Number of doctors in Iowa increases

Iowa continues to see a steady increase in its supply of doctors, despite gloomy predictions that physicians would flee the profession because of big changes in health care.

A new report from the Iowa Board of Medicine says 6,829 physicians worked in the state last year. That was up 2 percent from 2012, and up 12 percent from 2006.

Iowa continues to have fewer doctors per capita than the U.S. average, and it faces significant doctor shortages in some medical specialties and rural regions. But overall, Iowa's supply of doctors has risen much faster than the state's population over the past three decades.

The profession is undergoing major changes, including new rules and practices stemming from the Affordable Care Act. That has caused grumbling in the ranks.

"There were rumors that with the ACA, people would be leaving in droves. But I haven't seen that happening," said Dr. J.D. Polk, dean of the College of Osteopathic Medicine at Des Moines University.

Polk said he still expects a spurt of physician retirements in the next few years. Some veteran doctors probably stuck around a few extra years because their retirement savings accounts plummeted during the recession, but they'll be hanging up their stethoscopes soon, he said.

Also, Polk said, older doctors tend to be less comfortable with new technologies, including vastly increased use of electronic medical records. But Polk predicts that medical schools, which are brimming with students, will be able to more than make up for physician retirements.

Medical-school applications climbed 6 percent nationally last year to a record 48,014, according to the Association of American Medical Colleges. The number of graduates also has been increasing, with the addition of several medical schools nationally and the expansion of enrollment at many existing schools. Des Moines University's osteopathic medical college saw 4,139 applications last year, nearly double what it received nine years ago. The school accepts about 500 per year.

The Affordable Care Act, also known as Obamacare, has accelerated several trends washing over the medical profession. For example, much of the care that used to be provided in small, independent clinics is now being done in large health systems. One of the keys to the health-reform movement is a shift to integrated care, under which various professionals share information and coordinate their efforts to keep patients well instead of just treating individual symptoms. Such efforts are easier to organize in a large medical system.

Older doctors are more likely to have owned a solo practice or worked with a few partners, Polk said. Many of them bristle at the idea of becoming employees of a hospital company, but most new doctors don't seem to mind the corporate arrangements, he said.

"They don't know anything else, whereas if you've had your own practice and been your own boss for 30 years, it could be kind of hard to go work for a hospital system."

For many younger doctors, the lack of independence is balanced by the knowledge that by working for a system, they'll be spared the hassles of running a small business, Polk said.

The University of Iowa medical school, which accepts about 150 students per year, carefully tracks the supply of doctors in the state. The UI's counting method differs a bit from the state medical board's method, but it also shows a steady overall increase. The university's Iowa Health Professions Tracking Center reports that the number of doctors working in the state rose 90 percent from 1977 through 2012. During those same 35 years, the state's population climbed just 6 percent, according to the Census Bureau.

The increase in physician numbers here lags the national trend, according to the UI program. From 2000 through 2010, the supply of Iowa doctors rose 15 percent, compared to a 22 percent increase nationally. But Iowa's general population growth of 4 percent during that decade also was slower than the nation's, which was nearly 10 percent.

However, medical leaders stress that the state must work to attract and retain more doctors. "We have increasing population and we have increasing needs," said Dr. Jeff Maire, president of the Iowa Medical Society.

Maire, who is a Des Moines surgeon, noted that Iowa ranks 41st in the number of active physicians per capita, and it has deep shortages in several specialties. Psychiatry, obstetrics and emergency medicine are among the toughest to fill, particularly in small towns.

The recruitment effort is complicated by the fact that Medicare and Medicaid, the government health-insurance programs for the elderly and poor, pay Iowa providers some of the lowest rates in the nation. Maire also noted that demand for medical services is expected to rise as Americans age and as more people gain health insurance under the Affordable Care Act.

Also, he said, many doctors complain that their productivity has dropped as they spend more time entering information into computers. That problem could ease as physicians become accustomed to the new systems, he said, but it won't disappear.

The state and federal governments have programs to encourage physicians to move to rural Iowa. Rewards include assistance in repaying student loans, and, for foreign doctors, visas they can use to stay in the United States.

Iowa medical leaders applaud those efforts, but they also say the main choke point is a shortage of residency slots for young doctors to complete their training after medical school. Many residency programs depend on federal financing, which is hard to come by. Iowa leaders are looking at ways to add such programs here, with the hope that many doctors who train in Iowa would settle down here.

In Des Moines, Broad­lawns Medical Center is considering starting a psychiatry residency program, which would be just the second one in the state and would address one of Iowa's most critical health care needs.

Mercy Medical Center in Des Moines last year started a residency program for doctors training in internal medicine, a type of primary-care specialty that should be in demand as integrated health systems grow.

The three-year training program plans to graduate 10 physicians per year. Its director, Dr. Leatrice Olson, said the program is drawing interest from medical-school graduates from Iowa and around the country. She's optimistic many will stay here and might consider setting up in rural areas.

Olson, who has practiced medicine 30 years, agreed with other veteran physicians that despite the grumbling, their profession will adapt to changes, including computerized records and increasingly large health-care systems.

"We have to evolve with the times," she said. "With the newer doctors, it won't be as big of a deal."

One of those newer doctors is Phillip Tran, who is finishing his first year in Mercy's new internal-medicine residency program. Tran thinks nothing of carrying a laptop computer with him as he moves from exam room to exam room, and he expresses satisfaction with his experience in Des Moines.

Tran, who went to medical school in New York, said he heard that Mercy had a good reputation. He never would have considered moving to Iowa if the residency opportunity hadn't arisen. His friends were surprised when he told them he was headed here, he recalled with a chuckle.

But Des Moines reminds him of the medium-sized city where he grew up in Vietnam, with a relaxed way of life and nice opportunities for outdoor activities. "I love Iowa. I love it," he said.

Would he consider staying here and helping the state continue increasing its supply of doctors? Maybe, he answered. "I'm enjoying my career here," he said. "So far so good."

How Iowa ranks

Active physicians per 100,000 people: Iowa, 209. U.S. average, 245. State rank, 41st.

Active primary care physicians per 100,000 people: Iowa, 84. U.S. average, 90. State rank, 33rd.

Percent of active physicians who are 60 or older: Iowa, 25%. U.S. average, 27%.

Percent of active physicians who are younger than 40: Iowa, 19%. U.S. average, 17%.

Percent of active physicians who graduated from foreign medical schools: Iowa, 18%. U.S. average, 18%

Sources: Association of American Medical Colleges, Iowa Board of Medicine

6,829: The number of physicians working in Iowa in 2013

2%: The increase in physicians working in Iowa from 2012 to 2013