[Podcast] Kiss of Death Locations for 2023

kiss of death for doctors 2023

Every year we share with you our ‘Kiss of Death’ locations for the upcoming year. This is a must-watch for any potential practice owner.

Watch the video here:

A Note from Scott McDonald on This Week’s Episode:

Every year, we publish a list of the sites that are “Risky.” We call these areas the “Kiss of Death” Sites.  If you are considering one for purchase or a start-up, we want you to think twice. The factors that make these locations less-than-desirable, change each year.  For example, in recent years, locations that had high unemployment were risky.  But at this time, unemployment has not been a major factor in what makes a good or bad location.  Rather, this year, locations that have above-average crime are undesirable.  Perhaps more important, locations that have a high cost of living, rising taxes (income and property) and a reduced birth rate are having a more difficult time,  Almost without exception, they are losing population.

In this episode, I take the time to examine the key factors that matter as well as the specific states and cities that suffer from “The Kiss of Death.”

This is an important episode if you don’t like risk.  And I have tried to be as specific as possible just why this is so.  Some locations (many) are committing economic suicide.  Others have adopted a poisonous political message that is going to harm them.  In the end, it is not a single factor.  Rather, it is one of many.
I hope you enjoy this message and take it to heart

Podcast Transcript

Scott McDonald: [00:00:14] Hello, this is Scott McDonald of Dr. Demographics. And today we’re going to do our annual review of locations that bite the suck that are not very good. These are locations that we refer to as having the kiss of death. Now, I know this may sound weird, but this is probably our most popular session that we do throughout the year. It really is an explanation of where you don’t want to wind up going. Now I bring this up because there right now is kind of a rush for people to get into practices there. They’re just scrambling. They feel that if they don’t make a decision right now, they’re going to have no chance for the future. Well, I’ve been doing this now for really close to 40 years. And what I’ve found is that’s not entirely true. However, there is a good idea to make sure you you take advantage of the opportunities as they present themselves. Now, at Doctor Demographics, our job is to quickly and inexpensively evaluate locations, to say, Is this good or bad? Now. Our competition has this habit of sort of saying every place is good, and that’s because they don’t want to take anybody off. They also don’t ever want to be wrong. And who does? But at doctor demographics, we actually go on a limb and we will tell you locations that have promise or locations that will suck those water. We can tell you what to do and what not to do. Now, here’s why I think it’s particularly important, because right now, money is expensive.

Scott McDonald: [00:02:00] Risks are very high. If you blow it, you may blow it for a long period of time. Now, some people have said that the coming recession is going to last for two or three years. That’s a very, very long time. So you have to be particularly careful about choosing the locations you go to. And our job is not to sell you something like no offense against brokers and realtors, but they only get paid if somebody decides to move on their property. Our job is to give you an idea of where to look. Even if there’s not a practice for sale in that area. But if there is. Our job is to tell you how good it is or how bad it is. Now, an important part of that is how bad it can be. So we have this locations with the kiss of death, which is what our program is about. So stay with me for a little while. I think you’re going to enjoy it again. It’s a little tart, little sarcastic, but. Well, I think you can handle it. Now the locations with the kiss of death doesn’t necessarily mean that these areas can’t support a practice. That is not what we’re saying. And in fact, what we’re often saying is this would be a good area if if other conditions were met or if something that we see in the future is like the change.

Scott McDonald: [00:03:28] And in fact, as I go through this list, I actually am going to tell you some locations that I think right now don’t look so good, but in a short period of time will. So stick with me. The locations are not all the worst places to live or to practice in the United States. It’s not a comprehensive list of the places that are bad. I know some of the locations you’re already going to anticipate. I don’t want to go there. No way. Stick with me to the end. Now, still, you may recognize some common themes that contribute to the problems of certain locations. So where should you avoid going? That’s the theme today. What are the places where there is more risk than there ought to be? Now what makes a kiss of death location? I coined the expression, and here’s what I meant or what I mean when I use that term. There are more risks than there should be. In short, yes, every location is imperfect. There is no site that is wonderful and just dramatically great risks are are going to be defined as those locations that are going to take longer for you to grow and to gain value in your practice, or they’ll likely to limit or have limited success. Now, I’m saying this because some people say don’t get into a health care practice. It’s not a good idea. Look, doctors, I’m going to tell you the truth. I’ve been doing it for a long time.

