For medical students in Iowa and throughout the country, Friday was Match Day. That's an anxiety-filled reveal ceremony where the soon-to-be graduates open sealed envelopes to find our where they'll do their residency training. The post-graduate programs are vital to earning a license to practice, and help determine if young doctors will stay in the state.
There’s a clear connection between where a physician did their residency and where they end up practicing. But Iowa doesn’t have enough residency slots for its growing number of medical students. That means the state is missing out on potential doctors. And of the residents that are here, two thirds may leave once they’re done, says Joyce Vista-Wayne, president of the Iowa Medical Society.
“Why are we not recruiting and retaining physicians in Iowa? Lots of factors, but you know, number one…number one is economics,” she said.
Namely, high student debt and lower pay compared to other states.
“They’re starting their practice with $200,000 to $300,000 in debt with them! So obviously they’ll be going to a state where they know that at least for compensation it would help offset the expense,” she said.
According to the Association of American Medical Colleges, the median amount of student loan debt for medical students in 2016 was $190,000, and the median overall cost of attendance was $249,000.
But Chris Cooper at the University of Iowa's Carver College of Medicine says debt isn't the largest factor in recent graduates' career decisions. He oversees medical education at the school. Cooper cites mentoring opportunities and support networks, as well as the quality of life and amenities of a community. He says others, even native Iowans, "just want to get out". But once graduates move away and jumpstart their lives and careers, it's difficult to get them back.
"If they leave for residency, it's a 15-20 percent chance they come back," Cooper says.
Which is why Cooper says expanding residency programs is key to meeting the state's need for physicians. But Congress capped federal funding for residency slots back in 1997. Cooper says the chances of Washington changing that are slim. And he doesn't have faith state lawmakers will allocate new funding either.
In the meantime, Cooper says Iowa is getting good at exporting medical students to other states. According to the Association of American Medical Colleges, Iowa ranks 10th in the country for the number of medical students per 100,000 people, but it ranks 44th in the number of active physicians.
If Iowa doesn’t retain more physicians, the state is projected to have a shortage of 200 primary care doctors by 2025.