Best and worst states to practice in 2015

Medscape recently released its annual list of the best and worst places to practice in the United States.

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States are ranked according to several factors like cost-of-living, malpractice payouts per capita, overall state and local tax burden, and physician compensation. Medscape also asked their readers for their opinions and reviewed responses from the Physicians Foundation’s 2014 survey.

Related: Best and worst states to practice 2014

But what makes a state great for MDs doesn’t always translate for ODs, of course. So, we asked ODs across the country about what makes their state a great place to practice optometry. Did your state make the list?

Click here to check out the best places to practice

Click here to check out the worst places to practice 

25. Virginia

Rounding out the best list at 25 is Virginia. While it has the lowest average physician compensation of any state on this list at $251,000, Virginia does offer a reasonable cost of living, especially compared to its neighbors, Maryland and Delaware. It also has low malpractice payouts per capita.

If you’re considering Virginia, check out the city of Richmond, which is growing at a rate twice that of the U.S. as a whole. Richmond is home to six Fortune 500 companies and the city has targeted health and life sciences as an area for growth.

24. Colorado

Colorado is a mix of pros and cons financially. The tax burden and malpractice payout are below the national average. Median household income is above the national average. Physician compensation is close to the national average. But thanks to relatively expensive housing, Colorado’s cost of living is slightly above the national average.

"We've got a vibrant economy, a low unemployment, so everybody is pretty happy," says Bob Prouty, OD, FAAO, who practices in Centennial. "We're also almost always one of the healthiest, leanest states every year. Everybody is pretty healthy and health-conscious." 

And like many of its peers on the best list, Colorado is one big outdoor playground with some of the best skiing, hiking, and mountain biking in the country.

Medscape recommends Denver thanks to its low unemployment and diversified economy.

"I think it's a good state for optometry, too," says Dr. Prouty. "There is a healthy relationship between optometry and ophthalmology here. And optometry is well respected in the medical force." 

23. Michigan

While the recession hit Detroit hard, many other areas of Michigan, like Ann Arbor and Grand Rapids, are thriving. Michigan has the seventh lowest cost of living in the country, and malpractice payouts are low here. Michigan is also home to plenty of universities and medical schools.

“Michigan is a great state in which to practice optometry and raise a family,” says Michigan Optometric Association (MOA) President Paul Anton Hodge, OD, FAAO. “Michigan offers a low cost of living, wonderful outdoor recreational activities, entertainment options, breweries, wineries, and cultural opportunities across the state. Michigan has one optometry college, The Michigan College of Optometry at Ferris State University in Big Rapids, Michigan with an annual class size of 38.” 

Dr. Hodge says Michigan ODs are fortunate that the MOA is a strong affiliate of the American Optometric Association (AOA) and serves to advance and support optometry in serving Michigan's eyecare needs.

For the single doc, Medscape recommends Ann Arbor for its college town atmosphere, sports, entertainment, and restaurants. Got a family? Medscape recommends Grand Rapids.

22. North Carolina

Medscape says North Carolina has a something for everyone-mountains and beaches, professional and college sports teams, and a number of medical schools, research hospitals, and plenty of community hospitals. Cost of living is 3.5 percent below average, and average physician compensation is $269,000.

Not only is it a beautiful state, but Optometry Times Editorial Advisory Board member Crystal Brimer, OD, FAAO, says North Carolina is a fabulous place to practice-so much so that she can’t imagine practicing anywhere else.

“We have really, really good therapeutic laws and privileges here,” says Dr. Brimer, who practices in Wilmington. “It’s also very difficult to pass boards here, so we have doctors who are very proud. They’re high caliber, and they try to keep up in the latest in patient care and equipment, partially because of where they practice.”

Due to the difficulty of the board exams, Dr. Brimer says, there is not an oversupply of optometrists in the state.

“Once you’ve passed the boards, it’s easy to find a job. This is not the kind of place where there are ODs on every corner,” she says. “And to a certain extent, it’s protected us from commercial places coming in, at least in a high volume.”

