Dermatologists are in demand. Of that there is no doubt about it. And, one of the most exciting (and difficult) decisions a dermatologist will make in his or her career will be where to setup practice. Yes, since there is more of a demand for dermatologists than supply, there are an unlimited number of places across the United States from which to choose. The world is your oyster! But not all oysters are created equal, so there are a few things to keep in mind when choosing where to practice.
Location! Location!! Location!!!
When thinking about where to setup your first practice or where to relocate an established one, there really are 2 main location categories – urban and rural. Both have their benefits and challenges, and it is up to you to decide which ones you can and can’t live without.
For an urban example, take New York City. The city hospitals have several dermatology departments and every year many graduate from their coveted programs. A large portion will stay in the area for reasons similar to ones you might – friends, family, culture, and landmarks. The point is, this failure to fly the educational nest happens every year, thus saturating New York City with dermatologists, making starting a practice more challenging.
On the other hand, let’s take a look at a rural town in the State of Mississippi, ranked #1 in states with the worst physician shortages. If you did your homework and found a small town with no dermatologist practicing, chances are they would throw you a parade, and possibly offer a signing bonus, if you were to setup shop there. The cost of living is also low, and the BBQ is out of this world. However, if mosquitos aren’t your thing or your idea of a night out starts, rather than ends, at 10pm, rural Mississippi may not be for you.
The point is urban and rural locations each have their merits. Big cities come preloaded with ample patients, diverse opportunities and all the services that make life easy, so it is no surprise that most dermatologists are looking to practice in metropolitan areas. However, small towns offer a slower pace, wide open spaces, and unique lifestyle opportunities, and new dermatologists might find more success in areas where there is less competition.
Either way, you are going to have to choose, and once you have, it is time to do your research.
Research, Research & More Research!
Whether you decided to practice in a bustling, concrete jungle or a “blink and you’ll miss it” little town, “research” is the word of the day. It is a MUST to utilize all the demographical statistics you can get your hands on for the cities and states in which you might want to practice. Knowing information regarding salaries, taxes, and licensing rules, as well as lifestyle benefits, could mean the difference between a practice of prosperity or one that is short-lived.
In MD Edge, Dr. Brett M. Coldiron wisely suggested that “you start with an old classic, the “Places Rated Almanac: The Classic Guide for Finding Your Best Places to Live in America” (Washington: Places Rated Books, 2007).” He refers to it as a “resource … that provides all kinds of details on different areas of the country that you may not have considered, including median income, schools, climate, and livability.” I agree but suggest there are 2 major items to consider – salary and lifestyle.
Salary is one of the first questions that is asked when a dermatologist is looking for a position on the Dermatology Authority Job Board and is one we encourage practices to answer when posting a job. Many times, the enthusiasm about practicing in a specific location does not have the salary to match. Due to a larger supply of dermatologists, the salary is often lowest in the most popular destinations. Here are some states to keep in mind when considering salary:
The 5 states with the lowest salary, adjusted for cost of living are:
- New York
- District of Columbia
The 5 states with the highest salary, adjusted for cost of living are:
- South Dakota
- Iowa 1
Perhaps you are beginning to see that some states that were not even on your radar actually have a lot to offer, including a higher salary and a lower cost of living.
Where to live is a personal lifestyle choice. Everyone has different preferences regarding climate, recreation and personal interests. While some people would prefer to live on or near a warm coast, others seek cool mountain air. That being said, there are some lifestyle factors involved in making a practice location choice that all can identify with – fun, relaxation and entertainment.
The most popular places to practice usually include ample amenities and services in the area. Things like theatres, golf courses, sports and fitness facilities, fine dining, and natural attractions have almost nothing to do with an actual dermatology practice, but they are large components of what people are looking for in a location. And, while California and Florida rate among the highest in the “most fun” category, tax considerations, salary and other aspects may dim some of that sunshine. That is why a comprehensive look at each state provides a guideline that can be applied to each dermatologist’s situation.
