Physician Unfriendly States?

[Paddington]

For those of us looking for jobs, is there some listing of "physician unfriendly states"? i.e. High amount of lawsuits, high cost of malpractice or tail coverage, high amount of Medicaid, low reimbursements, etc.?

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[TexasPhysician]

Florida

 

[colbgw02]

Florida

Truth. Also, isn't Pennsylvania pretty bad? I vaguely remember a news story about a physician shortage there following an exodus.

I'm sure the AMA or specialty-specific associations publish data on this kind of thing that'll be a lot more useful than responses on this thread.

 

[Fah-Q]

In no particular order:
California, Nevada, Oregon, Illinois, Pennsylvania, Florida.

This is not a complete list but these are the worst. You would have to be absolutely nuts to start a practice in any of these states right now.

 

[Paddington]

In no particular order:
California, Nevada, Oregon, Illinois, Pennsylvania, Florida.

This is not a complete list but these are the worst. You would have to be absolutely nuts to start a practice in any of these states right now.

What's interesting is that CA, NV, OR, metro FL, and the Chicago area in IL are pretty saturated as far as jobs go. I see very few job listings for those areas. So despite the unfriendliness, doctors fill up jobs in those places very quickly and tend to stay there.

 

[newdude2009]

What's interesting is that CA, NV, OR, metro FL, and the Chicago area in IL are pretty saturated as far as jobs go. I see very few job listings for those areas. So despite the unfriendliness, doctors fill up jobs in those places very quickly and tend to stay there.

4/6 of those states have pretty good weather year round.

why is Florida so bad? I thought with the amount of elderly in the state it would be more physician friendly.

 

[Law2Doc]

In no particular order:
California, Nevada, Oregon, Illinois, Pennsylvania, Florida.

This is not a complete list but these are the worst. You would have to be absolutely nuts to start a practice in any of these states right now.

Florida and Nevada both have some variation of a homestead protection so you can't lose your house, which offsets some of the negatives. Illinois used to be known in legal circles as the state with some of the highest jury awards, so lawyers often try to bring cases there. California is known as a liberal, plaintiff friendly legal system. I'm not sure all of these are in the same category.

The only real difference for doctors in various jurisdictions is their insurance premiums, so I'm not sure you'd be "nuts" opening shop in any state -- you'd just have to crunch the numbers and see if the market supports you well even with higher applicable insurance rates.

 

[Law2Doc]

What's interesting is that CA, NV, OR, metro FL, and the Chicago area in IL are pretty saturated as far as jobs go. I see very few job listings for those areas. So despite the unfriendliness, doctors fill up jobs in those places very quickly and tend to stay there.

Location is more important than a few hundred dollars in premiums each month for most doctors.

 

[prominence]

Florida and Nevada both have some variation of a homestead protection so you can't lose your house, which offsets some of the negatives.

Does anyone know if New Jersey offers homestead protection? Is there a complete list of states that offer homestead variation?

 

[Law2Doc]

... Is there a complete list of states that offer homestead variation?

I only skimmed this, but it seems like a reasonably comprehensive list. http://www.lawchek.net/resources/forms/que/homestead.htm

 

[deleted109597]

It's specialty dependent, for one.
Also, lack of state income taxes may make a fairly large difference. There are states that don't have state income tax, and you bring home more money each year.
Tort reform is another issue. Decide if the state you want to work in has a decent liability reform package. I disagree with Law2Doc that it is a few hundred dollars in premiums alone that helps them make this decision. Remember, Florida also has the 3 strikes law. I can't imagine wanting to work in a state where the trial lawyers have so much power. Even if it isn't as bad as it was in 2004, it's still pretty scary that you can lose your license over 3 petty complaints. Also, you have to report every single settlement against you, and if the state you practice in makes it easy for people to file meaningless claims, and your carrier settles these instead of fighting them, you could end up with a long list of settlements simply for doing your job.
While Florida might have nice weather, it sucks for doctors. Unless you have sovereign immunity by working for the state.

 

[Mattchiavelli]

Illinois = no caps on malpractice suits = just practice in indiana where your malpractice premiums will be way cheaper :b

Also california kind of blows, seeing as there was a lawsuit naming a nursing home and a physician in a lawsuit for "assault with a deadly weapon" for giving someone with agitation and AzDz an atypical antipsychotic......

