116 3rd St SE
Cedar Rapids, Iowa 52401
Sounding the alarm: Iowa needs more doctors
Problem is most acute in rural areas, but Corridor health care leaders worry about what’s ahead
- Top health officials in Cedar Rapids and Iowa City say the state is facing a physician shortage.
- The problem is more acute in rural areas, which have difficulty recruiting physicians because of lower pay.
- Even in cities, fewer physicians are choosing primary care, instead opting for specialties that come with higher pay.
- The shortage is expected to intensify in the next seven to 10 years due to physician retirements.
Dr. Alexandra “Alix” Sharp graduated from the University of Iowa Carver College of Medicine this month. She’s doing her four-year OB/GYN residency at the University of Iowa Hospitals and Clinics in Iowa City.
“The faculty and residents were welcoming and supportive, and I felt like this was the place for me,” said Sharp, 25, whose undergraduate degree is from Luther College in Decorah. “I have a tremendous amount of respect for the providers I have worked with and have received incredible training.”
Sharp plans to keep living and working in Iowa, giving hope to the state medical professionals who will be in Cedar Rapids this week sounding the alarm about physician shortages in Iowa.
Iowa has 5,778 working physicians, down from 5,900 last year, according to Greg Nelson, assistant dean for clinical education programs at the Carver College of Medicine.
Linn County has 491 physicians now, down from 523 in 2019. Of those 32 doctors no longer working, 23 practiced family medicine, an area of shortages statewide, where two-thirds of the physicians who’ve left the workforce had been in family practice.
"The No. 1 reason for retiring, or relocating from Iowa, was they were generally not happy“ with their practice, Nelson said. ”The second reason was salary and income. Third was lifestyle.“
Of the six OB/GYN doctors who graduated from the UI this month, Sharp is the only one staying in Iowa for her residency.
‘10 years from now’
Top health officials in Cedar Rapids and Iowa City agree Iowa is facing a physician shortage, particularly in primary care, or family medicine, though it is not as severe in the Corridor as in rural areas of the state. All of the health officials interviewed for this story say they are continuously recruiting doctors.
"I'm more concerned about what happens 10 years from now,'' Dr. Timothy Quinn, president and CEO of Mercy Medical Center in Cedar Rapids, said. "People are living longer, having more complex health conditions and need doctors longer. It's an increasing mismatch between supply (patients) and providers.
In general, he said, people needing to see a doctor can get in to see one, though “it is more challenging than 10 years ago. It's going to be a more severe challenge seven to 10 years from now" due to the significant number of doctors who will be retiring in the next 15 years, he said.
One factor that is affecting health care professional numbers was the “burnout” physicians and nurses experienced during and following the COVID-19 pandemic, Quinn said, noting the hiring and recruiting of nurses is just now getting back to normal.
The biggest physician recruiting challenges he sees now are in oncology (cancer) and gastroenterology specialties.
“We want quality trained people whose mission matches ours,” Quinn said. “If we can get them to Cedar Rapids, they almost always stay here. (Our patients) are nice to work with. That's not true in a lot of places around the country.”
What to do?
Iowa ranks 45th in the nation in patient-to-physician ratio per 100,000 population.
That and other “pressing issues” are what Iowa Medical Society officials will be discussing with the Cedar Rapids health care providers throughout the day Wednesday, one of several such meetings the society is holding around the state. The discussions will be followed by a networking event in Cedar Rapids in the evening.
“Communities like Cedar Rapids are essential to the progress of addressing Iowa’s physician shortage. With the University of Iowa Carver College of Medicine so close by, we must focus on retaining graduates through strategic residency placements,” said Dr. Alison Lynch, president-elect of the Iowa Medical Society and a doctor at UIHC.
The U.S. had a shortage of about 46,000 doctors in 2021, a number projected to rise to 124,000 by 2034, according to the Association of American Medical Colleges. Up to 48,000 of those openings will be for primary care physicians.
Iowa’s physician workforce supply-to-demand was at a 75 percent adequacy in 2023. That’s projected to fall to 71 percent by 2036, according to the U.S. Health Resources & Services Administration.
