Episode 51 – Annual Best Places to Consider – Podcast

Episode 51 – Annual Best Places to Consider

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Podcast Transcript

Hello, this is Scott McDonald and welcome to the Perfect Place to Put a Practice Podcast.

Every year about this time we put together a list of the locations around the United States that appear to be the best places to consider opening a practice.  At the outset, let me set the table on this information.  We are not going to say that these are the locations that will not have competition.  The issue of whether a site has too much or too little competition is often decided based upon a segment of the community.  So, if I recommend Denver, Colorado, you should know that there are places in the region of Denver that are going to be highly saturated with competing practices and other locations that will not.  But the greater Denver area is where one should consider as potential places to practice based upon the criteria I lay out.


Next point is that I will not deal with very small geographic areas.  The reason goes back many years when I recommended some select communities and there was a mad-dash for them.  I want to avoid that again if I can help it.  I will speak in terms of states and metropolitan areas so we won’t stress out about a particular neighborhood. 


The last point has to do with the criteria of selection. There are myriad lists on the Internet about what the best place to live or work or retire might be.  But when you look at the numbers that the analyst used to create their algorithms of what makes a good place, the demographer who gathered the list would have an agenda that might be quite different from yours.  One list we examined put a premium on libraries per capita.  Others would look at fine dining establishments per capita.  Well, fine.  I suppose that everyone has their own priorities but they very often have nothing to do with professional practices.  When I put together my own list of communities based upon data I am looking for the following:

  1. Typically I am looking for an increase in population.
  2. Economic health and stability.
  3. Long-term diversity of employment. That is why “energy towns” do not often make my lists. I like places that are going to continue on a health track for at least five years.
  4. Reasonable regulation. There are some places that the local and state governments are not friendly to business formation including professional practices.

On one note, I am not a believer that only places with affluence are desirable.  Sure, it is good to have money but most professionals have a desire to keep their money.  That is why considering places with a reasonable cost-of-living is desirable.  In fact, as I have been working in professional practice demographics, I believe that there is no proof the rich people make better patients.  They don’t necessary pay their bills on time.  They are not more cooperative.  Therefore, it might help to shift our paradigms a little.  And don’t forget that we are not listing a comprehensive list of good locations.  These are just a few that have been rising on our monitors


So, were should you consider going:

Nevada: There are going to be some good locations in the Greater Las Vegas area but there are also some downright terrible sites here.  That is why we are not recommending the entire state.  The southern part is volatile but, on the whole, it has some potential.  Our favorite for the state is actually in northwestern Nevada in the area of Reno/Sparks.  The new Tesla Battery factory is going to make for a little “boom” in this region but it may take a year or two to fully realize.  There are lots of Californians leaving their state but who don’t want to move too far from the region.  The State has a tax-friendly point-of-view.  Still, we are not recommending drinking the cool-aid of tourism.  With economic diversity, Nevada should do better.


Arizona: We have seen some good growth in many sectors of the economy.  Out-of-state residents are welcome.  The tax situation is reasonable. And obviously retirees are going to continue to come here as well as California ex-patriates.  Maricopa County’s east, north, and west are continuing to grow.  Pima County, where Tucson is located, is not quite as desirable but it is still doing better than many locations.  Eventually, we expect that the fringes of the Tucson and Phoenix regions will continue to have new housing while the inner cities will have more multi-family housing which will increase the diversity in the State.  There is every reason to believe We are often asked about the extreme north and the extreme west of Arizona but we don’t see much happening here.


Florida: This is not to say that every part of the state is going to do exceptionally well.  The west coast looks particularly promising around Tampa Bay.  The east side of the state is more of a question mark.  Its manufacturing has relied heavily upon Europe as a market as well as a source of tourism.  Unfortunately, that is not doing so well.  On the other hand, Jacksonville and Greater Orlando (which includes Kissimmee) may be helped should the military budget revive.  And we are predicting that it will revive.  This area has traditionally depended upon the economies of Latin America to thrive.  We don’t see a short-term revival in South America and we really don’t believe that in the short term an open Cuba will be much of a boon to the area.  But if Cuba were to be liberated from the Castro brothers, that could change in a hurry.   One unnoticed place that could have some long-term potential is Pensacola on the northern pan-handle.


Georgia: While manufacturing throughout the U.S. has been in trouble, the new-auto plants in this state could revive faster due to the newness of their plants.  But the Greater Atlanta market continues to “chug along” due to emigration from other U.S. states.  Many people with Georgia roots are returning from the Greater Chicago area as well as the larger cities in New England.   While very few demographers are noting this, we see that the potential exists for a southern exodus from southern Maryland and Northern Virginia within the next couple of years.  And it will probably surprise some folks when we mention that Savannah, Columbia, and Augusta may offer opportunities for new practices as these communities expand.  Don’t forget that the cost-of-living is extremely low in these areas.


