According to a , an online media and resource tool for doctors, Idaho, Mississippi, Tennessee and Texas rank highest on the this year’s list, based on metrics like malpractice frequency, reimbursement and overhead costs. The idea is that the more stress-factors — like disciplinary actions and tax burdens — that exist per capita, the less desirable the locale would be.

The ranks do not, however, take into account lifestyle factors like cultural attractions and recreation, so doctors may need to do some research before moving their families to a place with no movie theater.

That could be why the worst places to practice include vacation destinations like New York, Washington, D.C. and Hawaii. In these states, the report says taxes and malpractice might be high enough to overshadow the benefits of living near conference destinations and Broadway.

“The financial issues involved in being in practice in New York are very, very complex, and it requires a lot of effort just to keep your head above water,” said now Mississippi-based physician Steven Shapiro, in the report.

Shapiro moved his practice from the Empire State to the Magnolia State 17 years ago, and has been there ever since.

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