North Dakota ranks first in Medscape's annual list of the best places to practice medicine in the United States, which this year focused on measuring "happiness in work and home life."

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Methods

For the list, Medscape compiled data from sources including its own Physician Compensation Report, CDC, Gallup, Wallethub, and others.

Medscape considered eight factors related to physician work life, including a state's:

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• Percentage of adults and children who go without medical care, as measured by U.S. News & World Report's Best States report;
• Physician burnout rate, as measured by Medscape's 2018 National Physician Burnout and Depression Report;
• Average physician compensation, as measured by Medscape's 2017 Compensation Report;
• Health care quality, as measured by U.S. News' Best States report;
• Malpractice rates, based on data from the National Practitioner Data Bank;
• Physician happiness at work, as measured by Medscape's 2018 Lifestyle and Happiness Report;
• Performance on public health measures, such as obesity, smoking, suicide, and mortality rates, as measured by U.S. News' Best States report; and
• Uninsured rates, as measured by the Kaiser Family Foundation.

Medscape also considered seven factors related to physician life outside of work, including a state's:

• Higher-educational levels;
• Average lifespan;
• Physician happiness outside of the workplace;
• Median earnings;
• Tax burden;
• Unemployment rates; and
• Provider well-being.

Rankings

According to Medscape, the 10 best states to practice medicine are:

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1. North Dakota;
2. Hawaii;
3. Nebraska;
4. Vermont;
5. Iowa;
6. New Hampshire;
7. Colorado;
8. Minnesota;
9. Utah;
10. Connecticut.

Medscape's Carol Peckham writes that physicians in North Dakota are highly paid and have some of the lowest burnout and malpractice rates in the country. In addition, the state ranks in seventh place in health care quality and has an uninsured rate of just 8%. North Dakota also ranks eighth in the United States in longevity, with an average life expectancy of 79.5 years, and is one of the 20 best states for higher education, median earnings, and low tax rates, Peckham writes.

Meanwhile, according to Medscape, the five worst states to practice medicine in are:

1. West Virginia;
2. Louisiana;
3. Mississippi;
4. Kentucky; and
5. New Mexico.

While West Virginia has low burnout rates, Peckham writes that physician compensation is far lower and malpractice rates are far higher than in most other states, while the state also struggles on public health measures (Peckham, Medscape, 5/2; Knowles, Becker's Hospital Review, 5/2).

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