Tennessee: One of the things that is doing particularly well in Tennessee is the employment rate.   Many companies have moved here because it is the classic “right to work state.”  Hiring costs are low and regulation from the state and county governments are reasonable.   It means that this state has a future that is going to touch its largest metropolitan areas including Nashville and Knoxville.  When I have traveled throughout the state, there are many reasons why this is a favorite state of so many professionals who have been disaffected by the difficulty in finding work in other places.  The weather is mostly reasonable.  And this is a place where one can raise a family in a growing community.  In other lectures I have discussed the phenomenon of “cultural congeniality.”   Now, I will grant that Clarksville is not a rich community.  But if you are looking for a place that is growing and has crazy potential for growth, this is certainly a community to consider.   In point of fact, I think this entire state has several “gems” that are going to shine in the next decade. 


Washington State: I will be honest here, I don’t personally love the State.  It is expensive.  It has some serious anti-growth problems backed into the pie.  It is far too tied to China and the big Asian Economies.  That being said, there is no denying that the entire state is growing and is likely to continue growing.   You would be missing out on understanding the appeal of Washington if you stuck close to the Seattle-Tacoma corridor.  Granted, this is where the high tech and export manufacturing hub is.  But I just don’t see the long-term draw that my colleagues in demographics see.  I have been evaluating the state for a long-time to find locations for practices.  And one has to admit that there is money and energy in the region.  I just don’t see it translating into new practice areas.  That would be found more in the extreme east side of the state (on the other side of the Cascades.  It is a different state entirely and has the potential of much more growth than it has enjoyed.  But I would also recommend looking at these Eastern Washington smaller towns and cities to where I think there is most potential for a developing state.  It is the same kind of potential that I see in Idaho.


Idaho:  This often surprises people but I see Idaho as a destination for the first time in twenty years.  And that goes for the Greater Boise area as well as the extreme east of the State (including Idaho Falls, Pocatello, and Rexburg).  The southern part of the state is developing in the established communities.  But if you are not familiar with the state, it can seem like a great big wilderness.  It is undeniable that the state is a great place given the low-cost of living (and correspondingly low wages).  One can earn half as much in Greater Seattle and still own a mansion and a thriving practice.  But one hidden benefit to this State is the growth that is occurring.  Not only is it enjoying immigration from other states, it also has a strong birth-rate.  This means that the state happens to be one of the youngest in the U.S. next to Utah.  That means that pediatric services are in demand and will grow over time.  If you are doctor who has lived in Idaho, you have a serious advantage.  Most professionals raised outside of the West are not likely to consider it.  More soup for you!


South Carolina: For years, South Carolina was a backwater.  But times have changed.  The three biggest metropolitan areas are all growing, have good employment, and lots of amenities.  Charleston, Columbia, and Greenville are the centers of growing communities with serious potential yet to come.  For a time I was reluctant to recommend this state because I found it hard to “break in” to the local, professional clique.  But that has changed in the last ten years.  It doesn’t hurt that so many large businesses have moved here.  It is a tax friendly area and they are welcoming of those from other states. It has been forced on them a little as new residents continue to come.  This means that the state has become more cosmopolitan without losing its charm.  

Obviously, there are going to be some elements that make this a complex state in which to practice.  But as we look at the demographic character of the population, quality-of-life, and growth, it looks like a promising area.

Utah: The first thing that we hear when we mention Utah is, “There are too many doctors there already!”  Yes, there certainly are many doctors but “too many” is just not true, especially in the northern part of the state.  The southern areas like Cedar City and St. George are steadily growing in population but the economy is founded on retirees.  That is a problem for some people.  On the other hand, Northern Utah is still doing well, particularly on either side of the Point of the Mountain (Lehi, Draper, South Jordan).  Look for a spike in growth as the area currently occupied by the State Prison is developed.  As an aside, the new prison is moving to the west side of the airport.  The area is being called “Silicon Slopes” due to the increase in high tech firms.  This growth is just starting.

Some doctors worry that the area is predominantly Mormon.  Well, it is and will likely continue to be so (like Eastern Idaho) but there is an increasing number of non-Mormons coming to the area who are well-educated and well-employed.


Indiana: People from Illinois tend to laugh when they hear that.  But the reason for believing that the state will continue to grow is that, primarily, it is not Illinois.  High taxes and excessive regulation are driving businesses to make the short hop to this state nearby.  If Cook County continues with its plan to greatly expand the minimum wage, it will accelerate this shift to the neighboring state.  Indiana is a right-to-work state that offers a much lower cost-of-living to Illinois while also offering proximity to a large mid-west population.

We are liking what we see in Indianapolis and Fort Wayne.  Some of the smaller towns in these areas are also looking better as well.  Granted, this may take a few years to develop its full potential but we think for those who want to practice in the Midwest, Indiana is a place with promise.

Before we end, let’s give a few shout-outs to  some states that almost made out top 10 list.  These include:

Arkansas (Jonesboro), Colorado (particularly north of the Denver Metro area), and Ohio (Youngstown, Greater Columbus). 

You have noticed that we have not covered Texas.  That is because there are several sites in the Lone Star State that deserve special mention.  We will handle that in a special edition of this podcast.  In the episode after that we are going to list our Dangerous Sites list.  That’s right, I am going to be specific about locations that are of real concern to us.


This is Scott McDonald of DoctorDemographics.com.  Thanks for listening.