In choosing a state in which to set up a practice, physicians should study tax and regulatory policy, writes third-year family medicine resident Philip Eskew, D.O., J.D., M.B.A. The winter issue of the Journal of American Physicians and Surgeons features Dr. Eskew’s article — “Which State Best Suits Your Medical Practice–an Analysis and Reference Guide,” — in which states are ranked in order of friendliness to independent practices.
Full article available at: http://www.jpands.org/vol19no4/eskew.pdf
Only South Dakota and Wyoming make the top tier. In the second tier are Idaho, Wisconsin, Indiana, North Dakota, Texas, and Alaska.
At the bottom, in tier 6, are Massachusetts and New Jersey. Tier 5 includes Connecticut, Rhode Island, the District of Columbia, Oregon, Maryland, New York, California, Ohio, and Illinois.
Vermont, now in tier 4, may soon be dead last, Eskew thinks, if implementation of its single-payer system bans private practice.
Key considerations for radiologists and surgeons, he writes, are certificate-of-need laws and regulations of out-patient surgery facilities, which protect hospitals from competition. Primary-care physicians may consider the ability to do in-office dispensing of prescription drugs, which can offer patients both convenience and lower prices, Eskew states.
Tax policy affects the financial viability of a practice, and its affordability for self-paying patients. Because Medicaid expansion is likely to mean higher taxes, Eskew considers it a negative in locating a practice.
Other issues that he considers include professional liability climate and the likelihood of unwarranted licensure board actions. Eskew also details unique requirements in several states, and their interest in forcing physicians to undergo costly proprietary “maintenance of certification” programs to obtain or renew their license.
The Journal is the official, peer-reviewed publication of the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties, founded in 1943 to preserve private medicine and the patient-physician relationship.
