One of the worst places to practice medicine? I think not!

According to a recent study, Hawaii ranks in the bottom 10 of states to practice medicine. WalletHub just published a study that looked at various factors affecting physicians, and ranked each state and the District of Columbia by scores, and Hawaii is 43 out of 51.

Is Hawaii such a bad place for doctors? Absolutely not.

WalletHub got it all wrong.

First of all, the parameters measured don’t accurately reflect our unique circumstances in the islands. Make no mistake, doctors are paid well, one of the highest compensated professions around. But when compared to the cost of living in a place where an average home is over $700,000, we can’t compete with No. 1-ranked Iowa, where it’s only a little over $150,000.

Other states with higher costs of living include New York, Maryland, Massachusetts, Connecticut, New Jersey — guess which states rank lower than the islands.

The ratings don’t reflect the excellence of medical care provided. After all, Harvard University is in one of the lowest ranking states, along with Columbia, John Hopkins and more.

Because of our limited land area, Hawaii will always have higher costs for housing, and any study that bases one of the main parameters on salary without taking this into account will forever make us look bad.

Having one measure that punishes the doctor shortage and another that punishes competition is fairly confusing.

The study also ranked the percentage of the population projected to be over 65. It’s as if being a senior citizen is a disease. Many of my healthiest patients are in this age group. We will all be there someday, so suggesting that doctors wouldn’t like to practice where there are a lot of older people really doesn’t seem right, especially in a state with the highest rate of life expectancy.

Two other high-value measures included a contradiction. First was the listing of the primary care shortage — the greater the shortage, the lower the ranking. Studies like this showing that it’s a bad place to practice medicine don’t help matters when trying to recruit new doctors. Although there is a definite need to have more primary care providers, the study only looked at doctors and did not take into account the other types of qualified providers such as advanced practicing nurses who are also available to fill the need.

At the same time that the shortage for primary care providers was noted, states that had a higher rate of competition ranked lower in the overall standings. The measure was looking at the number of physicians per 1,000 residents. Having one measure that punishes the doctor shortage and another that punishes competition is fairly confusing.

The other equation for health care is what it costs for patients. Although doctors may feel like they are not getting paid the same rates they would on the mainland, one cause may that Hawaii has one of the lowest health insurance rates in the nation.

Paying doctors more means premiums go up and that comes out of everyone’s pocket, either in the form of paying more for their individual insurance or in taxes to cover the costs of Medicaid.

Quality measures were also included in the study. Doctors have to keep up to date on the latest in medicine, usually though attendance at conferences or lectures that provide continuing medical education credits. Patients should want their doctors to be forever learning how to improve their skills. But the WalletHub survey listed the higher requirements as a deterrent to medical practice in Hawaii.

The punitiveness of the state medical board was listed as another core measure of the medical environment. More disciplinary actions taken against physicians is considered bad. However, the purpose of the state medical board is to protect patients from inappropriate physician practices and behaviors, so wouldn’t other doctors want those who aren’t following the rules to be weeded out?

Patients certainly want to be protected, so this shouldn’t be viewed as a negative when considering opening up a medical practice.

Malpractice payout awards are listed as well, with the presumption that higher payouts represent another reason to avoid practicing medicine in certain states. Hawaii ranks in the top 10 of the fewest malpractice suits in the nation. In addition, there is a cap on the amount of compensation that plaintiffs can receive in Hawaii, one of the lowest in the U.S.

Having served on several malpractice review panels, I know that the number of suits that do go to court are limited and if there is an egregious lapse in the standard of care, that should be compensated.

Practicing medicine in Hawaii has its challenges, everyone will agree, but there is no good reason that we are listed in the bottom 10 states in the nation.

I, for one, don’t believe it, and will hopefully be joined by wonderful new colleagues in the coming years who also see the beauty of not just the islands, but of a medical career in the place I call home.