The Iowa Medical Society is supporting five initiatives to expand the state’s physician workforce and aid in the recruitment and retention of physicians:
- Increasing from $2.5 million to $4 million for full funding of the Rural Physician Loan Repayment Program.
- Implementing polices called for in the Iowa Rural Healthcare Workforce Strategic Action Plan that was prepared for the Iowa Legislature.
- Increasing funding for more positions within Iowa’s physician residency and fellowship programs.
- Seeking opportunities for new residency and fellowship programs in Iowa.
- Creating tax credit incentives for new Iowa physicians and the experienced physicians who train them.
Close to crisis
Among those hesitant to term Iowa’s physician situation a crisis right now in Cedar Rapids is Dr. Dustin Arnold, chief medical officer at UnityPoint Health-St. Luke’s Hospital in Cedar Rapids.
“We're close. We're right on the cusp of being underserved in Cedar Rapids, based on our mature population,” Arnold said.
The city’s population has grown and is aging, requiring more care. In addition, physician retirements have increased from the usual dozen or so a year to more than 20 a year since the pandemic, he said.
And fewer physicians are choosing primary care, he said, noting young doctors are choosing specialty areas that come with higher pay.
Primary care is not in a desperate situation in Cedar Rapids, but the system is stressed, he said.
“It now takes about 10 to 20 days to get in for an appointment” with a primary care doctor, Arnold said. Emergency rooms and urgent care clinics are available to see patients who can’t wait that long, he noted.
Both UnityPoint and Mercy will be opening free-standing emergency rooms in Marion in the near future.
“However, rural areas have a more severe problem because they have a hard time recruiting new physicians, largely due to lower compensation,” Arnold said.
He said he ”loved rural health care“ when he practiced in Grinnell before coming to St. Luke’s in 2005.
Also, he said, rural doctors are on call more and can become isolated.
National problem
Dr. Gerard Clancy, senior associate dean for external affairs at the UI Carver College of Medicine, said the physician shortage goes beyond Iowa.
“This is really a national problem. The competition for physicians in national,” Clancy said, adding many physicians have a number of choices on where they work.
“Iowa has to make itself as attractive as possible,” he said. “We are trying to make an environment where physicians will want to stay here and practice ... and not want to retire early,” Clancy said.
Nationally, COVID burnout led to physicians retiring early, and a booming stock market has helped that trend along, he said.
The UI College of Medicine has about 1,500 physicians, with another 900 residents in training, he said.
Also, Des Moines University is graduating 213 doctors of osteopathy and 53 doctors of podiatry this month. The university is the No. 1 provider of primary care physicians in Iowa, according to spokeswoman Denise Lamphier, with 48 graduates entering primary care residencies in Iowa in 2023 and 2024.
Eric Dalton, CEO of the Physicians’ Clinic of Iowa (PCI) in Cedar Rapids, concurs the physician shortage is a national problem.
“I'm confident the needs of the community (here) are being met,” he said, adding, “Of course, we'd like to have more (doctors).”
PCI has 60 physicians, most of them specialists, and 25 physician assistants and nurse practitioners.
Family medicine is a small part of PCI's caseload, though Dalton said he’d like to see that area grow. The clinic also would like to have another neurologist on staff, Dalton said.
“Mental health care access and availability is a problem,” he said. “We do need more mental health care in Iowa.”
Challenges
One of those more worried about the physician workforce in the Corridor is Dr. Fadi Yacoub, who works at Mercy Cedar Rapids and is an Iowa Medical Society board member.
He sees Cedar Rapids as having “a persistent shortage across various specialties, including internal medicine, surgery, and trauma care.” Also, he said, patients now experience “significantly longer wait times” to get an appointment with a primary care physician.
He noted the closing of the Cedar Rapids Family Medicine Residency Program on July 1, 2020. Both Cedar Rapids hospitals supported the three-year residency program, begun in 1971, but discontinued it after only 31 percent of the family medicine residents remained in Cedar Rapids after they graduated.
That loss, he said, “highlights the city's reliance on external programs to meet health care needs.”
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