As the U.S. health care system faces mounting shortages of physician shortages, state and federal leaders are scrambling to improve workforce pipelines. Yet in many states, the problem isn’t just training enough doctors – it’s convincing them to stay.
New physicians often leave the state where they trained, and in some parts of the country, retention rates are alarmingly low. In the states with the weakest retention, fewer than 40% of doctors stay to practice after completing their residency, while the top-performing states boast retention rates above 75%. At the state level, retention rates are correlated with factors like health care salary as well as outcomes like mortality due to medical error. A closer look at the data reveals the states with the lowest physician retention rates.
To determine the states with the lowest physician retention rates, 24/7 Wall St. reviewed data on physician retention from the Association of American Medical Colleges. States were ranked based on the percentage of physicians who are practicing in the same state where they completed their residency. Retention rates are based on individuals who completed residency between 2013 and 2022.
Supplemental data on median annual salary for health care practitioners and technical occupations are from the Bureau of Labor Statistics Occupational Employment and Wage Statistics program and are for May 2024. Data used to calculate the average dollar amount of medical malpractice payouts per resident from 2015 to 2024 are from the National Practitioner Data Bank of the U.S. Department of Health & Human Services and the U.S. Census Bureau’s Population and Housing Unit Estimates program, while data on mortality due to medical and surgical complications from 2021 to 2023 are from the CDC’s WONDER database.
50. California
- Physicians practicing in state of residency: 77.5%
- Concentration of physicians: 315.6 per 100,000 residents (122,963 total)
- Median annual salary for healthcare practitioners: $119,990
- Deaths from medical and surgical care complications, 2021-2023: 0.6 per 100,000 people
- Average medical malpractice payout, 2015-2024: $299,154
49. Alaska
- Physicians practicing in state of residency: 70.8%
- Concentration of physicians: 289.6 per 100,000 residents (2,124 total)
- Median annual salary for healthcare practitioners: $102,660
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $515,917
48. Texas
- Physicians practicing in state of residency: 66.5%
- Concentration of physicians: 243.1 per 100,000 residents (74,164 total)
- Median annual salary for healthcare practitioners: $79,510
- Deaths from medical and surgical care complications, 2021-2023: 1.2 per 100,000 people
- Average medical malpractice payout, 2015-2024: $229,548
47. Idaho
- Physicians practicing in state of residency: 66.4%
- Concentration of physicians: 192.7 per 100,000 residents (3,786 total)
- Median annual salary for healthcare practitioners: $79,780
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $503,098
46. Florida
- Physicians practicing in state of residency: 65.0%
- Concentration of physicians: 286.5 per 100,000 residents (64,791 total)
- Median annual salary for healthcare practitioners: $80,020
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $304,022
45. Montana
- Physicians practicing in state of residency: 63.4%
- Concentration of physicians: 248.6 per 100,000 residents (2,816 total)
- Median annual salary for healthcare practitioners: $79,850
- Deaths from medical and surgical care complications, 2021-2023: 1.2 per 100,000 people
- Average medical malpractice payout, 2015-2024: $375,543
44. Oregon
- Physicians practicing in state of residency: 61.6%
- Concentration of physicians: 318.1 per 100,000 residents (13,468 total)
- Median annual salary for healthcare practitioners: $108,070
- Deaths from medical and surgical care complications, 2021-2023: 1.1 per 100,000 people
- Average medical malpractice payout, 2015-2024: $593,962
43. Maine
- Physicians practicing in state of residency: 60.2%
- Concentration of physicians: 379.2 per 100,000 residents (5,293 total)
- Median annual salary for healthcare practitioners: $82,860
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $586,353
42. Oklahoma