Scott McDonald: [00:05:11] This is a heck of a lot better than the stock market. And there are other locations that you might want to consider that will be better or worse than these. What we’re trying to do is say, how do you rationalize what’s going to work for you? Now costs are rising. The population is shrinking, at least in many locations. Not at all. But in many, employment is worsening. In other words, you are not working and making as much money as you were. So that is happening. Equity is not increasing for most practices. Now that doesn’t mean it’s not a good idea to get into a practice. I believe that the sooner you can do it, the better off you’re going to be. Remember, you can always refinance your debt as interest rates drop. That is an option. But I’m not saying that everybody has to do it today. I’m saying you need to plan today. Now. I want you to keep something in mind that really throws a lot of people when they go through this exercise. There is not one set of data. It’s a combination ultimately, and that makes it a little bit of a problem. It’s confusing. Now you can handle one, maybe even two of these factors at a time. But as I go through the factors, I want you to realize that the place you had your heart set on may not be good because there are more factors that make it a bad place to go.

Scott McDonald: [00:06:53] Now, if these factors and locations change from year to year, few places are permanently bad. Please, please get that some places. And next week I’m going to do the places with Promise episode, which is always very popular as well. Where should you be looking? Now I’m going to tell you what’s really bad. This year may have been a great place last year or could change this year. So it’s a moving target. That’s what I want you to understand. Diamonds in the rough locations exist, so there are some places that are just awful. Still, they’re not a Phenix. And I don’t mean a city Phenix. I mean born in glory and ashes kind of Phenix. But I want you to understand ugly locations. You have to figure out why are they doing so badly? Now I’m going to be very specific in this, and that’s going to make a lot of people mad. I’m sorry, but I’ve got to tell you the truth. And by the way, you should know I’m not being paid to try to sell you on a site. Or I’m not trying to sell you services on on accepting a location. Our job is to give you an honest measurement of how good or bad a site might be or to give you practical alternatives. So if you give me five locations that you’re looking at, I can tell you which one is best, and I will tell you which one’s worst.

Scott McDonald: [00:08:24] And I will tell you why. So the market conditions, especially the priorities and insurgencies, tend to shift. So. I’ll give you an example, and that’s unemployment. There was a time in which the only demographic factor that really mattered to people was how good is the employment? We were in a downturn economically the last one of these recessions, and right now it looks like a lot of people are finding work. Now, that may change and it may change dramatically overnight. But there are some other things that I want you to understand that make an area, good or bad, that changes over time. Now, the population character and I mean by that, various factors like their ethnography, their growth density, language problems that might make it difficult for a practice to survive. Those things matter, but they’re not permanent. There’s also medical procedures and conditions that will make one location very good for the delivery of a service and not so good for another. Now I found out that oral and maxillofacial surgeons do not do particularly well in a high rise. And you may say why? Certainly high rises are less expensive per square foot and they’re often located in downtown areas. Why wouldn’t they be great? Well, it’s because people throw up after surgery. I didn’t make the rules. It just happens. And therefore, we found that those people who went into a surgery and then were in recovery and then going out to the car to be picked up, that elevator mattered a lot.

Scott McDonald: [00:10:22] Now, medical conditions like this do matter. There are some places that are much more beneficial to serve than others. If you have a large youth population, teens, if you have many who are the 20 somethings or 50 somethings, they see the medical conditions and procedures and the means of delivery of those services will vary based upon where they are. Now, what I’m getting at here is the market conditions are likely to change. So I’m taking it right now from what we’re seeing in all kinds of practices. So please hear me out. Now economic conditions are a variable. But you see, it’s not a single thing. How much money are you going to be able to retain in a recession or with very big inflation, which is the fear right now? Those things change and it may be very influential in one location and not another. You probably already know that inflation is going crazy in some sites and not at all crazy in others. Or at least it’s much more modest. The same thing is true in the post-pandemic world of housing types. So what people have found out, they want to live in a single family dwelling area and their patients who can have good credit because they own a home make for a very good place for some expensive procedures. But it’s also true that some procedures are almost exclusively reserved for the population that’s over 50 and 60 years of age.