 

[newdude2009]

just go practice in the middle east where they appreciate their docs and no insurance to hassle with.

 

[Raryn]

In no particular order:
California, Nevada, Oregon, Illinois, Pennsylvania, Florida.

This is not a complete list but these are the worst. You would have to be absolutely nuts to start a practice in any of these states right now.

You're right on Illinois, Pennsylvania, Florida, Nevada. Not sure on Oregon.

California is truly a mixed bag. California has had a non-economic damages cap of $250,000 (one of the lowest in the country) for almost 40 years. And about half of California has some of the lowest malpractice rates in the country, awesome salaries, and a low cost of living. And when I say *lowest*, I do mean just about the lowest in the country. See: http://www.ama-assn.org/amednews/2011/10/17/prsb1017.htm Those counties in CA are actually the #1 lowest for Ob/Gyn malpractice rates. Period.

You just need to avoid Los Angeles and the surrounding areas. That's what is saturated, has !@#$ty salaries, and practices pay the most for malpractice in the state. (On the other hand, CA does have a 10% state income tax, but salaries in places like the central valley are high enough to make up for it.)

What we should take into consideration though, is outside of solo practice (which is dying), doctors don't pay their own malpractice insurance. Your group/hospital/whatever will pay it, and your salary is what you take home after the practices expenses are all taken out. Just like you don't worry about the practice's rent, you don't worry about the malpractice insurance.

 

[Paddington]

Location is more important than a few hundred dollars in premiums each month for most doctors.

Unfortunately, it's not a few hundred dollars. It's more like tens of thousands of dollars difference, per year. I was looking at a job in one of those states. After I interviewed and got the contract, I started looking into mundane stuff that us residents don't usually think about, such as tail coverage. I got a few quotes and didn't take the job - in part - because of how insanely high it was. Relative to the salary I would be getting, I would be wiped out completely if I chose to leave that job. And this was in a non metropolitan part of that state, I was told that premiums for urban areas were double. If you take a job in certain problem states, you better start stock piling cash right on day one for the tail coverage and not "splurge" for a good 5 years (the period in which it keeps growing continuously).

 

[Fah-Q]

You're right on Illinois, Pennsylvania, Florida, Nevada. Not sure on Oregon.

You are correct. I meant Washington, not Oregon. Sorry for the error.

There are a variety of reasons to avoid each of the states I listed. Malpractice is just part of the puzzle. For example, California is a capped state but salaries in and around the bigger cities are in the lowest 10% in the nation and cost of living is in the highest 10%. You do the math.

As for Washington state, I'll just let this little gem of an article explain to you how physicians are viewed there....http://seattletimes.nwsource.com/html/localnews/2017449883_emergency08m.html?syndication=rss

Florida and Nevada are malpractice nightmares. Many docs hide away assets in trusts, etc, and don't purchase malpractice insurance because they can't afford it.

I'll also add Pennsylvania and Wisconsin to the list as both states have recently confiscated money from physicians to help fill in state budget holes elsewhere. Truly disgusting and hard to believe it happened in the good ole US of A.

Texas is currently the promised land for physicians. Doctors are flocking there in record numbers. It also is one of the fastest growing states and all those people need doctors.

 

[Raryn]

You are correct. I meant Washington, not Oregon. Sorry for the error.

There are a variety of reasons to avoid each of the states I listed. Malpractice is just part of the puzzle. For example, California is a capped state but salaries in and around the bigger cities are in the lowest 10% in the nation and cost of living is in the highest 10%. You do the math.

As for Washington state, I'll just let this little gem of an article explain to you how physicians are viewed there....http://seattletimes.nwsource.com/html/localnews/2017449883_emergency08m.html?syndication=rss

Florida and Nevada are malpractice nightmares. Many docs hide away assets in trusts, etc, and don't purchase malpractice insurance because they can't afford it.

I'll also add Pennsylvania and Wisconsin to the list as both states have recently confiscated money from physicians to help fill in state budget holes elsewhere. Truly disgusting and hard to believe it happened in the good ole US of A.

Texas is currently the promised land for physicians. Doctors are flocking there in record numbers. It also is one of the fastest growing states and all those people need doctors.