Location benefits for dermatologists looking for a specific lifestyle will be balanced with the salary and opportunities available. So, if salary is the most important consideration, some lifestyle and location preferences may have to go by the wayside. In the same way, if certain considerations are non-negotiable, for example not being able to move out of state for family reasons, salary and lifestyle options will not be as flexible. Knowing these attributes, as well as the challenges and benefits of practicing in each state gives physicians a roadmap for the development of their professional practice.
My suggestion would be to make a list of the pros and cons of every city in which you might like to setup practice and put the winning cities on a shortlist. We have complied a list below to help you with your list, so don’t fret. Once you know the general area where you would like to settle, remember that the best jobs are not advertised. Dr. Coldiron suggests you “contact all the dermatology, multispeciality, and hospital groups in the area (yes, write them a nice snail mail letter) indicating you are interested, and ask them if they are hiring.” And above all, enjoy the process! It is your opportunity to get everything you want for you and for your practice. Happy Hunting!
Summary of Benefits and Challenges for Dermatologists, Per State:
Hourly: $134.39 average
Annually: $279,538 average
Income Tax:3 2-6%
Benefits: Mild weather, affordable housing, diverse geography and attractions, southern food.
Challenges:4 Lower population means less demand for services, tornado season, no professional sports team.
Hourly: $147.84 average
Annually: $307,500 average
Income Tax: 0-9%
Benefits: Low tax rate, ample wilderness and recreational opportunities.
Challenges: Remote northern location, cost of living, smaller client base, rated one of the worst states for business based on infrastructure and cost of doing business.
Income Tax: 2.59-4.94%
Benefits: Temperate climate, ample recreational opportunities, high population and demand for skin care, economic growth.
Challenges: High cost of living and hot summers.
Income Tax: 0-7%
Benefits: Low cost of doing business, lots of history, culture, architecture, and Ozark mountains.
Challenges: Lack of public transportation, remote location, high humidity, and rattlesnakes.
Income Tax: 1.1-14.63%
Benefits: Mild climate, lots of sun, west coast lifestyle, and large population concerned about skin health.
Challenges: High cost of living, air pollution in major cities, high unemployment.
Income Tax: 4.63%
Benefits: Strong growth in economy, business, and jobs. Mountains, ample outdoor and recreation opportunities.
Challenges: High altitude, high inflation and declining economic growth.
Income Tax: 3-6.7%
Benefits: Known for autumn scenery, lots of coastline and seafood. Rich history, right in the heart of the east coast.
Challenges: Most of the coastline is private land and there is a high cost of living.
Income Tax: 3-6.99%
Benefits: Central location with NYC and Washington DC in close proximity. More affordable than other east coast options.
Challenges: High cost of living, small geographic area.
Income Tax: none
Benefits: Stunning beaches and beautiful climate. Although it is more expensive to live and work, there is a larger client base. Being the sunshine state, Florida needs dermatologists.
Challenges: Fewest libraries per capita of all states, severe weather during hurricane season, and high rate of gun ownership.
Income Tax: 1-6%
Benefits: Plenty of southern hospitality and southern food. Good balance of rural and urban locations, affordable housing and peaches.
Challenges: Heavy traffic, sudden weather changes, and lots of pollen.
Income Tax: 1.4-8.25%
Benefits: Exotic, tropical lifestyle; sun, surf and fresh cuisine.
Challenges: High homeless rate, long distance to mainland US, and high cost of living.
Income Tax: 1.6-7.4%
Benefits: Affordable housing as well as, fishing, hunting, rafting, and many more outdoor opportunities at multiple parks including Yellowstone National Park.
Challenges: Large number of wildfires, cold winters, and limited access to air travel.
Income Tax: 4.95%
Benefits: Culture, history, urban luxury, four distinct seasons, and high quality schools.
Challenges: High rat population, urban sprawl, and high property tax.
Income Tax: 3.3%
Benefits: Access to the Indy 500, low taxes, one of the top 20 states for business based on infrastructure and cost of doing business.
Challenges: Increasing water pollution, high instances of meth use, tornadoes, and other wild weather.
Income Tax: 0.36-8.98%
Challenges: Sparse population, cold winters, tornado season, less culture and activities, and smaller cities.
