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Best and worst states for doctors: Where did your state land?

DOs in “best” and “worst” states weigh in on Medscape’s recent Best and Worst Places to Practice report.


As dean of the new Burrell College of Osteopathic Medicine (BCOM) in Las Cruces, New Mexico, George Mychaskiw, DO, has big plans to improve the health care landscape in the Land of Enchantment.

Dr. Mychaskiw is committed to serving New Mexico’s underserved populations despite the fact that the state recently landed the No. 1 “worst” slot on Medscape’s annual Best and Worst Places to Practice report. The news website analyzed cost-of-living, malpractice payouts and physician density figures for all 50 states and individual markets to make its rankings.

Below, DOs in a few of Medscape’s “worst” states discuss their efforts to improve the health care climate in a challenging environment, and DOs in two of the report’s “best” states share why they were drawn to the opportunities there.

New Mexico

Above-average unemployment and large Medicaid deficits are among the drawbacks to practicing in New Mexico, according to Medscape. Nevertheless, Dr. Mychaskiw, who is also a practicing physician, says he felt called to provide help where it’s greatly needed.

George Mychaskiw, DO

Long before BCOM’s first lecture occurs this August, he has been busy establishing residency training programs in areas of the state that desperately need doctors.

“Our goal is to have practicing physician graduates in every county in New Mexico,” he says.

West Virginia

The Mountain State, which ranked second on Medscape’s worst places to practice, is plagued by poverty and low well-being scores, according to Medscape’s report. For the past 40 years, the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg has been producing DOs committed to helping improve health outcomes in the state, including its rural areas.

While all WVSOM students complete at least three rural/underserved rotations, students who participate in the school’s Rural Health Initiative gain additional exposure to rural medicine through various activities, including a four-week wilderness medicine rotation.

“When you practice in a rural area, you have a little more responsibility because you’re working farther away from hospitals and specialists. Working in rural and underserved areas in medical school helps students be prepared for these challenges,” says WVSOM dean Craig Boisvert, DO.

In the 28 years Dr. Boisvert has worked there, WVSOM has developed several programs, including the Rural Health Initiative, to encourage students to practice medicine in West Virginia.

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North Carolina

A family vacation prompted Tiffany Lowe-Payne, DO, to relocate six years ago from New Jersey to North Carolina, which Medscape ranked the best state to practice for its six research hospitals and 100 community hospitals.

“I was pleasantly surprised how progressive the area is in terms of medical research,” says Dr. Lowe-Payne, a family physician in Raleigh, North Carolina. She practices near North Carolina’s research triangle, which is flanked by North Carolina State University, Duke University and the University of North Carolina at Chapel Hill.


Medscape ranked Texas the second-best state to practice due to its business-friendly environment with a growing population of young professionals—the same reasons that led internist Omesh Singh, DO, to return home to Texas after he graduated from medical school in Florida.

Omesh Singh, DO

“The suburbs in the Dallas-Fort Worth area continue to expand, bringing opportunities for new physicians that might not exist in more established areas like New York or Chicago,” says Dr. Singh, who practices in Fort Worth.

When speaking with colleagues contemplating the move to Texas, Dr. Singh says they are attracted by the state’s low cost of living, lack of a state income tax and the high demand for physicians to keep pace with the growing population.


  1. Paul Nielsen

    There are no “good” places left for doctors. We’ve been sold out by both the AMA and the AOA. I advise every student who rotates with me to change professions.

    1. Florida DO

      I feel sorry for Dr Nielson. In fact he shouldn’t be afforded the privilege of having students. We are supposed to be role models, mentors. Sour, disgusted, and fatigued doctors impart those feelings to students. I am sure thats just what a second or third year wants to hear while pulling all nighters to study for exams, “hey kid its not worth it”. perhaps Dr Nielson needs to change his venue of practice. Try a migrant and community health center, center for the homeless, Indian reservation, health department, medical school. Sure you may not make as much, but the lack of employee staffing, malpractice, and a defined salary, benefits may light your candles again.

      1. Roberto

        Florida DO, so what you are saying is that mentors need to be deceptive to medical students? The truth is most physicians are unhappy with medicine as a career. Premed and medical students need to be aware of what they are getting themselves into.

    2. Proud to be a DO preceptor!

      Ridiculous comment from Nielson. Do us all a favor and refuse to take students as a preceptor. You don’t know how.

    3. Ira B. Azneer,D.O.,FACOI

      I appreciate your feelings but truly if you are so jaded don’t teach. The world has changed and expectations have as well. We may not see the monetary rewards of the past but this new generation will still be well paid employees. As physicians, we should not discourage our successors but rather encourage them to practice responsively and respectfully.

    4. Roberto

      I totally agree with Dr Nielsen. Medicine as a career is the pits. The AOA and AMA have completely sold us out. Long hours, little pay, more and more demanding patients, paperwork, computer hassles, and the risk of a lawsuit make this profession as one of the least liked profession there is.

  2. Justice

    Article says worst but doesn’t say why. by hypothesise are these
    From Southern WV. WVSOM grad; part of the rural initiative, as a student. Goal was to work rural med, allopathic residency at an in state 900 bed hospital system. Education was good.

    Problem #1 State gov
    State gov. Is often misdirecting, occasionally lying. gave me $50k loan repayment, said it was forgiven debt over 3 years. Instead claimed regular income 1099 misc instead of forgiven debt 1099c. Owed 23k in taxes that year.
    Mostly Medicaid patients so pay was 110k government clinic, told I could get a bonus but no one would tell how. Wanted to do rural medicine but with irs payments and $1300 student loans, making 20k less than my classmates wasn’t acceptable.
    Government has extra hidden fees. Legislature uses 2-3 expert opinions to make policy, and law, without any quantifiable medical evidence for support.
    Malpractice is still screwed up but better with new law changes made a few years ago.
    Many practices have mostly Medicaid, overbearing beurocratic paperwork, pre-authorizations are a super pain. Medicaid pay for services is often less than 75% Medicare. Then in order to be paid an abysmal amount you have to return a percentage as a vague fee to be allowed to see these patients.
    Ever 2 or three years, Medicaid delays payments for several months while the legislature fights about budgets.

    Problem 2 -patients
    The good: Most of the older patients are polite attentive and the few uneducated ones want to be taught, you can make a difference.
    The bad: many of the younger expect a certain thing. “I came in with a chest cold and I need cxr, codeine, prednisone, diflucan, and clindamycin.” ; “But this is allergies with cough from drainage” ; “you only treat me this way because I have the medical card, I’ll go to the next urgent care and you won’t get my money anymore”

    Problem three not as bad but still the osteopathic board. Very slow to respond to complaints. To many rule differences between the boards. Very slow to accept modern cme methods

    Problem 4 living conditions
    Poor education, high personal property taxes, higher home, auto and malpractice rates than neighboring states.

    The good
    Overall the people are great, friendly, help you if you need it, the land is beautiful and a long weekend get away is often Less than 3-4 hour drive. To beautiful back country or a decent city.
    I still work in West Virginia; took a job where I do not deal with Medicaid. I live in Ohio; can see my home state from my porch but great schools, somewhat improved government and lower cost of living made me a buckeye. Still love the state and do some volunteer work for rural areas but I can’t go back to full on rural medicine or live in WV

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