What state(s) would you recommend?

[AD04]

Requirements:
- high physician pay / reimbursement
- low / no state income tax
- low risk of getting into / losing malpractice lawsuit

Bonuses:
- warm weather
- gun-friendly
- by the coast

If you practice in a state like this, please elaborate.

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[Stagg737]

Sounds like Texas or South Carolina to me...

 

[Taddy Mason]

ND/SD/MT meet all of the requirements (especially reimbursement), but only one of the 2 bonuses. Though MT is pretty scenic and offers a lot for outdoor activities.

 

[TexasPhysician]

Idaho and Midwest have it really good.

 

[st2205]

Idaho and Midwest have it really good.

Idaho checks most of those boxes. I know a job there paying 300k for a 4 day work week, all outpatient. Warm weather. About 30 minutes from larger city.

Don’t want to reveal too much because I’m trying to keep it on the DL, but it’s beautiful.

 

[VA Hopeful Dr]

Sounds like Texas or South Carolina to me...

Yep. I'm from SC and currently at the beach (3 hours from my house and I live on the complete other end of the state).

We're paid pretty well, not the highest but low COL.

My father in law is an OB. In 40 years he has never been sued. My family doctor uncle is the same.

Our state income tax rate isn't ideal, but we have the 8th lowest property tax rate in the country. Also we always have the cheapest gas, which is weird but I'm ok with it.

 

[MacDonaldTriad]

NYC, Boston, SF, LA, the Windy City... these places are crazy expensive but when 5 million or more people want to live in an expensive city, there are reasons for that. If you don't share those values, maybe your lucky and Springfield USA is easy.

 

[AD04]

Anyone have opinion on Tennessee ?

Idaho and Midwest have it really good.

How are they better than Texas

Idaho checks most of those boxes. I know a job there paying 300k for a 4 day work week, all outpatient. Warm weather. About 30 minutes from larger city.

Is that a picture of Idaho? I would not have expected palm trees there.

NYC, Boston, SF, LA, the Windy City... these places are crazy expensive but when 5 million or more people want to live in an expensive city, there are reasons for that. If you don't share those values, maybe your lucky and Springfield USA is easy.

Those are exactly the places I DON'T want to be. I'm trying to avoid Illinois as well.

 

[AD04]

Yep. I'm from SC and currently at the beach (3 hours from my house and I live on the complete other end of the state).

We're paid pretty well, not the highest but low COL.

My father in law is an OB. In 40 years he has never been sued. My family doctor uncle is the same.

Our state income tax rate isn't ideal, but we have the 8th lowest property tax rate in the country. Also we always have the cheapest gas, which is weird but I'm ok with it.

I drove through SC and it was a beautiful state. I may consider it.

 

[TexasPhysician]

Anyone have opinion on Tennessee ?



How are they better than Texas



Is that a picture of Idaho? I would not have expected palm trees there.

Texas isn’t bad, but the larger cities are pretty popular. The great thing about psych is that you can find work anywhere.

Idaho has great lakes.

 

[WisNeuro]

Texas isn’t bad, but the larger cities are pretty popular. The great thing about psych is that you can find work anywhere.
Idaho has great lakes.

But not the Great Lakes.

 

[Taddy Mason]

But not the Great Lakes.

Though it does have lake Coeur d’Alene - which is pretty great.

 

[WisNeuro]

Though it does have lake Coeur d’Alene - which is pretty great.

Pssh, lake Coeur d'Alene wouldn't have been able to bring down the Edmund Fitzgerald on its best day.

 

[Stagg737]

Requirements:
- high physician pay / reimbursement
- low / no state income tax
- low risk of getting into / losing malpractice lawsuit

Bonuses:
- warm weather
- gun-friendly
- by the coast

If you practice in a state like this, please elaborate.

Something to keep in mind about your second requirement. If there's no state income tax you're likely going to be hit hard somewhere else when it comes to taxes (property, sales, etc). The tax man will get his share one way or the other.

One of my best friends growing up lives near Nashville. Tennessee is gun friendly and is definitely warm, sometimes too warm and the humidity can get really bad. They're great in terms of taxes and part of why he moved there was the financial upside (he's very business oriented). Tennessee is also great for physicians in terms of reimbursement compared to COL. Idk about malpractice there, a quick look seems like it's not the best in that area. Also not by the coast.

Again, I think Texas and S.C. fit both your requirements and hit your bonuses the best.

 

[WisNeuro]

Again, I think Texas and S.C. fit both your requirements and hit your bonuses the best.

Texas, at least in my area and when I lived there, had sky high property taxes. Also, if you live by the coast, be prepared to completely remodel your flooded home every 5-10 years.

