Can Iowa turn the corner on its doctor shortage? A new report lays out how

When Nicholas Lind left the University of Iowa’s emergency medicine residency last summer and began working full-time in Cedar Rapids, he didn’t expect to see so many hospitals — from urban ERs to rural critical access facilities — all clamoring for physicians at the same time.

“Everybody’s hiring,” Lind said. “I still work at the university part-time because they're just in desperate need of docs there. You know, we’re still recruiting docs for our group, and my understanding is the Mercy ER group is as well. So I think there’s plenty to go around right now. We’re all trying to get more docs.”

He noted UnityPoint Health-Allen Hospital in Waterloo “is in desperate need of more” physicians.

“So we’re all needing more docs, and that includes emergency medicine and other specialties,” he said.

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Lind, who grew up in Iowa and trained in Iowa City before joining UnityPoint Health—St. Luke’s Hospital in Cedar Rapids, said the shortage touches every corner of the state — and every stage of the medical training pipeline.

“I think we could definitely use more primary care doctors in Iowa,” he said. “I think in general, additional residency spots bring more people to Iowa, and as long as they're training high-quality residents, I think it would be beneficial.”

His comments are echoed in a new report by the Iowa Medical Society, which earlier this year released a blueprint aimed at reversing the state’s physician shortages. The report — Operation I.O.W.A. Phase II — outlines a slate of steps for health systems, medical schools and policymakers to expand residency slots, build stronger rural training pathways, reduce administrative burdens and keep more early-career physicians in the state.

Iowa ranks 44th nationally in patient-to-physician ratio — 30 percent worse than the U.S. average — and has the fewest OB-GYNs per capita of any state.

The national shortage is forecast to reach up to 86,000 physicians by 2036.

‘A breath of fresh air’

Phase II builds on policy wins secured earlier this year after IMS released its first Operation I.O.W.A. report last year, including:

Iowa’s new prior authorization law (House File 303) requires utilization review organizations to acknowledge requests within 24 hours and issue determinations within 48 hours for urgent cases, 10 days for standard non-urgent cases, and up to 15 days when circumstances are complex or request volumes are unusually high.

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The law also mandates annual reviews to eliminate prior authorization requirements for services that are almost always approved, requires organizations to submit those reviews to the Insurance Commissioner for public posting, and gives patients and providers a direct complaint pathway to the insurance division — steps intended to speed care, reduce unnecessary paperwork and increase transparency in the process.

“Phase I laid the groundwork. Phase II is where we begin turning strategy into sustained action beyond the statehouse and into practice sites and academia,” IMS President Alison Lynch said in a statement. “The challenges ahead are urgent and complex, but Iowa has proven it can lead with collaboration and innovation.”

In interviews, Lynch and IMS Chief Executive Officer Steve Churchill emphasized that these policy wins will take time to translate into more physicians on the ground.

“I don't think there's been any significant changes in numbers yet, but I think it really was a breath of fresh air for physicians,” Lynch, director of addiction medicine fellowship and clinical professor of psychiatry and family and community medicine at the University of Iowa Carver College of Medicine, said.

“I think we feel that there is some hope coming, and there's some momentum and movement and recognition that this is an issue that affects all Iowans and that we need to do something about it collectively.”

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Churchill added: “To get a physician, you can't turn that person out overnight between undergraduate and medical school and residency training.”

He said Iowa is now competing with every surrounding state for a dwindling supply of new doctors. That means Iowa must make its environment as attractive as possible for physicians, noting lawmakers took a significant step by passing medical malpractice reforms that cap non-economic damages at $1 million — a change Churchill said sets Iowa apart from many states and gives medical practices greater predictability and certainty.

“Iowa has been very aggressive, more than most states, in trying to get ahead of this,” he said.

He noted the University of Dubuque is moving aggressively to bolster Iowa’s physician pipeline by launching the proposed John and Alice Butler College of Osteopathic Medicine. The school, which would be Iowa’s first new medical school in more than 125 years, aims to open summer of 2028 and will initially enroll 90 students, with a full capacity of 750 over the next decade, and be housed in a newly-acquired 117,000-square-foot downtown building.

Not enough residency slots

Both IMS leaders and front line physicians say the single most powerful way to boost Iowa’s workforce is to expand residency positions — because where physicians train is where they typically stay.

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Family-medicine physician and UnityPoint clinical leader Josh Rehmann said the data is unequivocal.

“If somebody does undergrad or medical school in the state, and then does their residency in the state, their likelihood to stay in practice in the state of Iowa is astronomically higher than if any of those components aren’t present,” Rehmann said.