Dr. Brimer says North Carolina also offers first-class medical facilities throughout the state. 

Medscape recommends a number of cities, including Raleigh, Durham, Chapel Hill, Greensboro, Winston-Salem, and High Point.

21. Arizona

Overall, Arizona doesn’t have the best financial situation for doctors, but setting up a practice in an underserved community can lead to a big payoff, according to Medscape.

Scottsdale makes the list as the best place to practice due to its low state and property taxes, low cost of living, abundant sunshine, and a high population of seniors who need healthcare.

20. Montana

While physician compensation and cost of living plant Montana very close to the national average, what sets the state apart is the quality of life and beautiful scenery. Montana offers pretty much any outdoor activity you could imagine, and that helps make Montana a very healthy state with low rates of smoking, obesity, and physical inactivity.

“We have an excellent scope of practice law, combined with a rural setting,” says Carl Roth, OD, FAAO, who practices in Bozeman. “This allows for full-scope practice with an excellent relationship with primary care physicians and ophthalmologists alike.

“As a small state, the sense of camaraderie in our state association is outstanding. The cliché holds true: Montana is a small town with long roads-colleagues are considered friends not competition. It is a great place to practice,” he says.

Real estate in college towns like Bozeman can be pricey, but Medscape says its easy access to ski resorts and Yellowstone National Park make it worth it.

“Montana routinely comes in the top ten places to live when considering outdoor recreational opportunities-just Google Missoula or Bozeman, and you will see a laundry list of why they are great places to live. And I feel the rest of the towns in Montana are not second best to these two towns, they just don't get the publicity,” says Dr. Roth.

“Regardless of metrics, quality of life index is an individual thing. Montana is a rural state-to love Montana is to love a rural way of life,” he says. “Small towns with big hearts.”

19. Louisiana

According to Medscape, Louisiana is an underserved state, so it recruits aggressively and pays its physicians well. Louisiana also made the list for its many independent practices, booming suburbs, and reliable Medicaid and Medicare reimbursements.

One of those booming suburbs in Prairieville, located 30 minutes south of Baton Rouge. Prairieville’s population has grown 60 percent over the last 15 years, thanks in part to its great public schools and low crime.

“We believe Louisiana is one of the best states to practice in due to having one of the three best laws in the U.S.,” says Optometry Association of Louisiana Executive Director James Sandefur, OD. “We can do laser and lid surgeries as well as prescribe all oral and topical medications to treat eye disease. Optometrists can practice to the full extent of their education and training here.”

Dr. Sandefur says Louisiana is an underserved state, which means a good supply of patients. He also says the state has a good third-party law which allows ODs to be reimbursed by insurers. 

18. Kansas

Medscape calls Kansas a well-kept secret. Its cost of living is eight percent below the national average, while malpractice payouts are about 30 percent lower. The state has made aggressive efforts to attract doctors to its rural, underserved communities, but now cities like Wichita are in need of healthcare providers-which is why Wichita made the list as Medscape’s recommended city.

Optometry Times Editorial Advisory Board member Jeffry Gerson, OD, FAAO, who practices in Shawnee, says Kansas is also a good place to practice for ODs. Kansas offers ODs a good scope of practice, generally good relationships with MDs, rural, urban, and suburban opportunities, and a relatively low cost of live, says Dr. Gerson.

17. Minnesota

Minnesota has a respectable showing, coming in at number 17. The state has an average physician compensation of $288,000 and a progressive healthcare community.

Minnesota isn’t just a good place for physicians. The state has strong schools, low unemployment, high average life expectancy, and lots of outdoor recreation.

"One of the benefits to practicing in Minnesota is actually the relationship with medical insurance carriers," says Viktoria Davis, OD, who practices in Madelia. "We have had Any Willing Provider laws for many years, so we as ODs don't find ourselves locked out of medical plans. In addition, most medical plans include a routine eye exam as a preventative health benefit-not subject to copays or deductibles. This means that most patients can obtain a comprehensive exam at no charge to them. And reimbursement is from major medical carriers, which usually pay well." 

