The 10 most entrepreneurial states in the US

Practice Management

Oregon was rated as the most entrepreneurial state in the U.S. followed by Idaho and Montana, according to data from QRFY.

For spine and orthopedic surgeons, that entrepreneurial spirit is often witnessed in private practices, which remain popular despite economic headwinds. Many physicians prefer the autonomy that running a private practice affords and the ability to focus on their specialties compared to a larger environment.

"The physician will have some control of his or her practice hours and, hopefully, eventual subspecialty practice environment, with the additional revenue possibilities of ancillary services, including ASC ownership, physical therapy, MRI, occupational health and medical equipment, etc.," Issada Thongtrangan, MD, of Microspine in Scottsdale, Ariz., said. "You can deliver quality care in a private practice setting. You can lower the practice expenses and adjust how you see fit without disrupting patient care."

The QRFY analysis looked at data from the U.S. Bureau of Labor Statistics to measure the number of new businesses in 2022 compared to 2023, according to a Feb. 22 news release shared with Becker's. States were ranked by the rate of business expansion.

The most entrepreneurial states are:


1. Oregon

2. Idaho

3. Montana

4. Virginia

5. Mississippi

6. Hawaii

7. Michigan

8. Tennessee

9. South Carolina

10. North Carolina

Analysts also ranked the least entrepreneurial. They are Washington, Nebraska, Maryland, Iowa, New Mexico, Nevada, Georgia, Delaware, Massachusetts and Pennsylvania.

The full dataset is here.

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