But Iowa has long lagged behind. The University of Iowa produces more medical graduates than there are residency positions available statewide, forcing many young doctors to complete training elsewhere — and not return.

Rehmann said the state’s $150 million investment is showing early signs of progress as hospitals begin planning new programs, though timelines are long.

“There’s a multiyear lag,” he said. “Our ER program took six years from the day we said we’re going to start it until the first class started. Even if tomorrow we said, ‘We’re going to open residency programs in X, Y, Z specialty,’ it’d probably take at least four to five years before the first class would start.”

Lynch said that after federal approval, it will take at least one to two years to stand up new programs — and at least five years before they produce graduates.

What keeps residents from staying?

Lind said it is no mystery why many out-of-state residents leave after training.

“Sometimes that is simply just like their family’s from another place. Sometimes it’s they want a new adventure,” he said.

But he believes Iowa undersells itself.

“Iowa has a lot to offer,” Lind said, citing the state’s low cost of living, safe communities and “great patient base.”

“Patients are nice … staff is really great … it’s a really good environment to work,” he said, but residency programs need to better showcase what physician jobs actually look like across the state — especially in rural communities. He said placing residents in rural settings — where shortages are often most acute — would help.

“We weren't really out in the rest of Iowa,” Lind said. “I think it would have been really beneficial for us to spend some time in rural Iowa, experiencing what that looks like, and what those kinds of jobs look like.”

IMS’ Phase II report calls for expanding rural rotations, creating mentor networks and developing three-year medical school tracks for students committed to rural practice.

The workforce strain

Rehmann said shortages are universal:

Virtual care is helping, he said, but not enough to offset retirements — especially as more than a third of Iowa’s physicians are 55 or older.

The IMS report also urges aggressive action to cut administrative tasks — from credentialing delays to prior authorization — that sap doctors’ time and fuel burnout.

Lynch said prior-authorization reform passed this year has already begun to help, but additional streamlining is needed to keep doctors in practice.

She said AI documentation tools have been transformative.

“I can turn on a program and it listens to my conversation … and converts it into a note. That has been a huge time saver for me,” she said.

UnityPoint is preparing to roll out embedded AI scribe tools for all clinicians by early 2026, which Rehmann expects will “have a huge reduction in note burden.”

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Early-career physicians: A pipeline that starts before high school

IMS leaders stressed that Iowa must boost the number of Iowa-born students entering medicine — because they are the most likely to stay.

But that’s getting harder, Churchill said.

“There are fewer students from high schools — natives of Iowa — applying to go to medical school at the University of Iowa,” he said. “And so we need to have the conversation while people are in middle school and junior high school and high school and college to be thinking about this as a career.”

Phase II recommends statewide mentorship programs, high school outreach, shadowing opportunities and partnerships with community colleges to rebuild the pipeline.

Risks of inaction: Closures, consolidation and declining access

If Iowa fails to act, the consequences are already visible.

Lynch noted that patients unable to find timely primary care increasingly turn to emergency rooms, which are also short staffed — a cycle that fuels burnout and attrition.

Churchill pointed to a group of radiologists in Mason City that has shrunk from 12 to seven, with no replacements on the horizon.

“If that’s gone … that’s a real problem for that community,” he said.

The ultimate threat, Lynch said, is stark: “Smaller hospitals close, and Iowans have to drive farther to get care.”

A bipartisan window — and a sense of urgency

Despite political divisions over health care nationally, Churchill said Iowa’s physician shortage has united policymakers.

“Everyone realizes it’s critically important … and Iowa is out front on a lot of these issues,” he said. “If we're not successful … the risk is we continue to decline … and it becomes a self-fulfilling prophecy that people just don't want to practice here.

“And it becomes worse and worse, and the wait time gets worse and worse, and it really affects people's lives here,” Churchill continued. “We're pretty much at the bottom of the pack. It's hard to imagine getting worse than where we are, but if we don't take action, we will.”

Lynch said the report and recommendations have “lit a fire of optimism” among Iowa physicians who feel, for the first time in years, that their concerns are being heard.

“We feel like we're being listened to. We feel like we have players, stakeholders who are taking seriously our input,” she said.

For physicians like Lind, progress can’t come soon enough.

“There’s a lot of opportunity,” he said. “And I think that’s across the board.”

Gazette visual journalist Nick Rohlman contributed to this report.

Comments: (319) 398-8499; tom.barton@thegazette.com