Gov. Reynolds presented plans to tackle Iowa’s physician shortage. How will they help?

Plans outlined this week by Iowa Gov. Kim Reynolds to address the state’s physician shortage by increasing medical residency slots in the state could help bolster access to physician services and rural health care.

The challenge will be making sure new residency slots can be supported across the state, as many small hospitals lack the infrastructure for residency programs, said Dr. Michael McCoy, president and CEO at Great River Health in West Burlington.

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“Not every hospital system, not every community can just say, ‘Hey, we can support a residency.’ The infrastructure to set that up is really difficult,” McCoy said.

Iowa and the rest of country is grappling with a worsening physician shortage, resulting in fierce competition for medical professionals. The United States is projected to have a shortage of up to 64,000 physicians that is expected to grow to 86,000 by 2036.

In 2024, Iowa had 5,778 working physicians, down from 5,900 in 2023, according to Greg Nelson, assistant dean for clinical education programs at the Carver College of Medicine, who shared the numbers with The Gazette last year.

"The No. 1 reason for retiring, or relocating from Iowa, was they were generally not happy“ with their practice, Nelson said last May. ”The second reason was salary and income. Third was lifestyle.“

The COVID-19 pandemic also exacerbated burnout among physicians, leading to more leaving the industry. And many physicians will reach retirement age within the next decade.

Governor’s plan would train 460 new doctors over four years

Iowa ranks 44th in the nation for patient-to-physician ratio per 100,000 population. Iowa also has the fewest OB/GYNs per capita of any state, according to the American College of Obstetricians and Gynecologists, and is one of five states with the highest losses of access to obstetric care over the past 13 years.

While the shortage of physicians in the Cedar Rapids-Iowa City Corridor is not as pronounced as it is in rural areas, top health officials in the area told The Gazette last year they’re concerned that problem will grow with time.

"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 last May. "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, Quinn 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.

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Sounding the alarm: Iowa needs more doctors

The state must do better, Reynolds said this week in her Condition of the State Address.

In an effort to increase the number of physicians in the state, Reynolds announced plans to create 115 new medical residency slots in Iowa each year for the next four years at the state’s 14 teaching hospitals.

Reynolds said she’s directing the Iowa Department of Health and Human Services to partner with University of Iowa Health Care and Broadlawns Medical Center in Des Moines to secure $150 million in federal dollars to train new medical residents. Once fully implemented over four years, 460 new physicians would be trained in Iowa, the governor’s office projects.

A spokesperson said UIHC officials were not available for comment Friday, and that they would likely have more information to share in the coming weeks. A Broadlawns spokesperson did not immediately return a message seeking comment Friday. A representative from the Iowa Hospital Association also was not immediately available for comment Friday.

Iowa has more medical school graduates each year than available first-year residency training positions, McCoy said.

Providing funding for more residency and fellowship training positions and financial support for medical educators across Iowa is crucial to closing the state’s workforce gap, he said. Residents and fellows who train in Iowa have a greater chance of staying in the state, according to the Iowa Medical Society.

Doing so, however, will require a more robust statewide teaching and supervision infrastructure, and consistent funding, McCoy said.

Smaller communities and hospitals have some family medicine and mental health residencies, but to expand the slots available, more infrastructure must be established, he said.

For example, in southeast Iowa, Great River Health can support residents through rotations, but not a residency program. McCoy said. Specialties like OB/GYN also need more support in the state, he said.

Funding for residency programs has been established through the Centers for Medicare & Medicaid Services, but reimbursement is difficult to provide, McCoy said.

“This, I think, really can help support the infrastructure in areas that are there, and then I think it'll be upon the rest of us in the state that have the ability to support that ... to have some slots where we can have rotations for some of the training for those residents,” he said. “A lot of us can help with that, but not a lot of us can set up a residency program.”

Reynolds this week also proposed:

The governor also announced $3 million in state grants designed to help fill high-demand health care jobs. Awarded programs must be work-based learning programs with an “earn-and-learn” component. That can include a registered apprenticeship, on-the-job training, or related programs, according to Iowa Workforce Development.

Reynolds said the grants will help bring “more medical professionals to every part of our state while strengthening our health care talent pipeline for many years to come.”

The governor said her administration also will seek federal approval to provide more Medicaid rate flexibility to encourage regional collaboration between health systems, with a focus on creating access to specialty care in rural areas.

‘Road map’ outlines nine ways to bolster Iowa’s physician pipeline

The Iowa Medical Society launched a physician workforce summit last month, gathering nearly 60 physicians, health care executives, policy experts and community leaders to craft solutions to combat Iowa’s physician shortage crisis.

McCoy serves a co-chair of that effort, Operation I.O.W.A. (Innovative Opportunities for Workforce Action). The group recently released its road map with recommendations to bolster Iowa’s physician pipeline.

Much of what the governor proposed aligns with the group’s goals and proposed solutions, McCoy said.

“We enthusiastically support and appreciate her really trying to get something right away to bolster the access to physician services,” McCoy said.

Among the group’s top solutions are increasing residency positions and physician reimbursement.

Each year, 400 physicians stop practicing in Iowa, according to the Iowa Medical Society. On average, about 35 percent retire, while 46 percent relocate to practice medicine in another state.

Iowa physician reimbursement is lower than most parts of the United States. As a result, a significant number of physicians with loan debt averaging $227,00 and up to $500,000, leave Iowa to practice in other states with higher compensation, McCoy said.

“That's a huge barrier to try to convince someone to come here, if they're going to get paid less for the same work that they can get paid for somewhere else,” he said.

Operation I.O.W.A. recommends the state:

By implementing a combination of these strategies, Iowa can make practicing medicine in the state more financially attractive and accessible for new physicians, McCoy said.

Dick Hogan, a correspondent for The Gazette, contributed to this report.

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