Scott McDonald: [00:12:09] So believe it or not, the housing type and the age in which the patient base resides can make a very big difference to the success of your practice. So you see, when we’re looking at an area, we’re taking several factors into account. The other thing is taxation. We found that there are right now a lot of people are saying, I don’t want to move to that area because the property taxes and income taxes are way too high. Now, that’s the nature of taxes, but there are some locations that have done marvelously well because they’ve dropped their income tax, and that’s why Florida and Texas have done so well. But there are several states that are dropping their tax rates and becoming more and more competitive for those other sites. So, yeah, I do take that into account. Mike Green is kind of an expert on taxation, too. He’s a very bright guy. Now. It’s also true and this is a changing thing. Political conditions are going to vary. Now, look, we know that Manhattan does not have a lot of friendly sites for practices, but even worse is Chicagoland. Chicagoland is exceptionally expensive for professionals to dwell in. Now, what’s weird is how many medical and dental schools there are in the greater Chicago area. So people will tend to want to stick around because they’ve had a child or bought a house and it’s making things very difficult. Now, political conditions shift and change.

Scott McDonald: [00:13:52] I don’t want to say that one place is going to be fantastic and permanently great, but I will say political conditions matter more now because they’re a predictor of what the future will be. So we take that into account. Now there’s a definition of geographic boundaries that is also important. And I’m not saying that there’s a big mark in the road that will say an area is good or bad. I’m just saying that as the price of fuel is increased, patients are much less willing to travel to get treatment. So they want everything to be within about a 7 to 10 minute radius of your practice where they live. And by the way, people are traveling from where they live as opposed to where they work. There was a time in which everybody in the nineties wanted to know how far it was from their office. Well, people are traveling to the office or from the office to your office at much smaller likelihood or less? Less likelihood. Now, the definition of the geographic boundaries means that you’ve got to look at how far is something away, but really how much time does it take to get there? Right now, fuel prices for private vehicles are very high. You probably know that no one wants to travel on public transportation to get to the doctor. And ridership in subways and trains and busses is really declining quickly. You may think, well, with the cost of gas, why would that be true? It’s because people are insecure traveling on public transportation.

Scott McDonald: [00:15:39] That’s what the surveys have been telling us. Now, competition ratios are likely to change a great deal in any market you go to. Remember, you don’t care what people are doing outside of, say, a 20 mile radius. Would you care about what’s going on in the five mile radius around the site? And actually, the ratios that we measure are a little more complex than they used to be. And that’s what we mean about ICE, Akron’s and transportation accessibility. So we’ll be talking about it as we go. You need to understand that viability and potential need to be examined year to year, because right now what is a good place as far as it’s viability may not be so good next year and the potential that a particular office site might have maybe at higher risk. So you have to rethink how good is this building to buy, because I’m going to be stuck here for a long period of time and what’s going to be the future? That’s what we measure for you. Now, yesterday’s loser may make a comeback, but for different reasons. Now, I’ll give you an example. Arizona has always been a so-so market. A lot of older people retired to Arizona. It’s generally a pretty solid thing. But the reason that it became good is because California was doing so badly and so people wanted to live somewhere close to their relatives and friends and recreation in California, so they chose to go to Arizona.

Scott McDonald: [00:17:25] New Mexico, by contrast, has never been great. It’s a place where a lot of federal employment happens. It’s the largest employer in New Mexico is the federal government. But you see, right now, it’s it’s looking better than it was because you can buy a house for a much more reasonable price than you can in other states. And that includes Utah. New Mexico is not that far away. So what makes it a reasonable place to go is changing. Now practice areas die by suicide. That may sound odd. It is. There is no reason why California is doing so badly. But even worse, there’s no reason why it should continue to do badly. But the residents and the political parties in California have got it in mind that they have to live according to a certain thing. So they have not allowed the building of homes. This. Stopping of building and then owning a home has been one reason California has suffered. And the same thing is true of a lot of places, including Virginia. By contrast, Texas and Florida seem to be very happy about having people own. And that’s why there is such a building spree there. But it ain’t cheap. And so people go to Texas and they go to Florida and they’re sticker shocked. But when you look at the potential of what it’s going to be tomorrow, maybe it’s not such a bad idea to get that office in your own home sooner rather than later.