- Physicians practicing in state of residency: 59.2%
- Concentration of physicians: 254.1 per 100,000 residents (10,300 total)
- Median annual salary for healthcare practitioners: $76,160
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $299,186
41. North Dakota
- Physicians practicing in state of residency: 59.1%
- Concentration of physicians: 315.3 per 100,000 residents (2,472 total)
- Median annual salary for healthcare practitioners: $77,750
- Deaths from medical and surgical care complications, 2021-2023: 1.1 per 100,000 people
- Average medical malpractice payout, 2015-2024: $368,061
40. Georgia
- Physicians practicing in state of residency: 59.0%
- Concentration of physicians: 272.9 per 100,000 residents (30,100 total)
- Median annual salary for healthcare practitioners: $81,520
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $548,590
39. Minnesota
- Physicians practicing in state of residency: 59.0%
- Concentration of physicians: 342.1 per 100,000 residents (19,632 total)
- Median annual salary for healthcare practitioners: $95,380
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $786,892
38. Mississippi
- Physicians practicing in state of residency: 58.4%
- Concentration of physicians: 245.3 per 100,000 residents (7,211 total)
- Median annual salary for healthcare practitioners: $64,960
- Deaths from medical and surgical care complications, 2021-2023: 1.6 per 100,000 people
- Average medical malpractice payout, 2015-2024: $326,381
37. Indiana
- Physicians practicing in state of residency: 58.4%
- Concentration of physicians: 269.9 per 100,000 residents (18,519 total)
- Median annual salary for healthcare practitioners: $78,330
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $249,288
36. Washington
- Physicians practicing in state of residency: 58.4%
- Concentration of physicians: 310.8 per 100,000 residents (24,280 total)
- Median annual salary for healthcare practitioners: $103,660
- Deaths from medical and surgical care complications, 2021-2023: 1.2 per 100,000 people
- Average medical malpractice payout, 2015-2024: $545,386
35. Colorado
- Physicians practicing in state of residency: 58.1%
- Concentration of physicians: 289.4 per 100,000 residents (17,011 total)
- Median annual salary for healthcare practitioners: $86,740
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $467,492
34. Louisiana
- Physicians practicing in state of residency: 58.0%
- Concentration of physicians: 304.8 per 100,000 residents (13,939 total)
- Median annual salary for healthcare practitioners: $69,940
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $260,824
33. South Dakota
- Physicians practicing in state of residency: 57.7%
- Concentration of physicians: 278.0 per 100,000 residents (2,556 total)
- Median annual salary for healthcare practitioners: $69,510
- Deaths from medical and surgical care complications, 2021-2023: 0.5 per 100,000 people
- Average medical malpractice payout, 2015-2024: $688,143
32. Arkansas
- Physicians practicing in state of residency: 56.8%
- Concentration of physicians: 257.4 per 100,000 residents (7,895 total)
- Median annual salary for healthcare practitioners: $67,930
- Deaths from medical and surgical care complications, 2021-2023: 1.6 per 100,000 people
- Average medical malpractice payout, 2015-2024: $403,338
31. Arizona
- Physicians practicing in state of residency: 56.2%
- Concentration of physicians: 268.6 per 100,000 residents (19,961 total)
- Median annual salary for healthcare practitioners: $87,750
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $451,285
30. Massachusetts
- Physicians practicing in state of residency: 56.2%
- Concentration of physicians: 526.2 per 100,000 residents (36,840 total)
- Median annual salary for healthcare practitioners: $97,790
- Deaths from medical and surgical care complications, 2021-2023: 0.8 per 100,000 people
- Average medical malpractice payout, 2015-2024: $764,434
29. Alabama
- Physicians practicing in state of residency: 54.9%
- Concentration of physicians: 262.5 per 100,000 residents (13,410 total)
- Median annual salary for healthcare practitioners: $64,590
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $572,647
28. Illinois
- Physicians practicing in state of residency: 54.8%
