As Iowa faces workforce shortages in nursing and other fields, a new study led by a University of Iowa professor has shed light on a possible tool to combat projected losses in rural health care specialties.
The study found that subsidizing cardiologists to travel to rural areas would help maintain needed access to health care, as the number of specialists leaving practice outstrips those entering.
The study was conducted by University of Iowa marketing professor Tom Gruka, Oxford University associate professor Jason Bell and Arizona State University assistant professor Sanghak Lee.
“You can’t just wish and hope that all of a sudden the magic fairy of cardiology is going to come up with a bunch of cardiologists — that’s not going to happen,” Gruka said. “So we have to be proactive and start thinking about what our state is facing as a whole, especially rural areas, and we have to do something about it now before it happens, because once it happens, there’s no quick fix. “
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Gruka said there are just under 200 cardiologists practicing in Iowa, almost all based in urban areas. Nationally, about 2,000 cardiologists leave practice due to retirement or other reasons each year, with about 1,500 graduates entering the field annually, leaving positions unfilled.
The number of cardiologists in the U.S. is projected to decline by up to 10 percent in the coming years, and rural areas will see the biggest impact, Gruka said. In Iowa, specialists use walk-in consultation clinics to reach rural residents, but travel can be expensive and time-consuming for sought-after doctors.
The study looked at how to maintain the level of care provided to Iowans across the state given these numbers and how to encourage specialists to continue attending consultation clinics.
“The retreat won’t be in the cities, necessarily the retreat in care will be in rural areas,” Gruka said. “It’s just to keep (the level of access to health care) where it is. Otherwise it’s going to shrink and shrink and when people have to travel too far to get care, they put it off and bad things happen things.”
The researchers looked at solutions developed by other countries to see what would work in the rural US. It turned out that Australia was dealing with the same problems as Iowa. The country has used two policies: hiring specialist doctors from outside the country, which Gruka said would not be useful here, and paying doctors to travel to rural areas to provide care.
The researchers found it would cost $430,000 a year, or about $80 for each clinic visit day, to maintain the level of care that was in place in 2019 as cardiologists retire or leave. They used data from Carver Medical College and developed a mathematical formula to see how much it would cost to fund a doctor’s travel to outside clinics, Gruka said, assuming doctors are paid nothing for travel.
“That sounds like a really big number, but it really isn’t, compared to hiring just one cardiologist to try to improve health care in the state.” They cost a lot of money,” Gruka said. “So it would be kind of a system-wide solution and it would restore access and preserve access in all the different cities that are currently enjoying this improved access in their own cities.”
The subsidy will pay cardiologists by the minute for their travel, which Gruka said could be seen as wasted time and money due to their inability to work while driving. Paying for their travel could make it easier for them to travel more, helping to maintain the state’s level of care.
Gruka said the study did not address who would pay that subsidy, whether it was through employers, insurance companies or the state or federal government. Instead, it focuses on the fact that it must be done if Iowans are going to continue to have access to the health care they need.
The network of visiting consultant clinics has been in place for decades, but as the number of cardiologists dwindles with fewer people to fill the gaps, Gruka said more needs to be done to keep the network going.
“Just because something has gone on forever doesn’t mean it’s going to continue to go on,” Gruka said. “We need to take some steps to see what’s happening, project what’s going to happen in the future, and then make sure that people who live in rural areas have equal access to health care.”