Medscape recommends Minneapolis-and for a good reason. Forbes also ranked the city on its Best Places for Business and Careers. Big-name companies like Target, General Mills, and Best Buy all make Minneapolis their home.

"In addition, there is the traditional 'Minnesota Nice.' The people are, in general, nicer-or at least less aggressive-than you may find elsewhere. Even disgruntled patients are not going to be disruptive or angry," says Dr. Davis. 

16. Georgia

Not only does Georgia offer its doctors an affordable lifestyle, healthy compensation, and reasonable taxes, it also has plenty of outdoor recreational activities for the active doctor to enjoy.

Optometry Times Editorial Advisory Board member Michael Rothschild, OD, says Georgia is a great place to practice optometry, as well. 

“While most of the doctors getting out of optometry school seem to gravitate into the big cites, the rural areas are all in need of optometric support,” says Dr. Rothschild, who practices in Carrollton. “Any optometrist wishing to live outside the big city will have multiple opportunities to become involved in a private practice that could grow into a partnership opportunity. Practices can still be started from scratch in these communities and do very well.”

Dr. Rothschild also speaks highly of the Georgia Optometric Association (GOA).

“The GOA is a very strong association that is supportive of all modes of optometric practice. There is an overall sense that we all look out for each other,” he says.   

Best place to practice in Georgia? Medscape recommends Suwanee, a northwestern suburb that is a great place to raise kids.

15. Iowa

Iowa comes in on the best list thanks to its overall healthy population, which boasts an above-average life expectancy and high school graduation and below-average smoking and obesity rates.

And it looks like things are going pretty well for the state’s physicians, too. Average physician compensation is five percent above the national average, while the cost of living is 7.4 percent below the national average and the tax burden is 10.2 percent below the national average.

Medscape recommends the city of Ames, which also ranked on Money’s Best Places to Live 2014, coming in at number eight. The city has a median family income of $77,000 and a median home price of under $146,000, and it is home to Iowa State University.

14. Missouri

The Show-Me State shows up in the number 14 spot. Even though physician compensation is four percent lower in Missouri than the national average, cost of living is about seven percent lower than the national. Low malpractice claim payouts-which sit at about half the national average-also help doctors in Missouri live comfortably.

The state’s underserved areas are desperate for doctors. Last year, the state passed a new law that allows recent medical school graduates to practice primary care in underserved areas without completing a residency in a teaching hospital.

Medscape recommends St. Louis, not only for its art and cultural opportunities, but also for its thriving healthcare community.

“As far as practicing optometry in the state of Missouri goes, there are ample opportunities to practice in rural areas of the state,” says Missouri Optometric Association Executive Director Lee Ann Barret, OD. “St. Louis is saturated because of the presence of UMSL-College of Optometry.”

13. Indiana

Medscape says Indiana is the best for Midwest livability and stability, with the cost of living nearly 10 percent lower than the national average, strong schools, and a variety of professional and college sports teams. Physician compensation is nearly six percent higher than the national average at $286,000, and the state was a pioneer in tort reform. 

Indianapolis has a lot of urban amenities, but the city has a short mean commute of less than 23 minutes and median home price of $118,000-a third less than the national average. The city is also home to pharmaceutical company Eli Lilly and insurance company Anthem.

12. Kentucky

Medscape says that despite often being overlooked as a practice location, Kentucky offers low cost of living and above-average physician compensation at $277,000, in addition to a variety of outdoor recreational activities.

But with the highest smoking rate in the country and obesity affecting a third of the adult population, Kentucky also has some serious health challenges.

Optometry Times Editorial Advisory Board member Ben Gaddie, OD, FAAO, who practices in Louisville, says Kentucky offers excellent scope of practice for ODs and good laws regarding OD inclusion in insurance panels.

The mid-sized, college town of Lexington made the list as Medscape’s recommended city.