Scott McDonald: [00:19:14] Now your priorities are not shared by everyone. Believe it or not, there are lots of folks who want locations to fail. That surprised me. It surprised me back when I was just a young man back in the 1980s when I started doing this, to realize that there are people who do not want. A. Urban blight. But more important, they didn’t want sprawl, which is what they called growing suburbs. Now in Utah, for example, and in Nevada. And looking at Idaho, they don’t have a problem with the idea of building. They rather like it. Now, that’s kept the price of housing more moderate. But you see, there are some people who don’t want any growth at all. So they’ve done restrictions, like much of California, to stop growth. Now Riverside County and is one of the exceptions San Bernardino County as well. But not that much. The whole state is kind of anti growth. There are some that appear to really want to become economic basket cases and I’ll put Chicagoland in that category. They have elected a mayor and city council who basically want to screw people over and they only want to grow in a certain way. They serve only a narrow market cycle and that is kind of a problem. But if you know what to look for, we can help you. Now specifically, I want to talk about the kiss of death states. I put the top kiss of the state.

Scott McDonald: [00:21:03] In the United States as New Jersey, it has a significant loss of population due to the cost of living. It’s it’s extremely expensive to live there and to build in New Jersey. The taxation is crazy high, and the quality of life, which is just not that great, has always been a problem. The crimes against people are the biggest problems that we’re seeing in metropolitan New Jersey now. That is going to go for the two big areas in the state, which is in the north and the south of New Jersey. The south is doing worse than the north. But then again, you probably knew about the problems that Philadelphia has had. And I’ll bring it up in a minute. Illinois is really close to New Jersey in being just a horrible place to live. I’m sorry to say it. They’ve got a big loss in population due to taxes. They don’t have affordable housing. The quality of life, especially in Chicagoland, is bad. And that is why Illinois is giving up so many residents. Where are they going? They’re going south. They’re going to Georgia and Alabama, Texas, Oklahoma. And and these are the states people are are targeting from that area. Now, look, if you’re in Washington state and Oregon, you’re not thinking about going to the southern United States, you’re thinking about going to the southern coastal areas. But there’s not a lot of options there. So I’m just going to tell you, it varies location to location.

Scott McDonald: [00:22:43] I believe that Illinois has got a golden belt. And I mean by that, the southern part of the state that’s more rural has more potential cost of building houses is much lower, employment is reasonable, transportation accessibility is good. But if you go to that Chicagoland area, people have gotten so used to the idea that they’re going to get robbed or killed, that they kind of accept the risks. Now. It surprises some people when I bring this next one up, New Hampshire. New Hampshire has very high taxes. It has very high cost of living. And what’s more is New Hampshire has a lot of older people. Nothing against older people, as you can tell. I’m getting to be a little older myself. Yes. Yes. I used to have more hair. But the point is, New Hampshire is kind of defeating itself because it has the myth in mind that any changes that it makes to zoning and to the cost of housing, new developments will mean that New Hampshire is going to be less perfect than it is. Look, I like New Hampshire. They’ve just made it very, very hard for doctors to be there. Connecticut is also a New England. The cost of housing is crazy high. The cost of living overall. In fact, everything in Connecticut is high. But here’s one thing you ought to know. The median household income in Connecticut is higher than even New York. And so a lot of people said, I want to live around really nice people who make a lot of money.

Scott McDonald: [00:24:22] And Connecticut seems to make them happy. Wealth and high employment rates are mitigating factors, but low family formation means it’s aging quickly. So what I’m saying is very few young families are saying, hey, we’re not getting hitched. We’re going to Connecticut. Not so much. So they may move in with their mom and dad, but they’re having a hard time after graduating in order to afford a house or find an apartment that is affordable. West Virginia. Now it’s bleeding people and has been for a very long time. It’s got a poor job market, poor lifestyle, education and and yeah, it’s got a problem. West Virginia has got a long term problem. And that’s Appalachia. But. It’s a major coal producer. It used to be an energy state. Barack Obama said coal shall not survive. And it may be that there are certain political people in Washington who want West Virginia to die. That’s unfortunate because the energy market may pick up and coal may be with the liquefaction of coal become a really good place to be in the future, but not right now. I want to talk about Hawaii. Now, who doesn’t love Hawaii? I mean, I like playing Apple. Come on. But the problem is it is so dramatically expensive to live there. If you’re not a native Hawaiian, you got a couple of strikes against you. It’s very high taxes and the energy costs are remarkable.

