Iowa is among the worst states in the country for physician-to-patient ratio.
It ranks 44th in United States for physicians per capita, according to the Iowa Medical Society. The problem is especially acute for patients in rural areas seeking specialized care.
It takes several years to train and educate a physician, so there is no quick fix. By 2030 — five years from now — Iowa is expected to be short about 1,600 doctors.
But healthcare professionals are working on solutions. The Iowa Medical Society is gathering representatives from across the state for an invite-only summit on growing and retaining the physician workforce. Operation I.O.W.A. (Innovative Opportunities for Workforce Action) will be held in Des Moines Dec. 6.
Why the shortage exists
Baby boomers are living longer than previous generations, and that's creating more need for patient care. At the same time, many physicians are baby boomers themselves, and they're getting ready to retire, said Steve Churchill, CEO of the Iowa Medical Society.
Other younger physicians are also experiencing burnout as a result of the pandemic and other workplace stressors.
“Physicians are concerned about the work-life balance and changing preferences in terms of their lifestyle, and the administrative burden is making it less attractive for some people to stay in the workforce,” Churchill said.
Replacing all those exiting the profession is no small task.
“When you consider that it takes over ten years from start to end to educate and train a physician, you really need to be planning ahead and have them in the pipeline earlier,” Churchill said.
For those in the pipeline, there's a limited number of residency slots where they can get the training they need. According to a presentation from Dr. Gerard Clancy, senior associate dean of the Carver College of Medicine, there are about 380 medical school graduates in Iowa every year, but only 278 first-year residency positions available each year.
How patients feel the impact
All of these factors have led to what Dr. Christi Taylor, chief medical officer of Clover Health, calls “a true crisis in the physician workforce.”
One way this manifests is in maternal healthcare deserts. According to data from the Iowa Medical Society, 31 obstetric units have closed in Iowa from 1999 to 2023. This has led to more rural mothers delivering at hospitals in urban areas.
Other specialized care is also difficult for rural patients to access. For example, Taylor said a new patient trying to see a neurologist could have to wait upwards of six months to get an appointment.
Great River Health is an independent health system in southeast Iowa with hospitals in Fort Madison and West Burlington. There are also several rural healthcare clinics within the system.
Dr. Michael McCoy, president and CEO of Great River Health, said 70 of the 93 rural units have had a loss in services.
“The reason you have the loss in services is because it's very difficult to recruit — yes, physicians, providers, but also some of the talented techs and support team that goes along with that.”
Solving the crisis
Churchill said he expects about 10% of the conversation at the Operation I.O.W.A. summit to be about the problem and 90% to be about the solutions.
“We hope to be able to come up with a short list of solutions that we can share with policy makers and academic institutions and with clinics that they can act on,” he said. “And we want to be collaborative with the Legislature and the office of the governor, but we also want to have solutions for the people who are out practicing every day.”
For Dr. Gerard Clancy, senior associate dean of the Carver College of Medicine, this means looking at the entire workplace pipeline.
“We need to look at the pre-meds, and, unfortunately we have a drop off in high school graduates going to college in this country. That'll probably get worse,” Clancy said. “We have medical students who are significantly burdened by their loan debt. We have residents who also were concerned about their loan debt. And then we have a practice environment that is not particularly happy.”
To mitigate this, Clancy proposed expanding the loan payback program in Iowa to include more physician specialists. He hopes legislative support will make that happen, but at the university level, he said the University of Iowa has been asking for private support to fundraise for scholarships as well.
He also said workshops physicians are required to attend lead to administrative burnout.
“For a first-year physician in Iowa, it's about 61.5 hours a year of additional training you have to do to keep your license going,” Clancy said. “That's nearly, you know, two weeks of physicians removed from practice in their first year.”
If those hours could be reduced to more efficient workshops, that would improve the workplace environment, he said.
McCoy added that onerous documentation is another administrative burden that can be streamlined.
“Believe it or not, for every 30 minutes a physician spends with the patient, they spend 45 minutes with paperwork,” McCoy said.
The experts highlighted there are many pressure points in the workforce and a multipronged approach will be needed to strengthen healthcare in the state.
“Our vision is to be the trusted voice to make Iowa a premier destination for physicians to live, work and to serve their community,” said Churchill.
To hear this conversation, listen to River to River, hosted by Ben Kieffer. Dani Gehr produced this episode.
