This ranking was initially published on Physician on FIRE in collaboration with Marit.
In our earlier post on the 2025 U.S. Ranking of Best (and Worst) States for Doctors to Retire Early, we ranked all 50 states using Marit’s Physician FIRE Index, which combines physician salary data with state-level data on cost of living, taxes, quality of life, and malpractice climate.
Now, we’re taking a closer look at the Top 10 and Bottom 10 states, and the factors that help or hinder physicians on their path to financial freedom.
Top 10 States for Physicians to Reach Financial Independence
These states come out on top because they combine high physician earnings with low taxes, manageable costs, and stable practice environments. On average, physicians can reach financial independence in roughly 10 to 13 years. Your geographic needs and lifestyle preferences may make some of these nonstarters, but it’s a diverse enough group that you’ll likely find at least one location here worthy of consideration.
1. Wyoming
Avg salary: $506k
Est yrs to FIRE: 9.1 yrs
State taxes: 0%
Cost of living: Favorable
Quality of life: Favorable
Malpractice environment: Favorable
In the least populous state (with just 579K residents as of the 2020 census), doctors are in high demand, earning an average of $506k per year. With no state income tax, low living expenses, and modest malpractice premiums, Wyoming offers an excellent environment for saving and investing consistently. If you love wide open spaces, horses, or skiing and are drawn to a relaxed pace of life and strong community ties, Wyoming is a great place to practice - and to retire within ten years.
2. Wisconsin
Avg salary: $481k
Est yrs to FIRE: 11.7 yrs
State taxes: 7.65%
Cost of living: Neutral
Quality of life: Favorable
Malpractice environment: Favorable
Wisconsin offers high salaries averaging $481k and strong malpractice protections (it ranks #1 tied with neighboring Minnesota, on the malpractice factor). Even with a moderate state income tax, physicians here save efficiently thanks to steady expenses and excellent work stability. Access to high-quality schools and an affordable cost of living help make financial independence both achievable and sustainable.
3. Florida
Avg salary: $457k
Est yrs to FIRE: 11.4 yrs
State taxes: 0%
Cost of living: Favorable
Quality of life: Neutral
Malpractice environment: Unfavorable
Florida combines solid physician pay at $457k with zero state income tax. While malpractice premiums are higher, the cost of living is reasonable in many regions, and when it comes to where you live and practice, you have options. Florida boasts the fourth most diverse population and 11 metro areas containing 500,000+ residents, making it a good choice for physicians who want big savings potential without a rural or small-town experience.
4. New Hampshire
Avg salary: $429k
Est yrs to FIRE: 14.1 yrs
State taxes: 0%
Cost of living: Favorable
Quality of life: Neutral
Malpractice environment: Favorable
New Hampshire stands out for its lack of income tax, strong quality-of-life metrics, and average physician salary of $429k. Although housing costs are higher than average, the state’s safety, schools, and easy access to ski mountains and Atlantic beaches appeal to physicians seeking balance. NH is the only New England state in the top ten and one of the few Northeastern states where financial independence can be reached in under 15 years.
5. Illinois
Avg salary: $448k
Est yrs to FIRE: 12.5 yrs
State taxes: 4.95%
Cost of living: Neutral
Quality of life: Neutral
Malpractice environment: Unfavorable
Illinois earns a top-five spot with average physician pay of $448k and reasonable living costs (even Chicago is affordable compared to big coastal cities). While taxes are moderate, the state benefits from a robust healthcare network and a wide range of practice options. For physicians who prefer a mix of urban and rural settings, Illinois provides flexibility without sacrificing financial progress.
6. Iowa
Avg salary: $474k
Est yrs to FIRE: 10.8 yrs
State taxes: 5.7%
Cost of living: Neutral
Quality of life: Favorable
Malpractice environment: Favorable
Iowa physicians earn around $474k per year, paired with one of the lowest costs of living in the country. Malpractice premiums are low, and physicians report high satisfaction with their work environment. The low-stress lifestyle here supports both financial and personal well-being, creating a strong foundation for early retirement goals.
