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(I'll be honest, it's probably closer to a three-minutes read, but worth the effort, I swear.)
Although Iowa's lawmakers tweaked many policies impacting health care, I am focused on those purporting to improve Iowans' access to health care.
HF972. The "Rural Healthcare Bill." This includes "hub-and-spoke" programs to enhance services at rural hospitals; it also revamps the tuition-loan-repayment-for-five-years'-service program. But the headline-grabber throughout the session was a promise of $150 million for 460 additional medical residencies (115/year). Various adminstration proxies proclaimed it would mean hundreds of new residency slots in the coming year, that these residencies would be launched by July 1, 2025, and that the chance of securing the $150 million in funding is "really good."
Not sure what proposed legislation those folks were reading from, but the bill passed by lawmakers bears little resemblance.
- This bill contains no specifics on the number of residency slots or the amount of funding the Iowa Dept. of HHS is directed to seek. But I guess if you never set a target, you can't miss.
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None of the 14 towns named as likely to receive these medical residents are "rural," so there's that.
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Based on historical data, the best we can hope for is to retain 152 physicians out of 460. Invest $1,000,000/licensed physician—with no minimum commitment to stick around? I can think of many ways to spend $150 million that really would enhance health care access for Iowans.
- Over the past three decades, medical school tuition has risen 97 percent, and eight out of ten medical residents now receive 50 or more job offers. Iowa's "loan repayment program" has not been updated since inception in 1995. There have never been more than 18 takers per year for this jurassic program and it ignores core workforce challenges.
- All provisions are premised on securing federal funding from HHS (Medicaid/Medicare). Raise your hand if you think the timing seems right.
But if you know me at all, you know I'm a cockeyed optimist, so let's assume the state agencies execute the PR version of HF 972. Best case scenario, Iowa adds 152 physicians by 2032. Considering our current decline in the doctor census and projected losses, the positive impact on health care access is negligible. And any impact on "rural health care" is less than that.
HF516. Priority admissions to medical and dental schools. This mandates the Univ. of Iowa schools of medicine and dentistry to choose Iowa "residents" for at least 80 percent of admissions. The Univ. of Iowa Hospitals and Clinics must give similar priority in granting residencies.
Do lawmakers believe "homegrown" students are more likely to remain here to practice? Because there's no data to support that. Iowa retains less than 23 percent of Carver and DMU graduates, and only a third of its residents. Compared with our seven neighboring states, Iowa is #8 for holding onto doctors, which puts us 44th in the nation. Woo hoo. If there were just some way to learn why that is...
Speaking of data, instead of going to the trouble of passing a law to learn where students go right after graduation from Carver, try visiting their website: Match Day at Carver. Duh.
Iowa's medical schools say they don't have any info on where graduates ultimately practice (my stats come from the Association of American Medical Colleges). HF516 also mandates UIH&C to report on the whereabouts of its medical residents the year after they leave. It's a start, but why can't someone in the administration just make a phone call? I guess lawmakers make laws, so there you go.
Leadership's strategies to address the life-threatening shortages in nurses and direct care workers? Crickets.
Oh, and here's a couple ideas that (thank goodness) did not survive:
HF386. Making medical school three years instead of four. Brilliant.
SF469. Issuing "emeritus" medical licenses for those aged 60+. A discounted fee and no bothersome continuing education requirement. Sounds like a solid idea. Good grief.
Iowans are not easily fooled. We see what's happening in rural and urban health care when loved ones spend ten to 24 hours in ER, specialist appointments are months out and staffing shortages lead to dangerous medical errors. Policy makers' resolute denial should make every Iowan more determined to focus on self-advocacy and being health literate consumers.
Brace yourselves. They're just getting started.
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