A new report released by the online finance website WalletHub ranks Hawai‘i among the worst states in the nation for practicing physicians.

In 2018’s Best & Worst States for Doctors, Hawai‘i ranked dead last for the average monthly starting salary of physicians, adjusted for cost of living. The Islands also ranked 50th in the nation among the states with the worst average annual wages for physicians, just head of Washington D.C.

The nationwide analysis was conducted to help doctors decide where to practice, and compared U.S. Census Bureau data across the 50 U.S. states and Washington D.C.

Hawai‘i ranked as follows according to the metrics:

Practicing in Hawai‘i (1=Best, 25=Average): 50th – Average annual wage of physicians (adjusted for cost of living)

51st – Average monthly starting salary of physicians (adjusted for cost of living)

20th – Hospitals per capita

13th – Projected percentage of population aged 65 and older by 2030

29th – Malpractice award payout amount per capita

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Overall, Hawai‘i ranked 47th in the nation among the worst states for doctors to practice in, ahead of Rhode Island, New York and New Jersey.