Benefits: High quality of life, stable economy, lowest unemployment of all the states, and little traffic.
Income Tax: 2.7-4.6%
Benefits: Well maintained roads, ample infrastructure and business incentives, award-winning breweries, and low cost of living.
Challenges: Lack of outdoor and recreation opportunities, sparse and remote geography.
Income Tax: 2-6%
Benefits: Low cost of doing business, affordable housing, rich history and culture, the Bourbon Trail, and horses.
Challenges: Lack of job opportunities, slow economy, and mostly rural population.
Income Tax: 2-6%
Benefits: Amazing food, culture, and music, affordable utilities, part of the gulf coast. And well-known for biking and outdoor sports opportunities.
Challenges: High poverty, murder and unemployment rate, rated one of the worst states for business based on infrastructure, and economy.
Income Tax: 5.8-7.15%
Benefits: Warm weather, stunning sunrises and landscapes, fresh seafood, and low crime rate.
Challenges: One of the bottom ten states to do business in based on workforce, economy, and infrastructure, also one of the least diverse state.
Income Tax: 2-5.75%
Benefits: High household income, strong workforce, delicious crabs, incredible marine life, and lots of attractions and activities.
Challenges: High murder rate, dense population, and high cost of doing business.
Income Tax: 10%
Benefits: Strong workforce, high quality education and research, quality of life, and luxury east coast lifestyle.
Challenges: High health insurance costs, cold winters, large number of traffic accidents, and large economic disparity.
Income Tax: 4.25%
Benefits: Great lakes, car capital of the world, lots of history and natural beauty.
Challenges: Low education rates, dwindling infrastructure, cold winters, unpredictable weather, lack of public transit, and lots of road construction.
Income Tax: 5.35-9.85%
Benefits: One of the top 10 states for business based on overall economy, quality of life and education, and more than one thousand individual lakes.
Challenges: Most tornadoes in the US, and coldest winter temperatures.
Income Tax: 3-5%
Benefits: Birthplace of the Blues, incredible music, food and culture, affordable housing and cost of living.
Challenges: Third worst state for doing business based on infrastructure, workforce and economy, shorter life expectancy and high poverty rate.
Income Tax: 1.5-6%
Benefits: Low cost of doing business, incredible caves and outdoor adventures, parks and recreations, and an affordable real estate market.
Challenges: Lots of flooding, high crime rate, and high rates of discrimination.
Income Tax: 1-6.9%
Benefits: Four season outdoor activities, high quality of life, ample health care and research facilities, and low cost of doing business.
Challenges: Dangerous roads, declining economy and infrastructure, lack of housing, and sparse population.
Income Tax: 2.46-6.84%
Benefits: One of the states with the best cost of doing business, strong economy and high level of education.
Challenges: Cold winters, lack of recreation, entertainment, and remote, rural location.
Income Tax: 0%
Benefits: Strong economy and infrastructure, Las Vegas, lots of sunshine, and low taxes.
Challenges: Lacking workforce, lower levels of education, high crime rate, and drug use.
Income Tax: 5%
Benefits: High quality of life, one of the healthiest states, abundant outdoor activities, and low crime rate.
Challenges: High property tax, lack of jobs, and long cold winters.
Income Tax: 1.4-8.97%
Benefits: High quality education and quality of life, access to stunning beaches and central to all east coast destinations, low crime rate, lots of arts and culture.
Challenges: High cost of doing business, lack of affordable housing, and pollution rates.
Income Tax: 1.7-4.9%
Benefits: Affordable housing and utilities, stunning canyons and valleys, and unique culture.
Challenges: One of the bottom ten states for doing business based on overall economy, quality of life, and education.
Income Tax: 4-8.82%
Benefits: Strong economy, high quality education, beautiful wildlife and coastline, many recreational activities, history and cultural experiences.
Challenges: Long commute, high cost of living, lack of affordable housing, and high taxes.
Income Tax: 5.75%
Benefits: Top 3 state for doing business based on overall economy and workforce, home to America’s first colony, lots of history, architecture and coastline.
