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Release: Aug. 25, 1999

'Victory' within reach for Iowa communities seeking family physicians

IOWA CITY, Iowa -- After 26 years of helping supply family doctors for Iowa communities, University of Iowa College of Medicine officials can say that "victory" is now well within reach. This declaration comes as 46 Iowa community groups prepare for the Family Practice Opportunities Fair, an annual event that links medical professionals with communities that need additional medical services.

The UI College of Medicine and the Iowa Family Practice Residents Council will host the event from 1-5 p.m. Saturday, Aug. 28 at the Polk County Convention Center in Des Moines. Iowa hospitals, medical clinics and community groups will present exhibits to 85 family practice resident physicians and nearly 50 physician assistant and nurse practitioner students training in Iowa.

"Iowa has made great progress over the past several years in its supply of family doctors," said Roger Tracy, UI College of Medicine assistant dean and director of the college's Office of Statewide Clinical Education Programs. "We've seen the number of Iowa communities with at least one physician increase steadily since 1995, after having steadily decreased since 1979."

Nearly three decades ago, the college, with encouragement from the Iowa Academy of Family Physicians and the Iowa Medical Society, established a statewide training program to increase the supply of the state's family physicians.

In 1973, Gov. Robert Ray championed the idea of Iowa producing its own supply of family doctors. A bipartisan group in the Iowa legislature guided enabling legislation through the Iowa General Assembly that same year. The legislation and related appropriations led to the establishment of a network of nine community-based training programs overseen by the UI College of Medicine. The programs continue to train medical college graduates in three-year residencies and are the major source of Iowa's family practice specialists.

The state will continue to need a ready supply of young family physicians, so the work certainly is not finished, Tracy noted.

There are, however, plenty of signs of progress.

For the first 20 years of the family physician training effort, Iowa was barely keeping pace with its loss of general practitioners due to retirement, relocation or death among the state's physician population. The state was only "breaking even" despite having record numbers of new family physicians entering practice in Iowa each year. During this period, the state retained more than 60 percent of its family practice graduates for entry into the physician workforce.

Today, Iowa is no longer "breaking even." For the past several years, the state has recorded net gains in its supply of family doctors, and family physician supply is now growing at a record pace. Last year, Iowa welcomed 86 new family physicians, who helped replace 48 physicians who left practice. The net gain of 38 doctors was the state's largest net gain of family physicians ever.

In fact, the state has experienced a net gain of 70 family physicians during the past three years, with 239 new family doctors entering practice and 169 retiring or relocating.

One could assume that the greatest share of these gains occurred in Iowa's larger cities but this is not the case, Tracy noted. Towns with populations under 15,000 received 57 percent (126) of the new doctors and benefited from 63 percent (44) of the statewide net gain over the past three years. He added that 27 percent of the total gain has occurred in towns with populations of 5,000 or less. This percentage is higher than any other population category in the state, including cities with populations of 50,000 or higher.

The recruitment success of small towns is measurable in another way, Tracy said. The number of Iowa towns with at least one doctor declined steadily from 296 in 1978 to 232 in 1995. Since then, the trend has reversed, and Iowa now has 251 communities with at least one physician.

"That number is expected to grow. Iowa communities like Conrad, Shell Rock and Earlham are now attracting Iowa family practice graduates," Tracy said.

The annual gains should continue as the number of new family physicians entering Iowa practices increases and the state loses fewer family doctors to retirement or relocation, Tracy said.

To illustrate, he noted that each year, more than a quarter of UI medical graduates choose family practice residencies, and about 70 percent of family practice residents who complete their training in Iowa stay in the state. At the same time, the state only has about 140 family physicians approaching retirement, and relocation is no longer a serious factor, Tracy said.

The large, regional health care systems that employ primary care physicians across Iowa have stabilized the physician workforce, particularly in rural areas. All told, these trends have led to a decline in the number of family practice openings in Iowa.

However, these circumstances are part of the success story, Tracy said.

"The decrease in the number of opportunities in metropolitan areas has led to a gain in the number of doctors in rural towns," he said. "That is why communities such as Anamosa, Pella and Sergeant Bluff, for example, recently were able to attract multiple family doctors. From the communities' standpoint, it has become a buyer's market."