11. Alabama

Medscape compares Alabama to South Carolina in that while it does not stand out in any particular category, the state has a strong performance overall. Alabama has a relatively low cost of living and tax burden. The per capita malpractice payout is below the national average, while the average physician compensation is just below the national average.

The recommended city of Birmingham will come to no surprise to most ODs because the city is home to the University of Alabama at Birmingham College of Optometry. Alabama is also home to Optometry Times Chief Optometric Editor Ernie Bowling, OD, FAAO, who practices in Gadsden.

“Alabama is a great place to practice,” he says. “I’ve been here five years, and I enjoy it tremendously-great optometric scope of practice, which allows for a range of care for my patients, and good working relationships with the ophthalmologists and general physicians I work with. Cost of living is low, and I live on the lake, so you’re not going to hear anything bad from me about quality of life.

“If there is one drawback, it is there is no shortage of ODs in Alabama,” says Dr. Bowling. “UAB School of Optometry is but 60 miles away, and it seems every year the new graduates like to hang around Alabama, again because to quality of life is so great, which makes for stiff competition for the eyecare dollar.”

10. Alaska

While cost of living can be high, Alaska rounds out the top 10 thanks to the fact that it does not charge an income tax, and its average physician compensation at $330,000 is nearly $50,000 above the national average. The state also offers an adventurous lifestyle and beautiful landscapes.

In Alaska, Medscape recommends the tight-knight community of Valdez, a small town that offers a variety of outdoor activities.

9. Nebraska

Nebraska has a variety factors that help the state rank high: cost of living well below the national average, low malpractice payouts, plenty of physician support, and a healthy population. In addition to being a healthy state, Nebraska is also a wealthy state with strong shale, agriculture, and telecommunication industries.

Best place to practice in Nebraska? Medscape says Omaha is a great choice due to its great schools, low crime rate, family-friendly amenities, low unemployment, and median income above the state average.

8. New Hampshire

While many of the other New England states suffer from a combination of high cost of living and high taxes, New Hampshire offers low taxes and an average physician compensation of $300,000.

The New Hampshire healthcare community has been quick to adapt to new developments in the healthcare marketplace, with nearly half of physicians in the state telling the Physicians Foundation survey that they participate in accountable care organizations (ACOs). New Hampshire also has one of the highest enrollment rates in its federal-run insurance marketplace. New Hampshire residents also rank number seven in overall health in the United Health Foundation state ranking.

Medscape says the Manchester-Nashua metropolitan area is a great place to consider, where nearly one third of the state’s population is located. The cities have strong ties to Boston, which is located just an hour away, but it is more affordable than the big city. Residents in this area of the state tend to be younger, more educated, and have a higher per capita income than the northern part of the state, Medscape says.

7. South Carolina

Medscape says the Palmetto State came in above average in all of the categories it considered, and South Carolina also offers a warm climate, hospitable people, several museums, and a good practice environment.

South Carolina’s capital, Columbia, is Medscape’s recommended city. Columbia is home to several museums and the University of South Carolina. For outdoor offerings, the city is just half an hour from Lake Murray and two hours from the beach.

“Practicing in South Carolina comes with many highs, and a few lows,” says Walter Mayo, OD, who practices in Georgetown. “The economy is vibrant in some areas, particularly in the tourism-driven coast, the Upstate, and some areas of the Midlands. Many rural areas are not so well off economically. Despite this, the wonderful people, and outstanding climate make for a great environment to live and work. Our excellent practice law is like icing on the cake.”

6. Idaho

Idaho offers a number of financial incentives for doctors, including an average physician compensation of $276,000, very low cost of living, moderate malpractice payouts, and an average tax burden.

Idaho is also a paradise for any doctor who likes to spend his free time in the outdoors, with plenty of year-round recreational activities. And for these active doctors, Medscape recommends Boise, which boasts low housing costs, plenty of outdoor activities, and an active nightlife.