- Concentration of physicians: 371.0 per 100,000 residents (46,563 total)
- Median annual salary for healthcare practitioners: $82,960
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $709,014
27. New York
- Physicians practicing in state of residency: 54.8%
- Concentration of physicians: 474.4 per 100,000 residents (92,846 total)
- Median annual salary for healthcare practitioners: $99,890
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $502,292
26. Michigan
- Physicians practicing in state of residency: 54.7%
- Concentration of physicians: 409.4 per 100,000 residents (41,090 total)
- Median annual salary for healthcare practitioners: $81,880
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $254,431
25. Wisconsin
- Physicians practicing in state of residency: 54.0%
- Concentration of physicians: 333.5 per 100,000 residents (19,713 total)
- Median annual salary for healthcare practitioners: $81,620
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $620,748
24. Kansas
- Physicians practicing in state of residency: 53.9%
- Concentration of physicians: 307.5 per 100,000 residents (9,043 total)
- Median annual salary for healthcare practitioners: $75,120
- Deaths from medical and surgical care complications, 2021-2023: 1.5 per 100,000 people
- Average medical malpractice payout, 2015-2024: $219,428
23. Utah
- Physicians practicing in state of residency: 53.5%
- Concentration of physicians: 251.9 per 100,000 residents (8,610 total)
- Median annual salary for healthcare practitioners: $79,440
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $333,200
22. Ohio
- Physicians practicing in state of residency: 53.4%
- Concentration of physicians: 380.6 per 100,000 residents (44,852 total)
- Median annual salary for healthcare practitioners: $79,130
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $482,997
21. South Carolina
- Physicians practicing in state of residency: 53.2%
- Concentration of physicians: 272.2 per 100,000 residents (14,626 total)
- Median annual salary for healthcare practitioners: $77,920
- Deaths from medical and surgical care complications, 2021-2023: 1.1 per 100,000 people
- Average medical malpractice payout, 2015-2024: $353,118
20. Nevada
- Physicians practicing in state of residency: 53.1%
- Concentration of physicians: 208.7 per 100,000 residents (6,667 total)
- Median annual salary for healthcare practitioners: $92,980
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $345,945
19. New Mexico
- Physicians practicing in state of residency: 52.8%
- Concentration of physicians: 322.0 per 100,000 residents (6,809 total)
- Median annual salary for healthcare practitioners: $84,380
- Deaths from medical and surgical care complications, 2021-2023: 1.5 per 100,000 people
- Average medical malpractice payout, 2015-2024: $376,700
18. North Carolina
- Physicians practicing in state of residency: 52.7%
- Concentration of physicians: 298.9 per 100,000 residents (32,386 total)
- Median annual salary for healthcare practitioners: $79,210
- Deaths from medical and surgical care complications, 2021-2023: 1.2 per 100,000 people
- Average medical malpractice payout, 2015-2024: $377,515
17. Missouri
- Physicians practicing in state of residency: 52.7%
- Concentration of physicians: 361.5 per 100,000 residents (22,402 total)
- Median annual salary for healthcare practitioners: $76,400
- Deaths from medical and surgical care complications, 2021-2023: 0.8 per 100,000 people
- Average medical malpractice payout, 2015-2024: $398,180
16. Vermont
- Physicians practicing in state of residency: 52.4%
- Concentration of physicians: 417.3 per 100,000 residents (2,702 total)
- Median annual salary for healthcare practitioners: $84,660
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $435,447
15. Nebraska
- Physicians practicing in state of residency: 52.2%
- Concentration of physicians: 350.0 per 100,000 residents (6,925 total)
- Median annual salary for healthcare practitioners: $79,420
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $381,935
14. Virginia
- Physicians practicing in state of residency: 51.0%
- Concentration of physicians: 314.1 per 100,000 residents (27,376 total)
- Median annual salary for healthcare practitioners: $81,700
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $493,490
