand...

But the problem with South Dakota is there is really only one big city with two hospital groups. That's it. Very little competition, and I've found hospital employee jobs tend to turn EM docs into even bigger cogs in the machine with little autonomy or due process.
 
GonnaBeADoc2222 said:
Lyme disease? Really? That's the reason not to move to New York?
Click to expand...

I've heard of this horrendous thing called "Chronic Lyme". Apparently it makes end-stage-fibromyalgia seem like a pleasure to deal with in comparison.....

So glad I live in the Sun Belt with little vegetation and no parasitic arthropods.
 
Is the market in Texas still decent for the smaller cities like lubbock, Midland, Amarillo, college station etc? I would think it would be hard to recruit to those places. Who in this world wants to live in Lubbock
 
cyanide12345678 said:
Is the market in Texas still decent for the smaller cities like lubbock, Midland, Amarillo, college station etc? I would think it would be hard to recruit to those places. Who in this world wants to live in Lubbock
Click to expand...
Midland, Amarillo? Sure. Kinda. Just got a Weatherby ad for somewhere 45 minutes outside Amarillo for 3k per 24. 8500 volume. Hard pass. Too much work for not enough pay. You won't be sleeping those 24s.
Lubbock is starting a residency program. There's not much out there currently.
B/CS is saturated.
The valley is open if you want to work for HCA/Envision. There's some openings on Beaumont. Occasionally you'll see stuff in DFW, but with the mass exodus from freestandings most of those are filled pretty quickly.
 
3k for 24 at 8500?
125/hr for 1 pph?
Very hard pass.
You know someone who doesn't know their worth will take it though.
Dr.McNinja said:
Midland, Amarillo? Sure. Kinda. Just got a Weatherby ad for somewhere 45 minutes outside Amarillo for 3k per 24. 8500 volume. Hard pass. Too much work for not enough pay. You won't be sleeping those 24s.
Lubbock is starting a residency program. There's not much out there currently.
B/CS is saturated.
The valley is open if you want to work for HCA/Envision. There's some openings on Beaumont. Occasionally you'll see stuff in DFW, but with the mass exodus from freestandings most of those are filled pretty quickly.
Click to expand...
 
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