 

[AD04]

I'm thinking of 4 main areas, all away from major cities:
- Tennessee
- Texas
- Indiana: tax rate of 3.3% is somewhat offset by low cost of living
- gulf coast (Florida / Alabama / Mississippi): This is probably the least financially viable option of the 4. Florida is a bit riskier in terms of malpractice, but doesn't have state income tax. Hopefully the risk is mitigated by being far away from South Florida. Alabama and Mississippi have a tax rate of 5%, but lower malpractice risk than Florida.

South Carolina would be awesome, but the tax rate is a bit high at 7%. Idaho's tax rate is also a bit high at 7.4%.

Something to keep in mind about your second requirement. If there's no state income tax you're likely going to be hit hard somewhere else when it comes to taxes (property, sales, etc). The tax man will get his share one way or the other.

I would rather have lower income tax and higher property / sales tax. I will make a high income. I don't have to live in a big house or buy a lot of things. Most likely, I'll rent for a few years too.

 

[trophyhusband]

I'm thinking of 4 main areas, all away from major cities:
- Tennessee
- Texas
- Indiana: tax rate of 3.3% is somewhat offset by low cost of living
- gulf coast (Florida / Alabama / Mississippi): This is probably the least financially viable option of the 4. Florida is a bit riskier in terms of malpractice, but doesn't have state income tax. Hopefully the risk is mitigated by being far away from South Florida. Alabama and Mississippi have a tax rate of 5%, but lower malpractice risk than Florida.

South Carolina would be awesome, but the tax rate is a bit high at 7%. Idaho's tax rate is also a bit high at 7.4%.



I would rather have lower income tax and higher property / sales tax. I will make a high income. I don't have to live in a big house or buy a lot of things. Most likely, I'll rent for a few years too.

Grew up in Indana and you're leaving out county income taxes which the state requires the counties to charge so they can advertise an artificially low state income tax. Still usually ends up at or below 5% but you'll want to take that into account.

I also don't know why you think you're not paying property tax when you're renting... the landlord has to pay it so you're paying it via your rent. Rental property taxes are usually higher than owner occupied taxes as well. We rent but we don't fool ourselves that we're not paying property taxes in one form or the other.

 

[WisNeuro]

Why the focus on some minutiae of state income tax? As was said in earlier statements, usually that tax is brought out in other ways (e.g., high property tax, high sales taxes, etc). Even if it didn't equal out, I'd rather pay an extra 5-10% of my income to live somewhere I thoroughly enjoy rather than someplace I'm "meh" about. Call it the "Happy Tax." I live in a state with a somewhat high state income tax and I'll still be able to retire in my 50's if I really wanted to. If you're good with your money, you can do well pretty much anywhere in the US as long as you don't live in the super expensive areas. Looking at you NYC and SF.

 

[VA Hopeful Dr]

I'm thinking of 4 main areas, all away from major cities:
- Tennessee
- Texas
- Indiana: tax rate of 3.3% is somewhat offset by low cost of living
- gulf coast (Florida / Alabama / Mississippi): This is probably the least financially viable option of the 4. Florida is a bit riskier in terms of malpractice, but doesn't have state income tax. Hopefully the risk is mitigated by being far away from South Florida. Alabama and Mississippi have a tax rate of 5%, but lower malpractice risk than Florida.

South Carolina would be awesome, but the tax rate is a bit high at 7%. Idaho's tax rate is also a bit high at 7.4%.



I would rather have lower income tax and higher property / sales tax. I will make a high income. I don't have to live in a big house or buy a lot of things. Most likely, I'll rent for a few years too.

Florida unless you have a very good reason is unwise. Malpractice is a disaster down there.

 

[Heathcliff]

Report by Medscape:

Best & Worst Places to Practice 2018

 

[WisNeuro]

Report by Medscape:

Best & Worst Places to Practice 2018

Woop, I live in one of the Top 10! Also have lived in 2 others in the Top 15. I'd generally agree, good places. Although, I don't miss the Washington weather.

 

[VA Hopeful Dr]

Report by Medscape:

Best & Worst Places to Practice 2018

That is easily the worst put together list I've seen outside advertised Facebook posts

 

[MacDonaldTriad]

It look like it is all based on pay vs COL. It has no input from weather, school systems, proximity to urban centers....

 

[VA Hopeful Dr]

It look like it is all based on pay vs COL. It has no input from weather, school systems, proximity to urban centers....

With heavy weight given to % of uninsured patients.

Heck 2 of the top 10 even say that they are burnout-heavy states...

 

[WingedOx]

Why the focus on some minutiae of state income tax? As was said in earlier statements, usually that tax is brought out in other ways (e.g., high property tax, high sales taxes, etc). Even if it didn't equal out, I'd rather pay an extra 5-10% of my income to live somewhere I thoroughly enjoy rather than someplace I'm "meh" about. Call it the "Happy Tax." I live in a state with a somewhat high state income tax and I'll still be able to retire in my 50's if I really wanted to. If you're good with your money, you can do well pretty much anywhere in the US as long as you don't live in the super expensive areas. Looking at you NYC and SF.