13. Kentucky
- Physicians practicing in state of residency: 50.9%
- Concentration of physicians: 283.5 per 100,000 residents (12,830 total)
- Median annual salary for healthcare practitioners: $76,380
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $378,136
12. West Virginia
- Physicians practicing in state of residency: 50.9%
- Concentration of physicians: 328.5 per 100,000 residents (5,814 total)
- Median annual salary for healthcare practitioners: $69,340
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $346,587
11. Hawaii
- Physicians practicing in state of residency: 49.4%
- Concentration of physicians: 309.5 per 100,000 residents (4,442 total)
- Median annual salary for healthcare practitioners: $104,000
- Deaths from medical and surgical care complications, 2021-2023: 0.7 per 100,000 people
- Average medical malpractice payout, 2015-2024: $634,281
10. Pennsylvania
- Physicians practicing in state of residency: 49.1%
- Concentration of physicians: 418.3 per 100,000 residents (54,224 total)
- Median annual salary for healthcare practitioners: $80,250
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $464,328
9. New Jersey
- Physicians practicing in state of residency: 48.4%
- Concentration of physicians: 364.2 per 100,000 residents (33,838 total)
- Median annual salary for healthcare practitioners: $100,350
- Deaths from medical and surgical care complications, 2021-2023: 0.8 per 100,000 people
- Average medical malpractice payout, 2015-2024: $514,257
8. Maryland
- Physicians practicing in state of residency: 48.2%
- Concentration of physicians: 444.6 per 100,000 residents (27,475 total)
- Median annual salary for healthcare practitioners: $95,620
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $445,997
7. Tennessee
- Physicians practicing in state of residency: 47.5%
- Concentration of physicians: 297.6 per 100,000 residents (21,208 total)
- Median annual salary for healthcare practitioners: $75,830
- Deaths from medical and surgical care complications, 2021-2023: 1.3 per 100,000 people
- Average medical malpractice payout, 2015-2024: $328,741
6. Iowa
- Physicians practicing in state of residency: 47.3%
- Concentration of physicians: 275.4 per 100,000 residents (8,833 total)
- Median annual salary for healthcare practitioners: $74,430
- Deaths from medical and surgical care complications, 2021-2023: 1.1 per 100,000 people
- Average medical malpractice payout, 2015-2024: $528,284
5. Connecticut
- Physicians practicing in state of residency: 45.6%
- Concentration of physicians: 451.4 per 100,000 residents (16,328 total)
- Median annual salary for healthcare practitioners: $97,450
- Deaths from medical and surgical care complications, 2021-2023: 0.8 per 100,000 people
- Average medical malpractice payout, 2015-2024: $711,861
4. Rhode Island
- Physicians practicing in state of residency: 42.9%
- Concentration of physicians: 434.4 per 100,000 residents (4,761 total)
- Median annual salary for healthcare practitioners: $90,690
- Deaths from medical and surgical care complications, 2021-2023: 1.1 per 100,000 people
- Average medical malpractice payout, 2015-2024: $561,605
3. Wyoming
- Physicians practicing in state of residency: 41.1%
- Concentration of physicians: 254.4 per 100,000 residents (1,486 total)
- Median annual salary for healthcare practitioners: $81,210
- Deaths from medical and surgical care complications, 2021-2023: 2.2 per 100,000 people
- Average medical malpractice payout, 2015-2024: $581,247
2. New Hampshire
- Physicians practicing in state of residency: 40.8%
- Concentration of physicians: 318.4 per 100,000 residents (4,464 total)
- Median annual salary for healthcare practitioners: $88,160
- Deaths from medical and surgical care complications, 2021-2023: 1.0 per 100,000 people
- Average medical malpractice payout, 2015-2024: $665,406
1. Delaware
- Physicians practicing in state of residency: 39.2%
- Concentration of physicians: 364.6 per 100,000 residents (3,762 total)
- Median annual salary for healthcare practitioners: $87,840
- Deaths from medical and surgical care complications, 2021-2023: 0.9 per 100,000 people
- Average medical malpractice payout, 2015-2024: $447,059
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