BVRMC leader reflects on Branstad plan to lure doctors

Monday, January 28, 2013

When Gov. Terry Branstad promised action to help Iowa's health community in his Condition of the State address, the words came as soothing medicine to industry professionals like those at Buena Vista Regional Medical Center.

Branstad served for a time as President of Des Moines University medical teaching facility, resigning to begin his comeback campaign. Thus far in his term, he has made a theme of pledging to transform Iowa into the healthiest state in the nation.

"While we are living longer lives, I have to ask, are we leading better lives?" he asked in his otherwise upbeat message last week. "The obesity epidemic and onset of more and ore chronic disease stretches the capacity of our medical system and stretches the ability of taxpayers to support programs such as Medicaid," he lamented.

Over the past 10 years, Iowa has fallen further and further behind in the number of physicians per 100,000 residents. Iowa is 46th in the nation in the number of doctors practicing internal medicine, 47th in pediatrics, 48th in psychiatry, and dead last in emergency medicine and obstetrics - despite being home to two medical schools.

Iowa has over 1,500 medical students currently enrolled in its med universities - but isn't doing much to keep them here, the governor concedes.

Branstad proposed spending $2 million in the next state budget year to support residency programs in Iowa, and another $2 million to help rural doctors repay their student loans, a program that would be expanded to include emergency and OB-GYN doctors as well as primary care physicians.

Rob Corerick, CEO of Buena Vista Regional Medical Center in Storm Lake, was pleased to hear of the state's newfound attention to attracting and retaining doctors.

Storm Lake has one physician planning a retirement in the near future, and several more who will reach that age within the next decade, he noted.

"Anything that would keep doctors in Iowa would be a positive thing," Colerick says. "We are fortunate in Storm Lake that we have some intrinsic things that make us an attractive place - things like the lake and a university and a hospital that is larger and more diverse than many in rural Iowa. We've worked hard to attract and retain physicians, and we are in a better situation than a lot of communities."

Not only do many rural cities struggle to keep doctors, they are having trouble finding nurses as their corps of professionals ages, he says.

BVRMC has worked with the area colleges to help bring along future health professionals, including medical internships for BVU students looking ahead to medical school. The med center also offers rotations for visiting young doctors to come through to broaden their experience, and perhaps decide they might like to come back after their education is complete.

Generally, he said, it takes some form of incentive to bring a new doctor to Storm Lake, although the process is easier if they originate from the region.

Paying back college loans may be helpful, he feels, as a few of the surrounding states already contribute to incentives in the ever-competitive hunt for young physicians.

"When I started in this field, a graduate from medical school maybe had $100,000 in loans to pay back... now all the sudden it is $200,000 and in some cases approaching $300,000," Colerick noted.

However, earmarking funds to pay off college loans specifically for OB and ER doctors may not be such a help to rural medicine at all. Unlike in larger cities, in communities such as Storm Lake, those tasks are performed by family doctors.

"In a way, if you are taking a doctor from primary care and encouraging them to go into just emergency room, you are robbing Peter to pay Paul," Colerick says.

In fact, many of the more rural hospitals are stopping such services, because they simply don't do enough of it to stay proficient at it, he says. "Ida Grove just stopped doing OB-GYN in the past year, so a place like that might not get to qualify for any of the incentive money." There are no worries about Storm Lake following suit - "We do a ton of that here - we have to do it."

Finally, to keep Iowa a "friendly" place to practice medicine, Iowa needs to cap lawsuits for non-economic damages, according to the governor.

"Frivolous lawsuits are harming our ability to attract and retain doctors," Branstad said in his speech. States with such caps have lower insurance costs than Iowa does, he claimed.

Colerick doesn't expect such action to make much difference to the recruiting of medical pros in Storm Lake.

"We've been fortunate not to be a part of those kind of lawsuits. There are probably varying degrees of how much a doctor is going to worry about those threats, but I don't think it the largest part of the mix."

He said that Nebraska tried to cap lawsuits several years ago, but ran into issues of constitutionality.

Rather than that, if there was one thing the state could do to help BVRMC and the rural Iowa health system, it would be to expand Medicade, says Colerick, an issue the governor didn't even address in his message.

"He originally said no to that, then kind of backed away. We will have to see where he stands on this for this session. In terms of lobbying from the Iowa health community, I'm sure that is the real, big issue," Colerick said.

There is a limit to what the state can do, however, the Storm Lake CEO knows - as a critical access facility, as most of Iowa's rural hospitals are - federal programs apply more directly to the BVRMC needs.

Despite the governor's obvious concerns, the local facility's staff is stable and the numbers decent, he feels. "In an era when inpatient numbers are clearly declining and more and more of the care is moving to outpatient, I can still say that the best practices and best medicine is still being done," Colerick says.

While there is concern over another sizeable proposed increase in rates for individual Blue Cross-Blue Shield policy holders, the BVRMC leader was quick to note that it isn't costs of facilities such as the local one justifying such hikes.

"What they are getting (in insurance) is not the same increase that we are getting. They claim their costs are going up that much... well, they ate not going up in Storm Lake."

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