Iowa's physician workforce is the backbone of the health care delivery system in Iowa. Iowa physicians practice in a range of specialties and in a wide variety of settings - from solo practitioners to members of large medical staffs. Regardless of their practice setting or specialty, physicians must respond to changing demographics within the state and in their own field. The capability of Iowa's physician workforce to adapt to these changes and meet the needs of Iowans will strongly impact the delivery of care.
The need for physician services in the United States will grow dramatically over the next ten years. Some researchers and policymakers indicate that physician capacity should be adequate nationally. Others argue that a physician deficit will occur by 2020. Regardless, Iowa's physician workforce faces future challenges. This conclusion is based on an evaluation of demographic trends in Iowa's population, current physician retention and recruiting rates, and the practice environment sought by graduates.
Primary and Specialty Care
Iowa ranks 6th nationally in the number of family physicians per population. This is good news in terms of Iowans' ability to access primary health care. However, Iowa is in short supply of many physician specialists to meet the state's growing needs. Currently, Iowa ranks 43rd overall in terms of providing access to direct patient care physicians. Direct patient care physicians do not include those physicians solely involved in administration, medical teaching, and research.
Low rates of physician specialists are problematic only if patient demand is not being met. This appears to be the case in Iowa for some specialties. It also should be noted that certain communities with a need for specialists do not advertise for them because they know they cannot successfully recruit physicians to their area. Iowa must attract more physicians in identified specialties to better meet the medical needs of its population.
Iowa Population Demographics
Iowa's physician workforce also must respond to the state's changing demographics. Iowa's aging population is a chief concern in this regard. According to the United States Census Bureau, the population of Iowans aged 80 and over is increasing more rapidly than any other group. Iowa ranks 3rd in the nation of percentage of persons aged 85 and older and 7th in persons aged 65 and older. As Iowans age, both acute and chronic care management needs will rise. The aging population often requires higher levels of care, which is challenging because many live in rural areas with less access to physicians. The aging population also will require physicians to better appreciate and develop skills in providing end-of-life care. The expense of treating Iowa's aging population, traditional budget pressures, and low provider reimbursement rates represent a significant and escalating challenge to the health of Iowans.
Iowa Physician Demographics
Iowa's aging demographics also affect the physician population. At least 44 percent of Iowa's practicing physicians are over 50, an age at which surveys have shown many physicians consider reducing their patient care activities. Future monitoring of Iowa's physician workforce must continue to include the age of Iowa physicians, changes in the practice of medicine that result in early retirement, and physician turnover rates. Adverse fluctuations in these areas would be of concern to Iowa.