Task Force Report Addresses Iowa's Physician Workforce

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Iowa’s supply of doctors has increased by more than 50 percent over the past 25 years, while the state’s population has remained stable, and this growth is expected to continue.

On the other hand, relocation, rather than retirement, is the main cause of physician attrition in Iowa.

These are among the findings included in a report issued today by leaders of the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics. The report is the product of a task force established last summer to examine issues related to Iowa’s physician workforce.

The UI-initiated task force, whose members included health care leaders, hospital executives and medical educators from across the state, was formed in part to address growing discussions at the national level regarding physician shortages in some U.S. regions and specialty areas.

“The University of Iowa is obviously a key participant in shaping the future of the state’s physician workforce, so we take seriously our role in gathering relevant data and encouraging this discussion,” said Peter Densen, M.D., executive dean in the UI Carver College of Medicine and chair of the task force.

Task force members identified and ranked the medical specialties that were perceived to be in the greatest need in their respective geographic regions. Supply and corresponding demand analyses were performed for each of the specialties; the task force also developed a critical demand index for measuring the intensity of demand across the specialties and estimating the amount of time, on average, needed to fill a position. The group also made recommendations related to physician retention and recruitment, medical education and training, and public policy.

“The task force did not analyze data for every specialty in Iowa, but rather those specialties that members selected as being key priorities in their areas of the state,” Densen noted. “This report is a first step in gaining a better understanding of the physician supply and demand in Iowa, one that requires collaboration among all the entities that have a stake in this issue.”

The physician supply, demand and trend data came from the Iowa Physician Information System, a one-of-a-kind database that has tracked the state’s physician population for more than 30 years. Developed and maintained by the Carver College of Medicine’s Office of Statewide Clinical Education Programs, the database is extremely useful in that it contains actual, not estimated, physician-supply figures and available practice opportunities.

Key points in the task force report include:

— From 1980 to 2005 the number of Iowa physicians increased 54 percent, while the state’s population grew by just 2 percent. Iowa today has more than 5,000 doctors, with approximately 2,000 in primary care (family medicine, general internal medicine and general pediatrics) and 3,000 in medical specialties.

— For the period 1996-2005, the state saw an average of 336 new physicians added to the workforce each year, while an annual average of 265 doctors left their positions in Iowa — an average net gain of 71 physicians each year over this period. Iowa’s primary care workforce is expected to continue its growth, as is the non-primary care workforce, although at a slower rate.

— While the rate of attrition to the state’s physician workforce remains stable, relocation accounts for more than 60 percent of the physicians who leave the state each year. Retirements account for only about one-fourth of the annual loss of Iowa’s doctors.

— A statewide practice opportunity analysis for specialties selected by the task force confirms an intense demand for psychiatrists and neurologists; moderate demand for general internists, obstetrician/gynecologists; and relatively less demand for family physicians and pediatricians.

— Women constitute a rapidly growing proportion of the state’s medical workforce. The percentage of women doctors in Iowa has nearly tripled from 8 percent in 1985 to 22 percent in 2005. This percentage will continue to grow since the number of women entering medicine today is essentially the same as that of men.

The task force’s key recommendations include:

— Identify the specific reasons for attrition related to physician relocation in order to develop strategies aimed at retaining Iowa physicians.

— Develop strategies aimed at retention, not only for physicians currently practicing in Iowa but also for medical residents who are receiving in-state specialty training as well as Iowa medical students who will begin specialty training after earning their degrees.

— Develop a system to actively recruit back to the state Iowa medical graduates who are receiving specialty training in other states.

— Increase opportunities for students to pursue medical education and training in Iowa.

Densen noted that the UI Carver College of Medicine, in recognition of workforce challenges, has increased its class size by six students for 2007-08. Next fall, 148 students will begin their medical education at the UI.

He also emphasized that the quality of medical care Iowans receive is outstanding and among the best in the United States. “In terms of quality of care provided to its Medicare patients, for example, studies have ranked Iowa sixth among states in quality. This exemplary outcome is even more extraordinary given that Iowa’s Medicare reimbursement rates from the federal government are among the lowest in the nation,” Densen noted. “What that means is that to date, any physician workforce challenges that might exist have not affected the quality of care Iowans receive.”

Densen stressed that Iowans should be assured that the state’s physician supply is strong. The challenges that Iowa and other rural states face relate to the uneven geographic distribution of physicians within the state, the mix of specialty-trained physicians, and less favorable reimbursement for physician services.

“The key is to find ways to increase retention among our physician population and be proactive in anticipating the specialties where future shortages might occur,” Densen said.
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