Physicians finishing training this year are weighing where to practice against three separate 2026 data sets — on livability, real pay and physician supply — metrics that don’t always overlap in the same geographies.
WalletHub’s annual ranking of the best and worst states for physicians, released in March, placed Montana at No. 1 for the second consecutive year. The analysis scored all 50 states and the District of Columbia across 19 metrics in two categories: opportunity and competition, and medical environment. Indiana ranked No. 2, followed by Louisiana, South Dakota, Minnesota, North Dakota, Missouri, Nebraska, Iowa and Wisconsin to round out the top 10. Mississippi, Utah, Kansas, South Carolina and Idaho completed the top 15. New York ranked last overall, followed by New Jersey, Rhode Island, Hawaii, the District of Columbia, Illinois, New Mexico, Oregon, Maryland, Vermont, Pennsylvania, Connecticut, California, New Hampshire and Massachusetts rounding out the bottom 15.
Line up that ranking against physician pay adjusted for cost of living, and a clear overlap emerges with North Dakota, Montana, Wisconsin, Kentucky and Indiana offering the highest real compensation in the country once cost of living is factored in, according to Bureau of Labor Statistics wage data.
North Dakota physicians earn the equivalent of $213.89 an hour after the adjustment, the highest in the nation. The District of Columbia, California, Massachusetts, Hawaii and Maryland offer the lowest cost-of-living-adjusted pay, nearly mirroring WalletHub’s worst-states list; the District of Columbia’s adjusted rate of $53.36 an hour is the lowest nationally. Physicians in Hawaii and California can out-earn their Midwestern peers on a pay stub, but a lower cost of living stretches a smaller salary further than a bigger one consumed by higher housing and everyday costs.
The physician density numbers help explain why the same states keep winning. The U.S. has 304 physicians per 100,000 residents on average, according to Association of American Medical Colleges data. Thirteen of the 15 states WalletHub ranked best for physicians in 2026 fall below that average, including Idaho, which has the lowest physician density in the country at 203 per 100,000. Only Minnesota and Missouri, both in the top 10, exceed the national rate.
The pattern reverses almost perfectly at the bottom of WalletHub’s list: all but one of its bottom 14 states with available data — New Mexico is the exception — have physician densities above the national average, led by Massachusetts at 485 per 100,000, the highest in the country. A market with fewer physicians per capita tends to be the same market paying and ranking the highest for the physicians who do practice there.
The overlap has a limit worth naming: “best for physicians” and “best for healthcare” are not the same measurement. Louisiana ranked No. 3 on WalletHub’s best-states-for-physicians list, but the state placed among the 10 worst states for healthcare overall in a separate WalletHub ranking scored on cost, access and outcomes rather than physician opportunity. New Mexico shows up on both worst-15 lists — seventh-worst for physicians and eighth-worst for healthcare overall. A state can offer real opportunity and income for an incoming physician while still asking that physician’s future patients to navigate a system with real access and outcomes problems.
Taken together, the 2026 data points incoming physicians toward a fairly narrow list of states where opportunity, real income and need overlap — and it looks less like the coasts and more like the Great Plains and Midwest.
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