Iowa health care leaders working on Iowa’s physician workforce challenges are optimistic that Gov. Kim Reynolds’ proposed legislation to create more than 450 new medical residency spots over the next four years will improve physician retention, the Business Record recently reported.

Increasing residency spots is one of the solutions identified in the Operation IOWA (Innovative Opportunities for Workforce Action) report, released by the Iowa Medical Society at the end of January. The report was created after a December 2024 summit that convened nearly 60 leaders from across the state to identify possible solutions for Iowa’s physician workforce shortage. It details 24 early-, mid- and late-career proposals.

Reynolds’ proposal has progressed through the Legislature in both chambers. House File 972 passed the full chamber on March 26 and Senate File 618 was introduced to an appropriations committee on April 1 after passing a subcommittee.

Dr. Maria Guevara Hernandez has worked at MercyOne Des Moines Medical Center for 11 years and for the last three years has served as the internal medicine residency program director, leading both the categorical internal medicine and primary care tracks.

Her role spans administration; education and inpatient care duties, including ensuring compliance with the Accreditation Council for Graduate Medical Education requirements; overseeing resident recruitment and selection; maintaining and updating the program curriculum and patient safety standards; coordinating with hospital administration; leading faculty development; and managing program budgets.

Below, she shares about the workforce challenges she sees in her work, and the possible effects of the legislation increasing residency spots.

If the legislation creating more than 450 new medical residency spots over the next four years passes, what effect do you think that will have on your work and Iowa’s overall health care workforce pipeline?
Expansion of residency programs requires new curriculum planning, faculty recruitment and resource allocation. More residency slots will help retain more physicians in Iowa, especially in underserved and rural areas, at least increasing the likelihood that residents will stay in Iowa after training. It is a great opportunity. It will require careful planning, faculty investment and resource expansions to ensure these new residency slots maintain high-quality training and meet Iowa’s long-term health care needs. The key will be strategic implementation to ensure sustainable growth.

How do the effects of health care workforce challenges show up in your work? Can you provide an example of an impact it has had in your day-to-day work?
Health care workforce challenges show up in my work as a program director and hospitalist in several ways, impacting both patient care and medical education. Physician shortages, especially in primary care and rural areas, lead to more admissions, increasing inpatient census and stretching available resources. Recruiting and retaining high-quality residents and faculty is difficult, especially in underserved areas. We have had outstanding senior residents who wanted to stay in Iowa but could not because of limited fellowship opportunities in their specialty of choice.

Outside of increased residency spots, are there other initiatives you think would help Iowa health care organizations address workforce needs?
Expanding residency slots is a great start, but Iowa health care organizations need a multifaceted approach to truly address workforce challenges. More fellowship slots and stronger support for existing residency programs is crucial. Many residents leave Iowa because they can’t find fellowship training in their specialty. If we had more fellowship programs, we could retain talent and increase the number of specialists staying in the state.

Expanding spots isn’t enough, programs need faculty, funding and infrastructure to properly train more residents. It is important to increase funding for faculty development and protected teaching time to prevent burnout, expand resident wellness programs to improve retention and prevent early burnout, and improve hospital infrastructure. If Iowa can implement a combination of these initiatives, we can build a sustainable health care workforce that meets both current and future needs.