Texas prides itself on going big. Our boots are tall, our hats are large, and our belt buckles are even bigger. Texas State Fair icon Big Tex is the largest cowboy on both sides of the Mississippi. Though we don’t have a state tax — which would provide a big payout for the state — we do have the third highest property tax rating for single family homes in the nation, which provides probably a bigger payout for the state.

For generations, Texans have been known for their larger-than-life attitudes and our “Texas state of mind.” It’s part of the reason why Joe Rogan moved his podcast here, and can be seen in some people’s “ain’t gonna happen to me” response to COVID-19 in places like a mask burning party in Collin County and a rodeo in Blue Ridge, where finding a mask during a global pandemic was like playing a game of Where’s Waldo? 

Usually, this larger-than-life attitude has served us well and led to our business friendly environment, especially with our lack of regulation (at least until a crisis like Hurricane Harvey or Winter Storm Uri punches us in the face with reasons why it may not be a good idea).

Now it seems our healthcare industry has gone big and topped a healthcare list in WalletHub’s most recent study ranking the 2021 Best & Worst States for Doctors. Texas has the lowest malpractice award payout amount per capita, followed by Arkansas, Idaho, Wisconsin, and Mississippi. 

Texas has the worst healthcare industry in the nation, according to a Sept. 24, 2018 Healthline report, due to our high uninsured rate, tough Medicaid regulations, and lack of services. Texas also “has some of the highest rates of disease and death” in the nation. But it is probably going to be somewhat a relief for some doctors to hear that we also rank number 1 when it comes to lowest payouts for medical malpractice lawsuits. 

In the March 22 report, WalletHub pointed out that doctors are among the highest paid and most educated professionals in the U.S. They were some of the highest earners in 2020 with a general physician pulling in about $197,000 a year, which isn’t too bad given that their student debt can average a couple of hundred thousand. So it makes sense why WalletHub would want to look at all 50 states and the District of Columbia to help doctors decide where they may want to practice or possibly move their practice. 

WalletHub looked at 19 key metrics compared among the states and DC, looking at data sets such as the average annual wage of physicians and the quality of the public hospital system to determine the ranking. 

According to the study, Montana ranks number 1 for the best state to practice medicine, followed by Minnesota, Idaho, Wisconsin, and Kansas. Sadly, 25 states outranked Texas as the best places for doctors to practice medicine, including Oklahoma, which ranked number 17. 

In fact, Texas failed to make it in the top five states for highest average annual wage for physicians, lowest projected competition by 2028, the most punitive state medical boards, and the most expensive annual malpractice liability insurance. 

Dr. Don Brady, interim chair, health care administration, School of Health Science – Methodist University, pointed out that the threat of malpractice lawsuits doesn’t affect their ability to do their job. “Except for OB/GYNs, it does not,” he said in the report. “Today, doctors follow protocols and care plans that make successful litigation almost impossible.” 

In fact, Medicaid is one of the major problems facing doctors and the health care community as a whole, Dr. Brady claims. The government originally started the program to provide medical coverage to poor children and poor pregnant women, but many states have since expanded its coverage area. 

“Most providers will confirm that Medicaid is a complicated insurance system requiring authorization for office visits, tests, and diagnostic procedures,” he said. “A text such as a CT scan may require the provider to spend several hours on the telephone with Medicaid trying to get the test approved. In most cases, it must be the provider who gets the tests approved.

“While states issue business licenses, occupancy permits, and other forms, these are not difficult challenges for medical providers,” he added. “Medicaid is an ever-changing, poor paying insurance that takes a great deal of time and effort for the entire medical community.”

Texas remains one of a few states that still hasn’t expanded their Medicaid coverage for low-income adults. It is part of the reason why we have had the highest uninsured rate in the country for many years. It’s a situation that is expected to worsen with the COVID-19 pandemic. According to a Jan. 4 report by Houston Public Media, Families USA, a consumer health advocacy group, found that 29 percent of Texas adults under 65 don’t have health insurance, and about 659,000 Texans lost their health coverage between February and May 2020 due to the COVID-19 pandemic. 

“We are doing an abysmal job at making sure that all Texans are covered through either public or private health [insurance],” Luis Figueroa, legislative and policy director for Every Texan, a public policy think tank, told Houston Public Media.  

Editor’s note: the original article stated that Texas ranked the highest in malpractice payouts when, in fact, Texas ranks the lowest. We apologize for the error.

Christian McPhate

Christian has been working as a freelance journalist in North Texas for more than a decade. His stories have appeared in the Dallas Observer, the Houston Press, and Rolling Stone magazine. He covers a...