Urgent need to address rural doctor shortage, national medical leader says in Iowa

DES MOINES — Bruce Scott sees the impact of physician shortages as he travels the country as president of the American Medical Association.

Scott fears the issue will only get worse unless more steps are taken to recruit and retain physicians, especially in rural areas.

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The problem is pronounced in Iowa. The state’s 227 physicians per 100,000 population is among the worst in the country, according to data compiled by the Association of American Medical Colleges.

Only seven states have lower rates of physicians per capita, according to the data.

“All of us became physicians to take care of patients, and that’s getting more and more difficult to do,” Scott said Friday during an interview at the Iowa Medical Society’s office. “The health care system should help us deliver quality of care and instead it’s getting in the way.”

Scott, an otolaryngologist and head and neck surgery specialist who has a private practice in Louisville, Kentucky, was in Iowa to meet with the Iowa Medical Society’s board of directors during the group’s annual summer meeting.

The Iowa Medical Society is a nonprofit professional advocacy organization that represents more than 6,000 physicians, residents, and medical students across the state, according to the organization.

During Friday’s interview, Scott and Christina Taylor, the Iowa Medical Society Board President, spoke about the need for more doctors as well as their concerns for how Iowa’s new abortion restrictions will impact a shortage of obstetricians and gynecologists.

Physician shortage in Iowa

Iowa ranks 45th in the nation for patient-to-physician ratio, and 97 of the state’s 99 counties are classified as health professional shortage areas, according to the American Medical Association.

According to the AMA, the situation in Iowa will become even more untenable with the prospect of rural Iowa physicians retiring and not being replaced by younger physicians due to lower wages, increased administrative burden, and the rising cost of practicing in rural areas.

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Sounding the alarm: Iowa needs more doctors

Patients are feeling the impact, Taylor said. She said the shortage has a pronounced impact on patients hoping to see specialists. She said some rural Iowa patients, unless they are facing emergencies, are being forced to wait up to three months to see a cardiologist or six months to see a neurologist.

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“That’s typical right now,” Taylor said. “So that’s as a new patient needing an evaluation for, ‘Hey, does Dad have Parkinson’s? Well, we’ll be getting an appointment in six months.’ That is not unheard of right now.”

Potential solutions

Scott said three main forces are driving the shortage of physicians: lower reimbursement payments, increased demands on administrative tasks, and debt for recent graduates.

To address student debt, Scott said loan repayment programs have proved to be effective physician recruitment tools. Iowa has such a program: the Rural Iowa Primary Care Loan Repayment Program. Although Taylor said the program has not been fully funded.

The Iowa program provides loan repayments up to $200,000 for doctors who graduate from an Iowa medical college and practice for at least five years in an Iowa community with a population of less than 26,000 that is located more than 20 miles from a city with a population of at least 50,000, or for psychiatric physicians in a federally designated mental health shortage area.

“The mechanism exists, but can we please fully fund that? Because it does work. It absolutely is an incentive,” Taylor said.

The state-funded program was allocated $2.6 million for the budget year that began July 1.

In the 2022 state budget year, there were 17 recipients and the average award was $189,000, according to the Iowa Legislative Services Agency.

Scott and Taylor also suggested more residency programs, citing research that shows young physicians are more likely to remain in an area where they serve their residency.

Impact of abortion restrictions

Scott and Taylor expressed concern for the impact of new restrictions on abortions in Iowa that will go into effect soon as the result of a recent Iowa Supreme Court ruling.

The June 28 ruling cleared the way for a law to go into effect that will ban abortions once cardiac activity can be detected, which is typically around the sixth week, often before the parent is aware of the pregnancy.

Taylor said the law violates a sacred trust between the physician and patient. She said it also will make it even more challenging to keep OBGYN physicians in Iowa, further exacerbating what is already a shortage.

“We’re disappointed in the recent ruling,” Taylor said. “We already have a physician shortage and we have deserts across Iowa where maternal fetal care is already a problem. And so we do anticipate that this will make things worse, and people who want to be able to provide health care and be obstetricians, it will be more difficult to recruit new practicing physicians.”

Scott said abortion restrictions like Iowa’s new law discourage physicians from becoming OBGYNs because it can force doctors to decide when a patient’s life is threatened from a legal standpoint instead of a medical standpoint.

“When you’re taking care of a patient, you don’t want to think about, ‘Am I going to lose my license? Am I going to go to jail? Am I going to get in trouble?’ You want to be taking care of the patient,” Scott said. “When you ask for a consultant, you want it to be another doctor, not a lawyer to find out whether you can give the care that you believe is in the best interest of your patient.”

Abortion in Iowa remains legal until roughly the 20th week of pregnancy, but only until court procedures in the coming weeks allow the new restrictions to go into effect.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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