7. South Dakota
Avg salary: $549k
Est yrs to FIRE: 8.6 yrs
State taxes: 0%
Cost of living: Favorable
Quality of life: Neutral
Malpractice environment: Favorable
South Dakota combines the highest average physician salary in the top ten at $549k, with no state income tax taking a cut. The state’s cost of living remains below the national average, and malpractice premiums are among the lowest in the nation. The main reason SD isn’t higher in the top 10 is its so-so quality-of-life rank of 34. But if you can make this state work for you, it will definitely work with your financial goals: many physicians here achieve financial independence in about a decade.
8. Pennsylvania
Avg salary: $434k
Est yrs to FIRE: 13.0 yrs
State taxes: 3.07%
Cost of living: Favorable
Quality of life: Neutral
Malpractice environment: Unfavorable
Physicians in Pennsylvania earn about $434k and benefit from relatively low housing costs compared to those in nearby states. Taxes are moderate, and the mix of urban and rural settings, along with many college towns, offers flexibility in choosing a work environment that supports savings and personal preferences. With solid infrastructure and a stable healthcare system, the state performs better than expected for long-term wealth building.
9. Mississippi
Avg salary: $528k
Est yrs to FIRE: 8.7 yrs
State taxes: 5%
Cost of living: Favorable
Quality of life: Favorable
Malpractice environment: Favorable
Mississippi offers one of the highest average physician salaries at $528k and ranks #1 for the lowest cost of living. Although the malpractice climate can be challenging, the low cost of real estate and everyday expenses can help physicians accelerate wealth accumulation. Often ranked the poorest state in the nation, the opportunity to care for underserved populations could also be a powerful draw for some.
10. North Dakota
Avg salary: $530k
Est yrs to FIRE: 9.7 yrs
State taxes: 2.9%
Cost of living: Favorable
Quality of life: Neutral
Malpractice environment: Favorable
North Dakota physicians earn an average of $530k annually and enjoy low taxes, affordable living, and a stable practice environment. With fewer than 800,000 residents, ND ranks #4 among the least populous states, a factor that can foster a strong sense of community and professional stability. Physicians here tend to save more of their income while maintaining an excellent quality of life.
Bottom 10 States for Physicians to Reach Financial Independence
These states come with very different financial conditions. High expenses, heavy tax burdens, and lower relative pay stretch the average timeline to financial independence in the bottom ten states to 25 years or more.
41. Arizona
Avg salary: $439k
Est yrs to FIRE: 13.4 yrs
State taxes: 4.5%
Cost of living: Neutral
Quality of life: Neutral
Malpractice environment: Unfavorable
Not long ago, Arizona had a reputation for affordability, but rapid population growth has pushed housing costs well above the national average and cut into the average physician salary of $439k. Combined with moderate taxes and rising insurance costs, savings potential is modest. The state’s warm winters and growing healthcare market remain appealing, but don’t expect a short path to early retirement.
42. Alaska
Avg salary: $465k
Est yrs to FIRE: 14.3 yrs
State taxes: 0%
Cost of living: Favorable
Quality of life: Unfavorable
Malpractice environment: Unfavorable
Alaska physicians earn around $465k, which sounds high for a rural state until adjusted for the surprisingly high cost of goods, energy, and housing. The lack of state income tax helps, but day-to-day expenses are among the highest in the nation. Geographic isolation may add to professional and personal costs (e.g. pricey travel to any conference or visit with loved ones in the lower 48). Still, the breathtaking landscapes will make financial setbacks worth it for some.
43. Delaware
Avg salary: $445k
Est yrs to FIRE: 15.0 yrs
State taxes: 6.6%
Cost of living: Unfavorable
Quality of life: Unfavorable
Malpractice environment: Unfavorable
Physicians in Delaware average $445k, yet higher taxes and a cost of living well above the national average, particularly for housing and healthcare, eat into gross income. While the state offers lots of coastline and reasonable proximity to major metro areas, its financial environment remains less favorable for long-term wealth building.