Yeah, seriously. I know the OP was ****ting on IL upthread, but our taxes are so regressive that you tend to come out ahead if you're a high earner. (that said, I wouldn't live in IL if I wasn't in Chicago proper)

 

[AD04]

The Medscape list is just a pile of randomness. It is definitely NOT based on pay or COL (with choices like Hawaii, California, Massachusetts, and Illinois).

This is what Medscape said about Illinois:

"Illinois physicians face more malpractices cases and their burnout rate is higher than in other states. Their compensation falls about in the middle. Illinois patients face a health care system with quality that ranks third from the bottom ... However, the tax burden is high ..."

I don't see how a state like that can make the list.

Why the focus on some minutiae of state income tax? As was said in earlier statements, usually that tax is brought out in other ways (e.g., high property tax, high sales taxes, etc). Even if it didn't equal out, I'd rather pay an extra 5-10% of my income to live somewhere I thoroughly enjoy rather than someplace I'm "meh" about. Call it the "Happy Tax." I live in a state with a somewhat high state income tax and I'll still be able to retire in my 50's if I really wanted to. If you're good with your money, you can do well pretty much anywhere in the US as long as you don't live in the super expensive areas. Looking at you NYC and SF.

Focusing on minutiae saves me five figures a year. I'm specifically focusing on income tax because it is easier for me to reduce spending than it is for me to reduce income. Anyways, high income tax states don't offer any benefits that low income tax states can't offer. On the contrary, low income tax states tend to be more gun-friendly and just so happens that many states with low income tax is in the south (warm).

I've lived in many places and I've found that I am a bit happier in warmer places or when I live right by the ocean. That is why I would consider Florida.

 

[slappy]

Focusing on minutiae saves me five figures a year. I'm specifically focusing on income tax because it is easier for me to reduce spending than it is for me to reduce income. Anyways, high income tax states don't offer any benefits that low income tax states can't offer. On the contrary, low income tax states tend to be more gun-friendly and just so happens that many states with low income tax is in the south (warm).

I'm astounded by your mastery of economics.

I've lived in many places and I've found that I am a bit happier in warmer places or when I live right by the ocean. That is why I would consider Florida.

How about moving to Mexico, and telepsychiatry?

 

[michaelrack]

I'm astounded by your mastery of economics.



How about moving to Mexico, and telepsychiatry?

TAXES would still be owed- federal income taxes (WITH a deduction for any taxes paid to Mexico) and would likely need to pay the state income tax (if any) as well

 

[michaelrack]

I would recommend living and practicing in TN, looking for a suburb of a major city that has lower property taxes than the city itself.

 

[TexasPhysician]

I would recommend living and practicing in TN, looking for a suburb of a major city that has lower property taxes than the city itself.

And there is likely a opening to gain patients as 1 psychiatrist is likely to lose her license in Memphis.

 

[WingedOx]

I don't see how a state like that can make the list.

It's almost as if making these comparisons based on state instead of metro is kinda dumb...

 

[whopper]

A bonus of working where there's a shortage of psychiatrist is the money.

A disadvantage is the lack of mental health infrastucture and seeing people suffer while you have little to refer them towards other than yourself.

 

[AD04]

I'm astounded by your mastery of economics.

How about moving to Mexico, and telepsychiatry?

I like the way you think. Telepsychiatry from abroad is something I've considered. If the logistics and financials make sense, it is certainly an option. From what I understand, those opportunities pay quite a bit less.

 

[Ahamis]

I'm astounded by your mastery of economics.



How about moving to Mexico, and telepsychiatry?

I thought you couldn't provide telephsychiatry service while living outside the USA.

 

[littlefred]

I thought you couldn't provide telephsychiatry service while living outside the USA.

I think some states allow it, maybe some psychiatrists living abroad and doing telepsych can elaborate.

 

[J ROD]

Stay out of SC.....full of rednecks and such......

 

[VA Hopeful Dr]

Stay out of SC.....full of rednecks and such......

You know what's funny, our newest general surgeon moved here from San Diego. He was able to get married here and has had less trouble being openly gay here than he did there.

We've got the only black Republican in the Senate, and the Upstate just re-elected the first openly gay state representative.

But what do I know.

 

[J ROD]

You know what's funny, our newest general surgeon moved here from San Diego. He was able to get married here and has had less trouble being openly gay here than he did there.

We've got the only black Republican in the Senate, and the Upstate just re-elected the first openly gay state representative.

But what do I know.