Iowa medical educators say expansion of residency slots for physicians must include adequate funding for faculty. (Photo via Getty Images)
Leaders of Iowa’s medical teaching programs say Gov. Kim Reynolds’ plans to address Iowa’s shortage of doctors must include enough money to hire adequate faculty for medical education and training.
Reynolds is seeking over $150 million in federal funding to increase the number of medical residency slots in Iowa. Those slots allow more medical students to train in Iowa in the hope they will remain in the state after graduation. However, adding more slots requires graduate medical education programs, or residencies, to add more faculty and staff, medical educators say.
A spokesperson for the Iowa Department of Health and Human Services said the $150 million in federal funding that Iowa is seeking includes money for faculty, but did not say how much.
Residencies must adhere to strict numbers for student-to-faculty ratios. The Accreditation Council for Graduate Medical Education sets those numbers, and they differ by specialty. For instance, Peter Larsen, regional director of Graduate Medical Education with MercyOne Iowa, said family medicine programs require a 4-to-1 student-to-faculty ratio. A residency program would lose accreditation through the ACGME if it failed to meet those ratios.
GET THE MORNING HEADLINES.
Larsen said the ratios are “a lot smaller than a lot of people think about most education environments.” For example, if the program were to double the number of medical residents in a rural community, he said, “we would essentially need to add about three or four additional full-time faculty who are dedicated almost 100% of their time to teaching residents, and in a relatively small community like North Iowa, that’s a lot. That’s a big number.”
Concerns about the need for funding for faculty are the same at a not-for-profit hospital system or a state university. Dr. Mark Wilson, associate dean of Graduate Medical Education at the University of Iowa Carver College of Medicine, said UI Health Care will have to expand its educational infrastructure and faculty development if it is to expand its residency program. “One of the sobering realities is that running effective clinical education programs for resident physicians is labor intensive,” Wilson said.
Expanding programs will take funding as hospitals in their current state are functioning with thin to nonexistent margins, according to Dr. Hijinio Carreon, chief medical executive at MercyOne. It’s then difficult for teaching systems like MercyOne to make plans in growing programs without knowing the full details of what federal funding could provide.
“We’re waiting to understand the details. And what’s critical around this is the funding and how that’ll be allocated along with slots,” said Mary Cownie, vice president of advocacy and government relations at MercyOne. “There’s a lot we don’t know that’s going to be critical for us to better understand in order to make those decisions. But to be clear, we stand ready to be a partner in this.”
Other proposals with a goal of increasing the number of Iowa physicians, like consolidating school loans and having UIHC programs give priority to Iowans, are “all very good ideas”, according to Cownie, and that they’ll complement the effort to increase the number of residency slots.
UnityPoint also agrees with the current efforts. In a statement, the health care system said it, “appreciates the ongoing work happening in Iowa to help ensure Iowans continue to have access to health care. Increasing residency slots as well as incentivizing providers to practice in Iowa is vital to this effort.”
Taken together, Iowa’s health care systems see the proposals as necessary to reverse Iowa’s negative trend of practicing physicians in the state. “Iowa’s facing a nearly 32% decrease in clinicians that are near retirement age or at retirement,” Carreon said. He said there are about 230 physicians retiring every year for the next several years, but only about 150 new physicians in Iowa that could possibly fill those vacancies.
As those new doctors determine where to practice after graduation, their training and community experiences are critical to their decision.
Dr. Paul Manternach, senior vice president of Physician Integration and chief medical officer at MercyOne North Iowa, agrees with Wilson that education is “resource intensive” and said, “you need to have those resources to really create the appropriate experience and learning environment.”
One goal is to “get rural kids into an Iowa med school. Once they’re in an Iowa med school, get them a community experience with faculty physicians … so that they know what it’s like to be a doctor in an Iowa community. And then they’ll stay in Iowa to practice. That’s basically what we’re trying to figure out how to do,” Manternach said.
The Iowa House passed a bill Wednesday with a similar goal, mandating that at least 80% of students admitted to the University of Iowa’s medical and dentistry colleges to be Iowa residents or people enrolled at Iowa colleges. The bill also gives priority for some medical residencies and fellowships to Iowa residents and people who received a post-secondary education in Iowa. Republicans said they believe the bill will help with retaining physicians.
However funding for faculty expansion is ultimately decided, Iowa’s physician shortage won’t change overnight. “This is a long game plan,” Manternach said. “This is long ball for Iowa to be successful in its health care delivery system.”
YOU MAKE OUR WORK POSSIBLE.