A panel of Des Moines-area health care professionals gathered for a public policy issue forum on Oct. 19 to discuss the status of Iowa’s health care system and the programs and policy initiatives they believe are needed to address the industry’s workforce shortage. 

Some key topics from the conversation included ways to incentivize physicians to work in rural areas; the need for hospitals to engage in partnerships across the community to help people get and stay healthy; expanding telemedicine services to rural communities; and developing a steady and diverse workforce pipeline with high school students.  

Speakers:

The four panelists were moderator David Stark, market president at UnityPoint Health – Des Moines; Anthony Coleman, then-president and CEO of Broadlawns Medical Center; Phil Blumberg, executive director of the Des Moines University Clinic; and Mike Wegner, MercyOne System chief operations officer and Central Iowa division president.

Broadlawns announced Nov. 2 that Coleman had resigned as president and CEO.

Following are four takeaways from the event, which was hosted by the Greater Des Moines Partnership.

Hospitals engaging in community partnerships is necessary “to make it as a society and maintain health”

Social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in the environments where people live, work and play that affect a wide range of health, functioning and quality-of-life outcomes and risks, according to the U.S. Department of Health and Human Services. Social determinants of health include economic stability, education access, health care access, neighborhood and built environment, and social and community context. 

“So when we talk about how hospitals benefit communities beyond just the acute care, there are a lot of hospitals that have realized nowadays, in order for us to make it as a society and maintain health, we have to engage in partnerships,” Coleman said. “What the pandemic has taught us is that now we thrive in ecosystems. Health care is an ecosystem where the hospital is the hub of the ecosystem. But in order to provide and maintain and sustain health, the hospital system needs partners, like the Greater Des Moines Partnership, it needs partners like United Way. There are things that a hospital can’t do that we can partner with organizations to do.” 

One example Coleman provided was Broadlawns’ partnership with the city of Des Moines that allowed for the completion of a walking trail. 

“Part of the social determinants of health is a safe neighborhood and walkability,” Coleman said. “I can say for myself, when I go home, when I get home in the evening, just taking a walk with my wife relieves stress, it relieves pressure, it adds to my health. We do that for 30 minutes a day, and you will add years to your life, or you will stop from shaving years off your life.”

Combatting lack of providers in rural areas with virtual care

Wegner said one solution to the difficulties of recruiting providers to rural areas is additional support for technology and infrastructure, so as new models of care are being developed, they can be available to rural communities. 

“I think today, with all of the technology that’s in place, a lot can be done virtually,” Wegner said. “Sometimes, you can have a program where you can set up a virtual primary care clinic, and if there’s not a physician in that community, you can do something over the computer, which might save that patient an hour and a half worth of driving time and have a great interaction with a primary care provider.” 

MercyOne, UnityPoint and Broadlawns all offer virtual care options (telehealth) that connect patients with a health care provider through a secure video chat without requiring the patient to leave their home.  

“It’s also important with this workforce shortage when you have a tertiary facility in Des Moines, make sure you have enough beds open for the patients who need that type of care,” Wegner said. “So how do you do that?” One of the ways is to make sure that you can provide the support to the rural communities so they have access to experts via some type of virtual connection, so you can keep those patients in that community. It’s better for the patient to not have to travel, they’ve got their family around them.” 

Panelists agree that more student loan forgiveness will attract talent, especially in rural areas. 

All four panelists shared their belief that more student loan forgiveness is needed to be able to recruit providers to rural areas. 

With rising costs of education, Coleman said physicians who are graduating with large amounts of debt are flocking to metropolitan areas where the pay rate is higher. 

“I think that there has to be bold policy, because what’s happening if you look at how exponentially expensive the cost of education has become, it has become cost prohibitive,” he said. “You have physicians who are graduating with half a million dollars of debt, and perhaps a spouse, so that’s a lot of pressure immediately.

“I don’t see policy catching up and answering that demand signal by saying, as a nation, we’re going to reward our physicians for going to rural areas by having these really attractive loan repayment programs. I mean, there is loan repayment out there, but it hasn’t kept pace with inflation of what it costs to get that type of education. So I think the short answer to this question would be I think there needs to be bold policy initiatives that incentivize physicians or health care providers for setting up practice in rural areas. And perhaps it’s two years, three years or four years, some type of commitment.”

Hiring high school students is improving the workforce shortage 

Wegner said that during each of the 2021-22 and 2022-23 school years, MercyOne hired about 125 high school students statewide, with about 45 of those students hired in the Des Moines area each year. 

This school year, MercyOne has 40 confirmed events at high schools in the state and expects to interact with over 15,000 students. 

“We have to figure out how to develop a robust, diverse pipeline with students,” Wegner said. “So a few years ago, we started to go back to the high schools that start[ed] to develop those future health care workers. We’re seeing we actually have 22 different entry-level positions that would be suitable for high school students.”

Some of the positions available to students are certified nursing assistants, emergency medical technicians or patient care assistants, as well as opportunities in food and nutrition or environmental services.

“The cool thing is the one-year retention rate is 78%,” Wegner said. “So those high school students, it’s their passion, they love it, they like to stay with us. And that retention rate I would say would be higher except for there’s some planned departure, so some of those students decide, I want to go to college and do a pre-med career. So we hope to get them back in the future, but [there are] a lot of opportunities for high school students.”