How to Choose a “Hot State” in Which to Practice: Starting a New Practice VIII

I’m sure some of the readers will wonder why this author is discussing states in which to practice. Why not skip this step and go directly to helping you determine a good practice location within a town or city?

The answer is simple. Some states have excellent practice and insurance laws that support and encourage the practice of chiropractic. These laws allow a DC to practice according to his practice philosophy. (Can you imagine being a mixer in a straight state?) They allow you to practice more comfortably, to practice more comprehensively and to become more financially successful. I call this type state a “hot state.” States that have poor insurance laws, restrictive practice laws, etc., result in the doctor practicing three to four times harder to earn the same income as his colleague who is practicing in a “hot state.” I call this type state a “cold state.” The difference between “chiropractic affluence” and “chiropractic poverty” is, quite often, an invisible line between states.


Other Factors

Other factors that contribute to a “hot” or “cold” state designation are laws that support or discourage a new practitioner and an excessively high tax structure, etc. If you could just as easily practice in a “hot state” with a lower tax rate, wouldn’t you?


Example of “Hot” and “Cold” States

Let me give you an example of “hot” and “cold” states. I had a client who wanted to go back to his home state to practice. I had him do a “hot” or “cold” state analysis. Upon completing his study, he reported that his home state was not only cold, it was freezing cold…a very tough environment in which to practice. But, he said, “My wife and I are from that state and we want to live close to our relatives.”

As a father, I completely understood his desire. I wanted all my children (three are DC’s) to live near me. I want to see my children and my grandchildren on a frequent basis. I definitely understand the pull of family.

I asked the doctor what town he was from. Then I asked, “If you lived within a one hour drive of your parents, would you be happy?”

He said, “Yes. That would be ideal.”

I advised him to live in his hometown in the “cold state,” one hour from his parents, but practice in the adjoining “hot state” (12 miles away). The adjoining “hot state” did not have a restrictive practice climate. This doctor is now earning double the income and treating the same number of patients as his friends who practice in the “cold state.”

The point I’m trying to make is: You have a choice. You have a choice as to where to live, and it doesn’t necessarily have to be in the same state you choose to practice, nor in the state in which you were raised.


Your Personal Preferences and the States That Fulfill Them

The first thing you need to do is analyze the type of terrain you and your spouse prefer. Do you like the seashore, desert country, mountains, rolling hills, or farm country? Do you like hot or cold weather? Do you like the four seasons or would you rather not be bothered with the change in seasons? I have seven children and I couldn’t imagine having to dress and undress seven children in winter clothes. I went south to take advantage of one season…summer.

Your next step is to determine the type of people with whom you wish to associate. Do you mix well with conservative people, like those from the Northeast? Do you prefer “down home folks” as found in Southern states? Do you associate better with solid Midwesterners or the laid back Californians?

Are the educational levels of the people surrounding your future practice site important to you? If you want to surround yourself with highly educated people, you’d be wise to choose a state whose population prizes higher education.


Let’s Put the Pieces Together

If you like rolling hills, warm weather and “down home folks,” you’ll probably like Tennessee, North Carolina, Virginia, Northern Georgia, Northern Alabama and Kentucky. You have a choice! You are not limited to any one state in order to get the kind of topography, weather, or people you like.

Do you like water, the four seasons, and conservative people? In this case, you’ve got the beautiful states of Maine, Connecticut, Massachusetts, New Jersey, Northern California, Oregon and Washington to choose from. Again, you’re not limited to one state.

My advice to all doctors starting a practice is to get in a car with their spouse, and drive the country to give themselves a chance to fall in love with several different areas.

If I had had a chance to drive this country after graduating from chiropractic college, I would have practiced in Boston, San Francisco, Southern California or Florida. Really narrowed it down, didn’t I? What I liked about Southern California is exactly the same thing I like about Florida. The same type people, same warm climate, and the same fresh air. However, Florida has more humidity than California; but you can live in Florida less expensively.

What was it that I liked about the northern states I chose? Boston has the same ambiance and educational opportunities as San Francisco. The people are very similar in attitude, dress, and education. The weather is comparably the same, except it snows in Boston. Winters in Boston are colder, whereas San Francisco has cooler summers.

When I wanted advice on where to set up my first practice, I wrote to my mentor and Logan Chiropractic College President, Dr. William Coggins. I wrote that I was undecided as to where I wanted to live and practice, but I was looking for the weather to be in the 70’s during the day and low 50’s at night. I’ll never forget his response. He said, “Pete, when you die and go to heaven, you’ll find weather like that. But, in the meantime, you should be looking in Florida or California!”


My Message to You Is Very Simple

Take the time to go out and look at different areas of the country. We advise our client doctors about “hot” and “cold” states every week. Discover where it is you would be happiest. Then analyze the states you like to determine which ones are “hot”. If you can be equally happy in a state that qualifies as “hot” as opposed to a state you liked that turned out to be “cold,” choose the “hot state”. A “hot state” will allow you to see more new patients, generate more income and become more successful.

Now that you have decided which state you want to practice in, the next article in this series will discuss “hot” and “cold” towns. Yes, each city can add or detract from your success.

By the way, here’s some “gee whiz” information. Eighty percent of married male doctors will go to their wife’s hometown to practice. If the male doctor is single, eighty percent will go back to his hometown to practice. Interesting, isn’t it?


Dr. Peter G. Fernandez is a world authority on starting a practice. He has thirty year’ experience in starting new practices, has written four books and numerous articles on the subject and has consulted in the opening of over 3,000 new practices. Contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; Phone: 727-392-0822, 1-800-882-4476; Fax 727-392-0489; or visit



Leave a Reply