5. Wyoming

Like Texas, Wyoming doesn’t have a state income tax, and its average physician compensation rate is $312,000. Managed care doesn’t have a presence in the state, so providers continue to practice a fee-for-service model. Medscape says the state benefits from a strong payer mix and financially stable, largely community-owned, healthcare organizations.

But with only 1,118 active physicians in the whole state, the Physicians Foundation 2014 Survey found that 97 percent say they are at capacity or overextended.

Medscape recommends Casper, which recently ranked as number 50 on Money’s Best Places to Live in America 2014. This growing small town offers big-city amenities like a symphony and a planetarium. 

4. Texas

Some of the reasons Texas landed at the number four spot include the fact that it has no state income tax, along with an excellent medical community, fewer malpractice lawsuits, and a variety of cities and geographies. The state also has a number of high-profile health systems and teaching institutions.

But, as we said earlier, what's good for MDs doesn't always translate for ODs. 

“Texas is a real mixed bag,” says Steve Nelson, OD, who practices in Portland. “Much of what makes practicing here enjoyable has more to do with living in Texas than practicing optometry, but lifestyle counts. We enjoy good reimbursement, particularly with Medicaid where even a routine exam reimburses $65 and 92004 brings in about $119. We have a fair access to medical plans, but we've also had some issues with the limitation of optometrists being forced into paired vision plans. We also have a reasonable cost of living in most of the state and there are many rural areas where someone can do well, not to mention that it's a beautiful place to live with a diverse geography."

Medscape recommends the city of Tyler, which offers the amenities and medical community of a much larger city.

"The ‘hot spots’ are extremely overpopulated with ODs leading to really low private pay advertised exams," says Dr. Nelson. "That can be a difficult thing to overcome if you don't have an established practice and with not one but two optometry schools pumping out new grads, I fear that will only get worse because Texas is such a nice place to live, those new grads won't leave. 

"We also suffer from being 47th in terms of scope, which only matters if you want to practice full-scope. Advocacy can also be extremely frustrating because of an extremely well-organized and funded medical association that fights us at every turn," he says. 

3. Oklahoma

Oklahoma offers a low average state and local tax burden at 8.5 percent-well below the national average of 9.8 percent. Physicians also reported a high average income of $304,000.

But Medscape says physicians here may have some trouble finding enough staff support because Oklahoma has only 746 nurses per 100,000 patients, which ranks the state about 15 percent below the national average.

Medscape recommends Tulsa because it is home to both OSU-Tulsa and the University of Tulsa. The city also boasts an active arts community.

2. Mississippi

Mississippi comes in at number two on the best states to practice. Medscape says the state has a respectable average physician compensation of $275,000. It also has relatively low taxes and malpractice payouts. Those factors-combined with an extremely low cost of living-means doctors here can live far more comfortably than their peers on the East Coast.

Senator David Parker, OD, says he’s not surprised that Mississippi ranked high on the list because Optometry Times’ sister publication Physician’s Practice recently ranked the state as the number-one place to practice for the second year in a row.

“Being a more rural state has allowed full scope practice for ODs for many years,” says Dr. Parker, who practices in Olive Branch. “In most areas, this has led to strong collaborative relationships with both the MDs and OMDs in surrounding areas.”  

Dr. Parker says that the state’s very low cost of living has lead companies to relocate to the state. It also allows doctors to live a more comfortable lifestyle and have less financial stress in the long run.

“Our small communities allow for strong personal relationships with our patients and friends,” says Dr. Parker. “There is very little patient turnover, leading to a more consistent patient flow and avenues for retirement.”

Medscape recommends the city of Oxford, a small city that is home to Ole Miss and offers a variety of cultural activities.

1. Tennessee

The Volunteer State ranks as the best place in the United States to practice, in part because Tennessee has the second lowest cost of living in the country and a tax burden of 7.6 percent.

The state’s per capita malpractice payout is $8.96, while the average physician compensation is $279,000. Other reasons Tennessee ranks high are its progressive communities and music and attractions.

