WalletHub on Monday released its 2021 ranking of the "Best & Worst States for Doctors," which ranks all 50 states and Washington, D.C. on factors such as average annual wage and quality of public hospital systems.

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About the list

WalletHub ranked the 50 states and Washington, D.C., based on 19 weighted metrics grouped into two categories: "Opportunity and Competition," worth up to 70 points, and "Medical Environment," worth up to 30 points.

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The Opportunity and Competition category consisted of 11 weighted metrics, including:

• Average annual wage (11.67 points);
• Average monthly starting salary (5.83 points);
• Hospitals per capita (5.83 points); and
• Insured population rate (5.83 points).

The Medical Environment category consisted of eight metrics each weighted 3.75 points, including:

• Quality of public hospital systems;
• Presence of nationally accredited health departments; and
• Punitiveness of state medical boards.

Each metric was scored on a 0 to 100-point scale, with 0 representing the least favorable conditions for a provider. WalletHub then used those scores to calculate each state's weighted average across all metrics and determine a final score.

While WalletHub did not alter its methodology from last year's list, the organization included a Q&A section for experts that featured questions about key issues for physicians amid the pandemic.

The best and worst states for doctors

WalletHub ranked Montana as the No. 1 state in which to practice medicine, followed by:

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2. Minnesota;
3. Idaho;
4. Wisconsin;
5. Kansas;
6. Tennessee;
7. North Dakota;
8. Nebraska;
9. Mississippi; and
10. Iowa.

The 10 lowest-ranked states in which to practice medicine, according to WalletHub, were:

51. Rhode Island;
52. Alaska;
53. New York;
54. District of Columbia;
55. New Jersey;
56. Massachusetts;
57. Delaware;
58. Connecticut;
59. Hawaii; and
60. New Hampshire.

WalletHub also released states' rankings on several individual metrics. For instance, Mississippi ranked first for average annual wage for physicians (adjusted for cost of living), while Washington, D.C., ranked last on that metric.

Massachusetts had the most punitive state medical board, while Delaware had the least punitive, according to WalletHub. Meanwhile, WalletHub found that annual malpractice liability insurance cost the least in New York and the most in Nebraska.

Challenges for providers amid Covid-19

This year, WalletHub in its "Ask the Experts" section on the rankings included a question about the "biggest issues facing doctors during the pandemic."

Several experts gave their thoughts, including Don Brady, interim chair of health care administration at Methodist University's School of Health Science, who said the biggest issue was"[s]erving the patients," and Leonard Nelson, a professor at the University of Alabama at Birmingham, Albany Medical College, and Samford University's Cumberland School of Law, who said providers during the pandemic had "to protect themselves from [contracting] Covid-19," including by screening patients and using telehealth when appropriate.

Chunhuei Chi, director of the Center for Global Health at the College of Public Health & Human Sciences at Oregon State University, added that other issues for doctors amid the pandemic include the "ability of the state/county to contain the spread of Covid-19 in the community," as well as the overall "[v]accination rate of the population" (Kiernan, WalletHub, 3/22; Ellison, Becker's Hospital Review, 3/23).