Doctors’ Dilemma: Finding the Ideal State with a Healthy Salary

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Doctors and PAs face a significant dilemma when choosing which state to set up their medical practice in. They aim to find a location that offers an optimal blend of a high physician salary to compensate for their expertise, as well as a positive practice environment and lifestyle perks to make the hectic career sustainable in the long term. However, these two critical factors – high compensation and good quality of life – often compete against each other, forcing doctors to make tradeoffs and prioritize either earning potential or daily enjoyment when selecting a home base.

This decision holds extra weight as physicians must recoup the costs of their intensive medical training while also planning where to launch a career that will span decades. Meanwhile, the healthcare landscape can vary widely between states – from salary ranges to cost of living adjustments to culture fit. This multi-layered analysis aims to dive deep into weighing earning potential against lifestyle, taxes, and practice environment factors across states.

Highest Salaries Adjusted for Cost of Living

While a high nominal salary seems attractive, doctors must consider the cost of living to determine real purchasing power. For example, California offers some of the highest average physician salaries, but the state also carries one of the highest costs of living. Adjusted for cost of living, the top 5 highest paying states are:

  1. North Dakota
  2. Wisconsin
  3. South Dakota
  4. Nebraska
  5. Virginia

These Midwest and Southern states combine strong compensation with affordable housing and tax rates. The tradeoff is usually a smaller city setting and potentially fewer cultural amenities.

Most Physician Assistant Friendly States

For physician assistants (PAs), salary also depends heavily on location. The top 5 PA salary states are:

  1. California – $120,960
  2. Nevada – $120,370
  3. Washington – $118,960
  4. Alaska – $118,050
  5. Texas – $117,060

For a PA salary by state, California and Texas lead with the highest nominal PA wages, but have high taxes and costs of living. Alaska and Washington have no state income tax and opportunities to serve underserved communities with loan forgiveness programs. Ultimately PAs must weigh earning potential against other lifestyle factors when choosing a home state.

Best Combination of Salary and Lifestyle

While no state offers the perfect combination across the board, some balance income and lifestyle better than others. Taking into account cost of living, tax rates, culture, outdoor access, and more, the top 5 states across specialties are:

  1. Minnesota
  2. North Carolina
  3. Wisconsin
  4. Colorado
  5. Texas

Doctors who prioritize both salary and lifestyle have found these states offer the best blend of compensation and a positive living environment. Major metropolitan hubs in these states still carry higher costs of living, so doctors may need to consider secondary markets.

The Ideal Situation Depends on Specialty and Priorities

There is no simple ranking of the objectively best states for all physicians. The ideal state depends greatly on specialty, career stage, and personal lifestyle factors. In general, compensation carries heavier weight for doctors still paying down medical school debt, while those established in their careers may prioritize location and pace of life. Determining one’s priorities and deal-breakers simplifies the decision of which state provides the best overall fit.


Finding the right state to practice medicine in is a complex, personal decision for doctors. While high-paying states for physicians hold appeal, the cost of living must also come into play when determining real income value. Overall, Minnesota, North Carolina, Wisconsin, Colorado, and Texas appear to strike the best balance across specialties, but the ideal location still depends greatly on individual priorities around lifestyle, salary, and practice environment.

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Master reviewer of all types of products. Love XL Fountain Sodas!! Cheer Mom extraordinaire. Socialite to all things small town and founder of Come socialize and connect with me.

One thought on “Doctors’ Dilemma: Finding the Ideal State with a Healthy Salary

  • Thank you for sharing

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