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DES MOINES — In facing a health care workforce shortage, Iowa lawmakers are considering solutions ranging from creating more residency slots to train physicians to consolidating student loans for those going into medicine.
Gov. Kim Reynolds highlighted the issue in January during her Condition of the State address, urging lawmakers to focus on the state’s physician shortage during this legislative session.
The physician shortage is not exclusive to Iowa, as the projected physician shortfall could reach as high as 86,000 physicians by 2036, according to the Association of American Medical Colleges.
But compared with other states, Iowa’s shortage is one of the most dire. Iowa ranked 44th in the nation for patient-to-physician ratio per 100,000 population in 2024, according to the Iowa Medical Society.
A main focus of Reynolds’ proposed plan, House File 972, is to draw in and then keep medical students in Iowa. The proposal includes consolidating five student loan repayment programs into one program to incentivize health care workers to work in rural and underserved areas of the state.
It would also repeal existing residency and fellowship programs and direct the Iowa Department of Health and Human Services to partner with University of Iowa Health Care and Broadlawns Medical Center in Des Moines to draw down $150 million in federal money to train medical residents in hospitals and create 115 new residency spots.
The proposal also would request federal approval for a health care “hub and spoke” partnership funding model to establish regional collaboration between health care providers in rural areas.
“This bill will help us build on our strong health care system, increasing the number of physicians in Iowa and ensuring rural communities across our state have the care they need,” Reynolds said in a post on X Wednesday after her proposal passed the Iowa House on a 95-1 vote. The bill still needs to pass out of the Senate.
During subcommittee meetings on the proposal in the House and Senate, representatives for a handful of health care organizations remained undecided on the bill, expressing concern that the plan’s student loan repayment consolidation would not include health care workers outside of the bill’seligible definition of "health care occupational categories that are in high demand.”
Representatives were concerned those who are in fields that qualify under the current loan program including dentistry, therapy, physical therapy and social work wouldn’t be eligible under the new proposal.
Kelly Garcia,director of Health and Human Services, said the department plans on hiring a health care economist to evaluate where the shortages are and will update the list of professions based on that finding.
Outside of the Iowa Capitol, health care facilities and training programs broadly are in support of Reynolds’ plan, with groups and hospitals including the Iowa Medical Society, UnityPoint and MercyOne backing it.
“We are projecting a concerning shortage of physicians in Iowa over the next few years due to retirements, demographic shifts and other financial challenges,” a spokesperson for UnityPoint said in a statement. “We are grateful for Gov. Reynolds’ proposal to increase the number of physicians in Iowa by investing in additional medical residency slots. This increase will be extremely beneficial because residency programs are less likely to have to turn away someone who wants to stay in Iowa to complete their training.”
Jared Seliger, president of Allen College in Waterloo, said he’s glad lawmakers are focusing on the workforce shortage, adding that the college has experienced it firsthand.
“We have a lot of really smart people across our state that work in the health care sector,” said Seliger, whose college offers nursing and health sciences degrees. “I hope that they're (lawmakers) getting the right people to the table to have these conversations and really solve for what the problems are and see what our government can do for us to help alleviate some of these problems.”
In Council Bluffs, Jennie Edmundson Hospital President and Chief Executive Officer David Burd says while the Legislature’s approach would help address workforce shortages health care facilities across the state are experiencing, it’s only one piece of the puzzle.
“It's a complex issue, and there are a lot of different factors that go into solving it, and the work that the governor and Legislature is doing, obviously, is a piece of it, but it's not the whole piece,” Burd said. “We have to do our part as well.”
Recruiting from Iowa
During the COVID-19 pandemic in 2020, Seliger said Allen College struggled to recruit students as excitement around working in the industry dipped during the turbulent time in health care.
But now, recruitment has bounced back as the job market has strengthened. Seliger said an essential factor in drawing students and recent graduates to work in the state’s rural health care facilities is recruiting Iowans.
Allen College predominantly focuses on recruiting students in the state, with roughly two-thirds coming from the northeastern corner of Iowa, spanning from Mason City and Waterloo over to Dubuque, according to Seliger.
“The hope is, if we're able to admit more students from Iowa, educate them here in Iowa, that they will stay in Iowa after they graduate and take some of these positions that we have available,” Seliger said. “If we can recruit from these rural areas, the hope is that they (students) want to stay close to their families, and they're going to go after they graduate here, take some of those jobs in the rural health care settings.”
Seliger said the college has a program that will pay up to $20,000 over the course of the student's final two semesters in exchange for a two-year work commitment at Allen Hospital after graduation, adding that hospitals across the state have similar programs.
In 2023, it's estimated that Iowa retained just 22 percent of its medical school graduates and 36.5 percent of its residency graduates.
Allen College is not the only place focused on recruiting Iowa students.
House File 516, which passed the House in March, would require 80 percent of those admitted to the UI’s medical and dentistry colleges to be Iowa residents or students at Iowa colleges. It would require the medical program to offer medical residency interviews to any applicant with Iowa ties who is working in a high-need field.
If passed, the bill is estimated to reduce revenues to the UI colleges of medicine and dentistry by $529,000 in 2027 as the campus forfeits the higher tuition paid by nonresidents.
Burd said his facility has also experienced difficulties drawing young Iowans to stay and work in the state, aside from emphasizing salaries and workplace culture.
“We have strong partnerships with the Methodist College, with Iowa Western Community College, and even with high schools to make sure that we're not only out there visible and recruiting people that want jobs today, but that we're also helping to build that future pipeline for folks that want to work within health care as well,” Burd said.