Once again, for CA the only really terrible areas are in and around LA. The more rural regions of CA have salaries double those and really do take advantage of the low malpractice in the state. And by more rural I mean areas like Fresno, which has a population of >500,000 in the city itself and probably the same in the surrounding region, depending on where you draw the line

As for WI, the WI supreme court last year made the governor pay the $ back to patient compensation fund, and it was returned in full, with appropriate interest. Salaries here are extremely competitive and the malpractice environment throughout the state (with the patient compensation fund intact) is one of the best in the nation. We're nowhere near as bad as Pennsylvania.

 

[Fah-Q]

As for WI, the WI supreme court last year made the governor pay the $ back to patient compensation fund, and it was returned in full, with appropriate interest. Salaries here are extremely competitive and the malpractice environment throughout the state (with the patient compensation fund intact) is one of the best in the nation. We're nowhere near as bad as Pennsylvania.

I would never set up practice in a state that confiscated money from doctors that was only returned after years of litigation. Stealing money should be illegal no matter who does it. Who knows what they will try next? It is not worth the risk when there are plenty of states where you don't have to worry about garbage like this happening.

 

[colbgw02]

To augment the original post, how does Hawaii fare?

I worked in Hawaii for a number of years, albeit as a resident, but my impression was that judges and juries tend to be very pro-plaintiff there. However, there didn't seem to be a particularly high rate of suites or litigation. Maybe that speaks to the burden the laws places on the plaintiff, but I honestly don't know.

What, I think, makes Hawaii relatively unfriendly is the low reimbursement coupled with the very high cost of living. Not only are physician salaries not proportionally higher in Hawaii to account for the cost of living, they are mostly lower, and - in some cases - substantially so.

 

[notdeadyet]

Ah yes, the "pineapple tax.". I'd forgotten about that. Not limited to medicine, all fields pay less in hawaii by the logic that people will be willing to earn less money to live in Hawaii. A great four years but I ain't itching to return to that....

 

[Danbo1957]

For those of us looking for jobs, is there some listing of "physician unfriendly states"? i.e. High amount of lawsuits, high cost of malpractice or tail coverage, high amount of Medicaid, low reimbursements, etc.?

All states except Texas.

 

[spartywrx]

All states except Texas.

" 'Cause God blessed Texas with His own hand
Brought down angels from the promised land
Gave 'em a place where they could dance
If you wanna see heaven brother here's your chance
I've been sent to spread the message
God blessed Texas "

-- Little Texas

http://www.youtube.com/watch?v=mbH60wCO-Yw

 

[michigator04]

http://www.pacificresearch.org/docLib/201007132_HPP72010_F.pdf

This was linked to in a thread on the EM board. It gives a composite ranking of all 50 states based on 8 factors that influence medico-legal costs. According to this Mississippi is the best state from that perspective, and Vermont is the worst.

 

[docB]

Florida and Nevada both have some variation of a homestead protection so you can't lose your house, which offsets some of the negatives. Illinois used to be known in legal circles as the state with some of the highest jury awards, so lawyers often try to bring cases there. California is known as a liberal, plaintiff friendly legal system. I'm not sure all of these are in the same category.

The only real difference for doctors in various jurisdictions is their insurance premiums, so I'm not sure you'd be "nuts" opening shop in any state -- you'd just have to crunch the numbers and see if the market supports you well even with higher applicable insurance rates.

My understanding of Nevada's homstead law is that it protects $250,000 of the value of your house. You can be ordered to liquidate your house and turn over everything above that. The thought was that you can get something else to live in for $250K and that should be good enough. Before the bust this was a real concern. Now that no one has any equity it doesn't matter so much.

What we should take into consideration though, is outside of solo practice (which is dying), doctors don't pay their own malpractice insurance. Your group/hospital/whatever will pay it, and your salary is what you take home after the practices expenses are all taken out. Just like you don't worry about the practice's rent, you don't worry about the malpractice insurance.

This is very bad advice. You really do need to care about the costs your practice pays. If you don't pay attention you will get taken advantage of big time. You have to remember that the practice's money is your money. Anything extra could be paid to you and anything wasted can't. Also keep in mind that most docs in groups have some partnership and/or profit sharing system.

 

[deleted103644]

http://www.pacificresearch.org/docLib/201007132_HPP72010_F.pdf

This was linked to in a thread on the EM board. It gives a composite ranking of all 50 states based on 8 factors that influence medico-legal costs. According to this Mississippi is the best state from that perspective, and Vermont is the worst.

Then again, you'd have to live in Mississippi.