Medscape says Nashville is highly saturated with doctors but recommends nearby Franklin and Murfeesboro, which both offer economically progressive communities, excellent schools, and good hospital systems.

“I moved to Tennessee over eight years ago and was happy to have an increased scope of practice in which I could prescribe oral medications and even perform basic lid procedures,” says Optometry Times Editorial Advisory Board member Marc Taub, OD, MS, FAAO, FCOVD, chief of vision therapy and rehabilitation at The Eye Center at  Southern College of Optometry in Memphis. “Tennessee has so much to offer, and there are so many different regions. There are so many different climates and terrains that it makes visiting so much fun. Add to that the low cost of living, major sports teams, and access to nature!”

Click here to check out the worst places to practice

Worst places to practice

The East Coast dominates Medscape’s list of worst places to practice-but is it as bad for ODs as it seems to be for MDs? We asked, and here’s what East Coast ODs had to say.

5. Connecticut

By now, you’ve probably guessed why Connecticut made it on the worst list-high cost of living and low average compensation. To say the cost of living is high in Connecticut is a bit of an understatement-it’s more than 45 percent higher than the national average.

The Physicians Foundation found Connecticut doctors have the lowest morale of physicians in any of the Northeastern states.

And Medscape says to stay away from Hartford because of its high crime, low job creation, and the fact that one third of its residents live below the poverty line.

4. Massachusetts

While the state is home to some of the best medical facilities and institutions in the world, Massachusetts landed on the worst list thanks to its high taxes, high cost of living, high housing costs, and an average physician compensation that is $23,000 below the national average.

Avoid Chelsea, the city located across the Mystic River from Boston, says Medscape. It’s struggling with a heroin epidemic and overtaxed schools.

3. Maryland

Medscape says doctors in Maryland-particularly those near Washington, D.C.-suffer from the same problems of many in and around East Coast metro areas: too many physicians and high cost of living. The state economy is slow to grow, but the good news is that the health services sector is the strongest industry sector in Maryland.

"Practicing in Maryland is challenging because, first, ODs can participate on HMO panels and, second, we have very restricted therapeutic laws," says Alan Glazier, OD, who practices in Rockville. "As far as competition, it's heavy, but I don't think particularly heavier than most metropolitan areas. We are faced with similar challenges otherwise, but the therapeutic law is our biggest handicap." 

Medscape says to avoid Baltimore, which ranks as the 40^th most violent city in the world. The city’s population is dwindling, and it’s known for its long commutes.

2. Rhode Island

High physician density combined with low average compensation (20 percent below the national average-whoa!), high cost of living, and high taxes are the reasons Rhode Island lands high on the list of worst places to practice.

And the state is suffering economically thanks to a stagnant population and out-migration of talent. Medscape particularly advises against the city of Providence-and with good reason. The city ranked among the worst for job creation according to a recent survey from Gallup. Another reason to stay away? Thumbtack recently gave Providence a failing grade for its overall friendliness toward small businesses.

1. New York

New York-specifically the city that never sleeps, New York City-ranked as the worst place to practice in the United States.

Physician compensation in New York is more than $22,000 below the national average at $249,000. And New York is notorious for its astronomical cost of living.

And it doesn’t get much better from there. High taxes, exorbitant medical liability, government mandates, and high physician density in the metropolitan areas make New York a bit of a nightmare for doctors.

“The article is spot on,” says Optometry Times Editorial Advisory Board member Justin Bazan, OD, who practices in Brooklyn. “Salaries here are similar as to what ODs in other major cities make, but the cost of living in NYC is insane. If you are looking to save money, NYC is not the place to do so for most ODs. It’s a city where you spend it almost as fast as you make it. The lure of NYC is that there is always something amazing to do-just be prepared to pay a hefty price for it, literally.”

What do you think of the rankings? Were there any that surprised you? Where would you rank your state on a list of best places to practice for ODs? Tell us in the comment section! 

Click here to check out last year’s list of best and worst places to practice