Scott McDonald: [00:26:10] But the biggest thing I hear from my clients who have put practices in Hawaii is. I got to get off this frigging island. I can’t stand how isolated it is. Now, everybody likes the moderate weather and likes the ocean views and the breezes and all that. That’s great. But in a difficult economic time, Hawaii is a very hard state to make a living and to justify staying. So a lot of people have left Hawaii. I know you thought I was going to bring up New York first. Look. In New York, especially in upstate New York, isn’t so bad. I mean, Rochester, for heaven’s sakes, who doesn’t like Rochester? Even Albany has some nice things about it. The political class in greater New York is tough. It’s very discouraging setting up a business because it costs a lot. They are hyper vigilant when it comes to covert. In other words, you get the sniffles. You better get into quarantine. And they’re very serious about that mask. So I’m just going to say my last trip to New York, which wasn’t that long ago, revealed that while the rest of the country has kind of moved on. New York is kind of mired in yesterday and that’s not good. I every year I get a call from a doctor who says, I want to go to Alaska. I want to be a part of the wild frontier of America. I just say move along. There’s nothing to see here.

Scott McDonald: [00:27:49] Alaska is not doing well. It’s not growing. Growing. The energy market has been greatly disturbed by the Biden administration. They don’t want new drilling oil leases. They believe it’s going to ruin the landscape. And so they’ve done everything they can to make sure that Alaska doesn’t grow, which doesn’t make most Alaskans happy. The energy could become its saving grace. I believe that oil and gas and other minerals are Alaska’s great legacy, but until there’s a will politically to develop it, it’s going to be a scary, risky place. Now, Louisiana. Is a miracle just about to happen. Now it’s got crime. It’s kind of hot and sticky. A lot of people put their fortunes into Louisiana and lost their shirts. So it’s gone up and down and up and down economically. But the natural resources in Louisiana, the charm of the place, the infrastructure, it is a really interesting place. But it has to wait for a little while before the miracle can happen. And therefore, I’m putting it on my well kiss of death list, because right now, Louisiana has an awful lot of risk. And I just want you to be aware of it. Mississippi has very good potential, but there is no will to discover what makes Mississippi so nice. Now, remember, Mississippi has got good weather, inexpensive housing. A lot of people are commuting, distance commuting from Mississippi because you can buy a house there for half the price that you can in neighboring states.

Scott McDonald: [00:29:45] So Mississippi has gotten kind of a negative. But now kiss of death or score? I think in time it will do well. But right now, Mississippi hasn’t really decided that it wants to grow. And neither of those political plans nor the business people who would normally make up Mississippi. But I believe in time it will. Now let’s talk about California. I’m from California. I live there. I was with the California Dental Association as their marketing manager. And it’s like there’s a bumper sticker. We hate you and we want you to live somewhere else. In other words, they don’t want a building or development and they’re doing everything they can because of the laws. The bail situation in the whole state of California is crazy. They don’t want to bring the price of living in California lower. They want to increase it because they believe everybody really wants to go to California. And of course, we’re seeing by the number of Ryder trucks and U-Haul that isn’t really true. The number of people who are immigrating to California is very high. But they ricochet from California into other states. Even though California may be the first place they want to go. It’s not where people settle. Now there are some cities that I want you to understand have very high risks. And I put them on my kiss of death lists. The first one is Detroit, Michigan. They may say, why are you picking on Detroit? Well, the biggest reason is that employment is not good.

Scott McDonald: [00:31:37] But worse, violent crime against people and against property is remarkably high. They’ve done everything they can to get the people who are middle class to leave. I think that was a political calculation because some people think it’s better if you’re not around. So Detroit is not doing well. It has not replaced its heavy manufacturing and it’s no longer the center of gravity when it comes to transportation arteries. I wish it were different because I frankly like not only Detroit but also the area around it. There’s a lot to like. It’s just right now, it’s hard to make a living there. Oakland, California, used to be one of my favorite cities in California, but the city officials in the state have made it so that Oakland is really kind of at the bottom of the barrel. Transportation has not improved, and in fact, it’s getting worse. Mass transit, as well as private vehicles, including trucks, is made it hard. Now, I know. I’m telling you, I’m picking on people. I’m just want you to realize what other people are thinking. Could Oakland make a comeback? It sure could, but not with the leadership it’s got now. Saint Louis, Missouri, has entered a danger zone. Crime is going crazy in the Saint Louis. It’s made it so the property values of decline because people are afraid and they put so much into infrastructure to keep fences up around their homes.