Challenges: High crime rate, hot summers, hurricane season, high taxes, and lower education quality.
Income Tax: 1.1-2.9%
Benefits: Affordable housing and cost of living, lack of competition, fresh air and open prairie, and high quality of life.
Challenges: Sparse population, long cold winters, and slow economy based on oil production.
Income Tax: 0.5-5%
Benefits: One of the top ten states for doing business based on infrastructure, economy, and cost of doing business, delicious ice cream, and ample parks and recreation.
Challenges: High air pollution, poor water quality, and cold winters.
Income Tax: 0.5-5%
Benefits: Low cost of living, affordable housing, low crime rate, ample outdoor activities.
Challenges: One of the bottom ten states in terms of doing business based on overall economy, workforce and education, tornadoes and unpredictable weather.
Income Tax: 5-9.9%
Benefits: Beautiful west coast rainforest, stunning mountains and ample outdoor activities, strong economy, and no sales tax.
Challenges: High cost of living, lack of affordable housing, lots of rain, high taxes and low wages.
Income Tax: 3.07%
Benefits: More affordable housing than other states in the region, great public transportation, high quality education, and lots of public services.
Challenges: High gas tax, declining economy, poor infrastructure, and many rural locations.
Income Tax: 3.75-5.99%
Benefits: Beautiful scenery, local food, culture and history, old architecture and mansions, and easy to get from place to place.
Challenges: Worst state for business based on overall economy, workforce and infrastructure.
Income Tax: 0-7%
Benefits: Delicious food, southern hospitality, mild weather, low property tax, and ample cultural and recreational activities.
Challenges: High crime rate, high cost of living, and declining economy.
Income Tax: none
Benefits: Low cost of living, strong economy, low crime rate, lots of outdoor activities, and affordable housing.
Challenges: Sparse population, declining infrastructure, and cold winters.
Income Tax: 6%
Benefits: Strong overall economy and infrastructure, heartland of country music, ample culture, history and recreation opportunities, and no personal income tax.
Challenges: Hot summers, severe weather, stagnant growth, and rising crime rate.
Income Tax: none
Benefits: Second best state for doing business based on overall workforce, economy and infrastructure, strong energy sector, and one of the best states for tax rates.
Challenges: Hot summers, high crime rates, low health insurance coverage, and lots of traffic.
Income Tax: 5%
Benefits: One of the top five states for doing business in terms of economy, high employment numbers, ample jobs, and strong business numbers.
Challenges: High levels of air pollution, lack of affordable housing, and political division.
Income Tax: 3.55-8.95%
Benefits: Plenty of peace and quiet, a safe place to live, low unemployment and incredible scenery known worldwide for the autumn foliage.
Challenges: Large snowfall and cold winters, remote location and isolated areas.
Income Tax: 2-5.7%
Benefits: Number one state for business based on workforce, infrastructure and education, lots of history, culture and recreational activities, beautiful beaches, mountains, and a strong economy.
Challenges: No professional sport team, and long grey winters.
Income Tax: 0%
Benefits: Economic opportunity, pacific ocean, rainforest, and mountains, access to high speed internet, and ample technical and professional positions.
Challenges: Low educational rates, high cost of living, plenty of rain, and lack of sun.
Income Tax: 3-6.5%
Benefits: Mountain biking and outdoor adventure, waterfalls and incredible scenery, low cost of living and affordable housing.
Challenges: Low employment rate, and loss of many industry jobs (steel, manufacturing) causing economic concern.
Income Tax: 4-7.65%
Benefits: Delicious dairy, award-winning cheese, farmers’ markets, lots of festivals and events, and affordable housing.
Challenges: Long winters, cold temperature, and limited infrastructure.
Income Tax: 0%
Benefits: Rodeos and all things western, wide open spaces, affordable living, and low unemployment.
Challenges: High wind, low population, mostly rural, and the highest suicide rate in the US.
by Kimberly Campbell
Founder, Dermatology Authority
Kim Campbell is the Founder of the Dermatology Authority, which provides Dermatology providers and businesses growth strategies. The Dermatology Authority does this through adding providers, practices, and consultative services.