A recent push to increase the number of medical residencies has health care leaders in Iowa optimistic about finding a cure for the state’s physician workforce shortage. 

After Gov. Kim Reynolds proposed a plan to use $150 million in federal dollars to create 115 new medical residency spots each year for the next four years, the hope is that opening more training opportunities in Iowa will lead to more people staying to practice. 

House Study Bill 191 was introduced to the Iowa Legislature on Feb. 17, and on Feb. 25 the House Health and Human Services Committee unanimously passed it. In addition to increasing the number of residency slots, the bill would consolidate, and more than double, the funding for current state-funded student loan repayment programs to $10 million.

The advancement comes on the heels of the January release of the Operation IOWA (Innovative Opportunities for Workforce Action) report, which outlines seven early-career physician pipeline solutions, nine midcareer solutions and eight late-career solutions for tackling the physician workforce crisis. 

Iowa is currently ranked 45th in the nation for patient-to-physician ratios per 100,000 population, according to the Iowa Medical Society.

Dr. Tom Evans, president and CEO of Compass Healthcare Collaborative, said the difference between now and over two decades ago, when he worked on workforce shortage issues as the Iowa Medical Society president in 2003, is a more comprehensive approach. 

Back then, Iowa ranked 45th in the nation in OB-GYNs per capita; today, it’s 51st, behind every other state and Puerto Rico. 

“We knew that we needed to increase residency slots [in 2003], but I would say the difference this time is we’re much more sophisticated with how we are working to increase the number of residency slots and how we’re working to support people so that they’ll stay in Iowa,” said Evans, who was part of the group that helped brainstorm solutions during the Operation IOWA summit in December.

The first early-career physician pipeline solution listed in the Operation IOWA report is to increase the number of residency training positions and provide financial support for medical educators across Iowa.

“We are tremendously excited that Gov. Kim Reynolds has taken on the physician shortage crisis and led in a very bold and visionary way by recommending that we increase the number of residency training slots in Iowa because the No. 1 indicator of where a resident will locate and practice and work is where they did their residency,” said Iowa Medical Society CEO Steve Churchill. “And right now, there’s not enough residency slots in Iowa to fill the needs of our students.”

The payoff from increasing medical residency slots, however, won’t be seen in the immediate future. 

“As we know with reimbursement changes that are occurring, if these clinicians are independent, it is accelerating their decision to potentially leave practice early, and where this [medical residency] proposal of the governor becomes even more important,” said Dr. Hijinio Carreon, regional chief medical officer for MercyOne. “The challenge is, unfortunately, it’s not going to fix what happens here in the next few years because this is really more of a long-term play.”

In the short term, Carreon said nurse practitioners and physician assistants have helped fill the gap in rural communities but are limited in what they can do and what they can manage, requiring a physician “to help them see those complicated cases.”

Public policy research organization Cicero Institute reports that 65 of Iowa’s 99 counties are health professional shortage areas.

“We know that there are certain areas that just don’t have any specialty care, and people have to travel significant lengths to get health care, and oftentimes that means that they’re just not receiving it,” said Dr. Christina Taylor, president of the Iowa Medical Society’s board of directors. “They either can’t do the travel or get the arrangements, so health care is being delayed or not occurring at all. So for the sake of people truly having access to care and getting the health care that they need, this impacts everyone in the state.” 

Among current practicing physicians in Iowa, 31.9% are within retirement age, according to the Cicero Institute, and part of what health care professionals are referring to as the “silver tsunami.” 

Iowa’s aging general population also means the need for medical care will continue to rise. In 2030, Iowans over 54 years old are expected to make up 41.1% of the working population, nearly 12 percentage points higher than in 2000, according to the Census Bureau. 

“Everybody knows that the demographics are shifting to an older population, but those people, older people, use more medical care,” Evans said. “They have more complex medical problems, and they need to be managed more aggressively. So we have more need and decreased capacity, and we’re kind of reaching a bit of a crisis mode now.” 

Brad Whipple, medical group chief operating officer for MercyOne, helps support advanced practice provider recruitment, including nurse practitioners (NPs) and physician assistants (PAs) for the nonprofit system of hospitals, clinics and health care facilities. MercyOne has seven major markets across Iowa in addition to 31 owned or affiliated hospital associations.

“What we’ve seen just on the primary care side alone is we’re facing an incredible deficit of primary care physicians across the state,” Whipple said. 

At MercyOne’s clinic in Centerville, where there is only one physician and four NPs and PAs, Whipple said they have been trying for three years to recruit a physician. 

“In the short term, we’ve had to restructure what that physician does and how he actually practices,” Whipple said. “He spends more time supporting those NPs and PAs and less time seeing patients just to make sure that they have the support that they need to be able to take care of the patients that they’re seeing in Centerville.”

With an aging population in the county seat of Appanoose County, the clinic is seeing more chronic diseases, he said.

“Short-term solution for us is how do we create team-based approaches, and at the same time, we’re trying really hard not to burn him out in the process,” Whipple said. “So in those communities, he’s the primary care physician, but he’s also overseeing the hospitalist program, overseeing the [emergency department], he has been the county coroner for a period of time, so it’s a lot to ask of those physicians in those areas.”

While there is broad support for increasing the medical residency slots available, one of the concerns is having the faculty in place to train students. 

“Could we look at individuals who are retiring within the state to try to get them to stay into practice longer, so they can help us build this pipeline?” Carreon said. “That’s something that we probably need to explore further, but we have to understand more kind of what the governor’s intent is with those dollars and how it’s going to impact us directly, so then we can better speak to what we can do.”

Dr. Paul Manternach, a family medicine physician in Mason City, underscored that “community-based, not-for-profit, mission-driven hospitals within the state of Iowa are producing a little over 40% of all the family medicine doctors.”

“One of the things we struggle with in this physician shortage area is we’ve got a physician shortage, so we need our physicians seeing our patients,” he said. “Well, education also takes time, so hopefully through this grant, as it gets structured and we get more information about it, we’ll see that there’s support for those educational departments within the community settings that are responsible for 40% of our primary care education.”

Mary Cownie, vice president of advocacy and government relations for MercyOne, is hopeful that the influx of residency slots will decrease the number of students leaving the state to train. 

“Ideally, if you increase the slots, you start to shift that problem where you’re not turning people away who want to stay in Iowa, who then have to leave,” she said. “Whereas we know if we can kind of keep that pathway and keep them here, our chances are going to increase.”

Taylor noted that the ability to attract and retain physicians to Iowa also requires a communitywide approach.

“We know that doctors don’t just work,” she said. “They live in their communities. They have families, they want to have fun hobbies and things to do and really be part of their communities and live and work in a place that they enjoy. 

“This really takes all of us to work on creating environments where physicians want to practice, so creative things that the chambers of commerce, local businesses can do to help make sure that we’ve got good housing. Just involve yourself as a community in helping the recruiting of physicians to your area. It’s good not only to bring the physicians in, but then it’s good for the community because you have those physicians help take care of everyone else in your city.”