44. Oregon
Avg salary: $451k
Est yrs to FIRE: 16.8 yrs
State taxes: 9.9%
Cost of living: Unfavorable
Quality of life: Unfavorable
Malpractice environment: Neutral
Oregon physicians earn $451k, but pay some of the highest income taxes in the country. The cost of housing in Portland and other urban centers continues to climb, eroding net savings. Despite easy access to mountains, rivers, wineries, and beaches, Oregon scores below the mean for quality of life, and the trade-off between outdoor adventure and savings makes it difficult to reach financial independence quickly.
45. Vermont
Avg salary: $383k
Est yrs to FIRE: 20.5 yrs
State taxes: 8.75%
Cost of living: Unfavorable
Quality of life: Neutral
Malpractice environment: Favorable
Vermont offers scenic beauty and a high standard of living, but it ranks low on financial metrics. The average physician salary of $383k feels even smaller when you account for high housing prices and state taxes. Vermont does have a favorable malpractice environment, but most physicians here face slower progress toward financial goals, making neighboring New Hampshire a smarter choice from a FIRE perspective.
46. New Mexico
Avg salary: $365k
Est yrs to FIRE: 16.3 yrs
State taxes: 5.9%
Cost of living: Neutral
Quality of life: Neutral
Malpractice environment: Unfavorable
Physicians in New Mexico earn around $365k, one of the lowest averages in the U.S. The “Land of Enchantment” boasts a modest cost of living, but limited earning potential and a smaller healthcare market lead to less enchanting savings rates. The result is a slower path to independence despite a relatively affordable lifestyle.
47. California
Avg salary: $447k
Est yrs to FIRE: 25.3 yrs
State taxes: 13.3%
Cost of living: Unfavorable
Quality of life: Unfavorable
Malpractice environment: Favorable
California physicians earn roughly $447k, yet high taxes and steep housing prices drastically limit savings. The cost of living in major cities can exceed the national average by 50 percent, and commuting from a more affordable suburb can mean extra hours away from home. Although quality-of-life scores are high, there are reasons California costs so much – financial independence often takes two or three times as long to achieve as in low-tax states.
48. Maryland
Avg salary: $328k
Est yrs to FIRE: 21.5 yrs
State taxes: 5.75%
Cost of living: Neutral
Quality of life: Unfavorable
Malpractice environment: Neutral
Maryland physicians average only $328k, with finances further constrained by high housing costs and combined state and local taxes near eight percent. The state’s proximity to major hospitals and government institutions in the DC metro provides career stability (and cultural riches) but limits flexibility in reducing expenses. Even with strong amenities, most physicians here face slow progress toward financial freedom.
49. Rhode Island
Avg salary: $324k
Est yrs to FIRE: 24.2 yrs
State taxes: 5.99%
Cost of living: Unfavorable
Quality of life: Neutral
Malpractice environment: Neutral
Physicians in Rhode Island earn about $324k, the lowest average salary on the list. The cost of living, particularly in coastal communities, remains high, and malpractice premiums add to the financial strain. While the Ocean State’s proximity to the Atlantic and Boston is appealing, the numbers simply do not add up for rapid wealth accumulation.
50. Hawaii
Avg salary: $364k
Est yrs to FIRE: 62.8 yrs
State taxes: 11%
Cost of living: Unfavorable
Quality of life: Unfavorable
Malpractice environment: Neutral
The 50th state to join the US ranks 50th here too, because physicians earn an average of $364k while facing the highest cost of living in the country and an 11 percent state income tax. Yes, the weather and scenery are sublime, but the financial tradeoffs are steep, extending the path to independence well beyond 50 years for many physicians. On the other hand… swimming in the Pacific year-round after work and living in a place others only dream of vacationing could make retirement feel a whole lot less urgent.
Small Differences Don’t Stay That Way
Across these states, even modest differences in taxes, expenses, and compensation compound dramatically over time. The result is a retirement timeline that can be twice as long in states like California or Hawaii vs. lower-cost, physician-friendly states such as Wyoming or Wisconsin. For physicians evaluating where to work or relocate, understanding how geography affects take-home pay and savings potential is essential. When you look at the full picture of your needs and values, you might conclude that a faster path to financial independence isn’t the top priority – but these decisions should always be financially informed, and Marit exists to ensure you have the data to make them.
