Lacking in Iowa’s attempt to add psychiatrists: trainers

DES MOINES — A lack of board-certified physicians needed to provide supervision, training and evaluation is hampering efforts by University of Iowa Health Care to staff residency sites under a state-funded psychiatry residency program created by lawmakers to address a severe shortage of mental health professionals in the state.

Lawmakers passed and Gov. Kim Reynolds signed a multimillion-dollar public health bill in 2022 that included funding for up to 12 additional positions for each residency class at the university to work at five designated state facilities, pending approval by the Accreditation Council for Graduate Medical Education.

Legislators last year amended the law to create nine psychiatric residencies and two psychiatric fellowships to be completed by medical school graduates in conjunction with the state Department of Health and Human Services. The legislation provided $100,000 annually for each residency and $150,000 annually for each fellowship to cover the cost of training, starting with the current fiscal year that began July 1.

Once approved, participating residents would complete a portion of their training at state mental health institutes in Cherokee and Independence, serving people with serious mental illness; the Iowa State Resource Center in Woodward, serving individuals with intellectual disabilities; the Iowa Medical and Classification Center at Oakdale, a medium security correctional facility; and the Iowa State Training Center in Eldora, serving adolescents with a history of criminal justice involvement.

However, only two of the five sites have been accredited, as the others lack required board-certified psychiatrists to give supervision, training and evaluation of residents, Jodi Tate, clinical professor of psychiatry and vice chair for education at the UI, recently told lawmakers. And those psychiatrists at the sites have heavy clinical loads, Tate said.

Citing a need to be creative for undertaking the expansion, “It’s not going to be a sprint. It’s going to be a marathon,” Tate said.

In its efforts to address barriers to accreditation, UIHC created elective rotations at four sites and added a board-certified psychiatrist at the State Training School in Eldora by using telepsychiatry through a collaboration with Health and Human Services to provide supervision for a resident providing care child and adolescent psychiatric care.

Tate said UIHC also is collaborating with rural clinics to expand telepsychiatry to deliver outpatient care in underserved areas, starting with hospitals and clinics in Washington and Van Buren counties. Outpatient care is a required component for psychiatry residency training programs.

UIHC also created a new one- to two-year public psychiatry fellowship for psychiatrists who have completed an accredited psychiatric residency training and who are interested in pursuing a career working with individuals who have complex health needs and/or underserved populations. Fellows can practice independently and supervise residents, addressing the accreditation challenges, Tate said. However, UIHC received only one applicant, who later declined the offer to participate.

Tate said UIHC has seen unexpected interest from residents wishing to participate in the fellowship during their fourth year of residency, but doesn’t address the challenges UIHC faces meeting accreditation standards.

“What I worry about is recruiting, getting psychiatrists at these sites to be able to expand more and have more learners at those sites,” she told lawmakers.

Tate suggested legislators amend eligibility requirements under the Rural Iowa Primary Care Loan Repayment Program established to address critical doctor shortages in rural communities to include those attending a residency program in Iowa in addition to medical school. The program provides loan repayment incentives up to $200,000 to individuals who practice in specified locations for up to five years.

Tate said that would help with recruitment, calling the current 60 percent retention rate of UIHC-trained psychiatrists, changes to loan repayment requirements and state funding to increase psychiatric residents a “winning combination.”

“I think we’re getting momentum, and I think we’re going to get there,” she told lawmakers.

There were 212 licensed psychiatrists practicing in the state in 2021, down from 236 in 2012, according to Iowa Health Professions Tracking Center at the UI Carver College of Medicine. And 66 percent of Iowa psychiatrists work in Johnson, Linn and Polk counties. Seventy-three of Iowa’s 99 counties do not have a psychiatrist.

“I agree that loan repayment always helps with recruiting physicians to the state. So if there’s a chance … to expand our loan repayment program, I think that would help with recruiting physicians to the state,” said Rep. Ann Meyer, R-Fort Dodge, chair of the House Health and Human Services Committee, said.

Meyer suggested the possibility of giving priority to Iowa students, but opening it up to graduates in surrounding states “if we’re not filling enough spots.”

“It’s interesting we don’t have all of those (residency) spots filled because we don’t have enough trainers,” she said.

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