Scott McDonald: [00:33:18] Now, Saint Louis has some really nice parts of it. This is not a slam against everything in the state. But it is a slam against some parts of the state or some parts of the county and city. Just recognize that if you go to these cities, they’re a little marginal. You really should get a viability study from us because we can tell you where to go. Now, Memphis, Tennessee, used to be a comeback city. Memphis has gotten crime-ridden and a lot of people have moved to Memphis, which is on the western side of the state, from other places in the south that are not so desirable. Yeah, it’s got great music in Memphis, but the point is it’s dangerous for a young family and it’s dangerous for a middle class owned practice to make a go of it. A lot of need. I’m just not seeing it as a place that I find attractive. Stockton, California was one of my favorite places, and I thought I was going to make a comeback. But when the county decided that it was not going to have a serious attention to law enforcement, violent crime and crime against people, a property that I thought Stockton has risen in the kiss of death criteria. So I’m not loving it. Does that mean that Modesto and Merced are not likely? Does it mean that Sacramento is on its heels? Let’s just say the Central Valley of California is not doing great and everything bad is kind of depicted in what’s happening in Stockton.

Scott McDonald: [00:35:02] Birmingham, Alabama, just kind of leapt on to the list again because of crime and poverty, because of homeless illness. The thing is, Birmingham has fixed itself and it isn’t federal programs that can do it. There has to be a will within the population and I just don’t see it. Baltimore, Maryland. It’s. I mean, if you ever are looking around Baltimore and you’re there at night, leave quickly because the police are demoralized, the criminal class is enthused, and it is become one of the ugliest cities in America. I’m really sorry to say that. Now, maybe you’re thinking I could serve the poor. And Baltimore is a great city to do that. But you have to remember the infrastructure in order to set up a practice that will be safe and secure is going to cost you. Cleveland, Ohio isn’t that bad. There are parts of Cleveland that are doing fine. As a general rule, Cleveland, you can pick out the right neighborhoods to go to, but if you’re not picky, you wind up in where somebody says, Oh, that’s a great place to practice. You really get a good measurement of the whole area. I am so sorry to say this. I love Atlanta, Georgia. I love it. I like their public transportation. I like the feel of the city. There are parts of it like Alpharetta and Rockwell, and I like it a lot. So Atlanta has some potential, but it looks like there’s encroachment into the nicer parts of the downtown area.

Scott McDonald: [00:36:55] So I don’t see the universities in Atlanta making good strides. And so that’s one reason that I put it on a kiss of Death City scene. Now it may come back. Don’t get me wrong. Every place can. But I’m not seeing it right now. Buffalo, New York. We just had a horrific mass killing in Buffalo. It isn’t an isolated thing. A buffalo has had a problem because it keeps attracting people who don’t mind dissing the police. Buffalo has not done real well with renovating its shopping and its employment base. And so for that reason, I worry about Buffalo. It could come back, but I’m not expecting it will anytime soon. Now. This surprised me. It’s Chattanooga, Tennessee. For the most part, Chattanooga is very nice. But there is a thing about Tennessee that the more south you go, the more south you are. I’m saying that culturally, Chattanooga is a little hard for some people who are not from Tennessee to put up with. It’s an acquired taste. So with the amount of crime, poverty, homelessness. I’m worried about it. Hartford, Connecticut, has the. Well, it’s expensive. It’s hard to find new places to go. And it’s getting older. Hartford had a wonderful condition that’s kind of blown it. Now, whenever I say that, I say it could come back and it’s true. But Hartford employment is not doing well. They’re not attracting people. So a lot of people who want to do distance working are kind of looking at Hartford and going, Why don’t I want to live there? I could be at someplace else and it would cost me less.

Scott McDonald: [00:39:00] And I’ve got a better quality of life. This pains me to say, but Houston hasn’t covered itself in glory. And this goes back to Katrina when when the big storm came, they moved a lot of people who were very poor and high crime prone into Houston. And it really hasn’t righted that ship yet. Now, granted, spring Texas, very close behind it has some potential. But greater Houston I’m worried about as far as it being a kiss of Death City. I just don’t see a lot of happening in Houston that makes me say, gee, do I want to put up with all that humidity? Oh, that’s great. And by the way, if you haven’t been through Houston’s humidity, it’s terrible. There. Now I’m going to add Chicago to this list, and that’s Chicago, Illinois. Chicago has a lot of good things about it, but unfortunately, almost all those good things have left to either go to Indiana or to the southern part of the state. Chicago itself is not well run. And therefore they’re looking at some disasters as far as quality of life and expense. It is being a difficult place to go. So I’m just saying. You may want to think twice. If we can help you figure out the perfect place to put a practice, I hope you’ll contact us at Doctor Demographics.