Gov. Reynolds signs bill intended to increase medical access in rural Iowa

WASHINGTON, Iowa — Physician assistants in Iowa no longer will be required to be supervised and have a written agreement with a specific physician in order to practice medicine under a bill signed into law Wednesday by Gov. Kim Reynolds.

Proponents say the measure will ensure PAs can more easily address the health care needs of Iowa’s underserved rural communities, authorizing them to provide health care services based on their medical education, training and experience.

“It really is an important bill that safely expands access to care by making it easier for physician assistants to practice in our state,” and addresses a clear need, Reynolds said. She said roughly 60 percent of physician assistants who graduate from Iowa colleges and universities leave to practice in other states that allow them greater independence and flexibility.

“PAs are capable, well-trained medical professionals who should be given every encouragement to serve Iowa communities, and that is what today’s bill is all about,” Reynolds said. “By eliminating the requirement for supervisor agreements between physicians and PAs, it allows providers and practitioners the flexibility to really structure the relationship as they see fit, rather than dictating an unnecessarily restrictive approach from the top down.”

How many PAs work in rural areas?

More than 40 percent of Iowa’s PAs work in rural settings, according to the Iowa Physician Assistant Society.

Reynolds noted the state takes a similar approach with nurse practitioners, “who continue to work collaboratively with physicians to meet the health needs of Iowans.”

The governor signed House File 424 during a ceremony at the Washington County Hospital and Clinics. Reynolds said the hospital and clinics serve “as a model of the kind of high-quality rural health care that every Iowa county needs and deserves.”

PAs play a critical role in providing both primary and specialty care — including mental health — at a time when Iowa is grappling with a shortage of providers and faces challenges providing equitable access to care due to the state’s large rural and aging population, said hospital Chief Executive Officer Todd Patterson.

Patterson said the law will allow the critical access hospital to draw from “a larger pool of talent” in rural areas, by “eliminating some of the administrative burdens that currently exists.” Requiring oversight by a specific physician presents challenges for rural hospitals that struggle to find physicians.

“Or, if you lose a physician, it may threaten your ability to maintain that relationship with a PA,” Patterson said.

As a result, Washington County Hospitals and Clinics does not currently have physician assistants on staff. All PAs utilized by the hospital and its three rural health clinics are contracted through other entities.

Removing the requirement now provides the hospital the opportunity to recruit PAs directly and more effectively — something Patterson said the hospital plans to pursue to improve access to care in rural communities.

“I really think that this gives us an opportunity address urgent health care needs in our town, our county and by extension our state,” he said.

State Sen. Dawn Driscoll, a Republican from Williamsburg whose district includes Washington County, floor managed the bill in the Iowa Senate. Driscoll hosted a legislative forum at the hospital last month with Rep. Heather Hora, a Republican from Washington, who supported the bill.

Driscoll said those conversations drew newfound attention to the issue, and she called the bill one of the more consequential items to pass this session.

Bill gives ‘goose bumps’

“It gives me goose bumps, you know, that you can see great legislation come forward and where it’s going to benefit all of Iowa, and especially rural Iowa,” Driscoll said.

Reynolds said the bill is part of package of proposals and priorities passed this session seeking to improve access to health care across Iowa, including targeted student loan forgiveness, fellowship programs and capping non-economic damages in medical malpractice lawsuits.

Reynold said she hopes the new law signals to PAs that “Iowa wants to welcome them with open arms, and we certainly want to keep you here.”

“We don’t want any more of you leaving the state,“ she said.

Critics, though, have said others measures signed into law by the governor placing new restrictions on transgender youth — including banning transgender minors from receiving gender-affirming care — will make it much more difficult to recruit providers to the state, making Iowa seem unwelcoming for LGBTQ people.

Reynolds pushed back, arguing the state has seen a net migration into the state.

“I believe you are going to continue to see those numbers grow,” Reynolds told reporters. “I’m really excited. Our national profile is rising. We are reducing taxes and regulations. We’re building out our health care system. We have been recognized as a top 10 state to live by U.S. News and World Report. … So I am excited about what is happening, and I am excited about our future.”

Reynolds did not respond to a reporter’s question about whether she would call lawmakers back for a special session to further restrict access to abortion, depending on how the Iowa Supreme Court rules on her request to reinstate a 2018 state law that would ban the procedure except in the earliest weeks of pregnancy before taking any more steps to restrict abortion in the state.

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