WalletHub, a personal-finance website, released a report Monday on the best and worst states for doctors to work in. California ranked toward the bottom at No. 40 out of 50 states plus the District of Columbia.

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To compare the states, WalletHub analysts examined 14 key metrics. The data set ranges from average annual wage of physicians to hospitals per capita to quality of the public hospital system.

While California ranked low (No. 46) for opportunity and competition factors, such as hospitals per capita, the insured population rate and primary care provider shortage, the state was actually ranked No. 8 overall for its medical environment, which examined the quality of the public hospital system, punitiveness of the state medical board, the malpractice award payout amount per capita and the annual malpractice liability insurance rate.

Among opportunity and competition factors, wages were given double weight. While California likely has higher salary amounts, wages were adjusted for cost of living, which brought the state’s ranking down significantly. For average annual wage of physicians, California was No. 44, and for average monthly starting salary, the state ranked No. 40.

With a higher population, California also does not have as many insured residents and hospital facilities as many other states. California ranked No. 39 for insured population rate and No. 26 for hospitals per capita.