Abby Davison, a third-year medical student at the University of Iowa’s College of Medicine, is hoping to stay in Iowa for her residency, where she plans to train to become an OB-GYN — a specialty Iowa critically needs.
Davison grew up in a military family, moving from state to state until she finally settled in Iowa and graduated from Pleasant Valley High School in Bettendorf.
She then received her Bachelor’s in Neuroscience and Ethics and Public Policy from the UI in 2022.
Now, she is hoping to stay close to home and start a family while studying at an OB-GYN program at the UI.
Davison said she wants to stay in Iowa to be close to her family and work to ensure reproductive and prenatal care are accessible and equitable for all Iowans who need it.
“I see Iowa as a place where I can continue to advocate for people to get that and continue to advocate for changes,” she said.
Davison wants to help negate the physician shortage the state is seeing, specifically in obstetrics and gynecological care. Iowa ranks near the bottom of all 50 states in access to OB-GYN care.
Iowa’s problems are not limited to a lack of OB-GYNs. The state is facing a broader physician shortage. Iowa Gov. Kim Reynolds pegged addressing the crisis as one of her top priorities for this legislative session.
During her annual Condition of the State Address, Reynolds said she would expand the number of residencies offered by the state’s teaching hospitals. Reynolds’ proposal would also double the amount the state invests in loan repayment programs for physicians who practice in rural areas.
Her plan comes as a nationwide physician shortage grows. According to the Association of American Medical Colleges, or AAMC, the U.S. is currently short 64,000 physicians, which could grow to 86,000 by 2036.
Iowa’s shortage is among the worst in the nation, ranking 44th, according to the Iowa Medical Society.
According to 2023 data from AAMC, Iowa had only 200 doctors that give direct patient care per 100,000 residents for all specialties — 54 less than the national average.
“The number of providers is shrinking, and the size of our people who need care is growing,” Christina Taylor, president of the Iowa Medical Society and chief medical officer at Clover Health, said. “So, we’re already in the situation of a deficit — we already don’t have enough doctors — and it’s getting worse.”
The shortage of primary care providers is worse. According to an analysis from Becker’s Hospital Review, Iowa had only 155 primary care providers per 100,000 residents in 2024.
The shortage of primary care providers is especially pronounced in Iowa’s rural counties.
According to federal data, nearly two-thirds of Iowa’s counties are designated as lacking primary care providers.
Iowa health experts say Reynolds’ proposals could help alleviate this shortage by keeping doctors in or bringing them to the state.
They point to research that shows where doctors train is the biggest factor in where they decide to practice.
Confronting retention struggles in Iowa
Iowa has some of the lowest retention rates of medical school students in the country with data from AAMC showing Iowa retains only 22.4 percent of the students who graduate from the state’s medical schools, compared to the national average of 37.9 percent.
Currently, the state has more medical students graduate than the number of open residency slots every year. According to the Iowa Medical Society, Iowa graduates roughly 384 medical school students at the state’s two medical schools, and the state only has roughly 274 residency slots open at the state’s 14 teaching hospitals. Iowa hosts 1,029 residents in programs that range from three to seven years long, according to data from AAMC.
Daniel Moe, a third-year UI medical student and board member of Iowa Medical Society, said this is mostly because of the discrepancy between the number of medical school graduates and the number of open residency positions in the state.
“If we have this already existing gap of more medical school graduates than medical residents, I think that’s a really great target for the governor to be prioritizing and trying to address that,” Moe said.
To close the gap, Reynolds proposed the state expand the number of residency slots by 115 and draw down $150 million in federal dollars to fund those new positions. The proposed plan would create roughly 460 new physician positions in Iowa in six years with most residencies lasting three years.
“The well-being of working families and rural communities also depends on access to high-quality health care. While we have challenges, Iowa has a strong foundation to build on,” Reynolds said in her Condition of the State on Jan. 14. “But we still need more medical professionals in every part of the state, including a greater variety of specialists.”
The move is crucial to bolstering Iowa’s physician workforce, Taylor said, as the state where a physician trains is the largest indicator of where they’ll practice.
“If they trained here, they’re far more likely to stay here,” Taylor said. “We’ve got to increase the number of people we’re training here because it’s not a guess of whether or not we’ll get more people practicing here. We will have more people practicing here if we increase the number of slots in those programs.”
Democrats are glad Reynolds is addressing the issue, specifically by offering more residencies, which tend to keep doctors in the state.
“Wherever a doctor does his or her residency, they tend to spend a lot of time there because by then they tend to be having children, and they don’t want to move their children,” Iowa Rep. Beth Wessel-Kroeschell, D-Ames, and the ranking member on the House Health and Human Services Committee, said. “And it’s a great way to get doctors into our state.”
However, Wessel-Kroeschell said she would like to see more robust action to solve the issue to help make Iowa more competitive.
Whitney Zahnd, an assistant professor of health management and policy at the UI's College of Public Health, said roughly 70 percent of doctors who complete their residency in a state stay there. However, she said, it is only one piece of the puzzle.
“That can be a really helpful way to hopefully retain those individuals who are doing the residency training here,” Zahnd said. “But I think it’s a multi-factor challenge — that a lot of things are playing a role in that shortage that we’re seeing.”
Advocates are thrilled the governor is running with her proposals, given they gave similar recommendations just a week prior to the governor’s address.
The Iowa Medical Society hosted a one-day summit coined Operation I.O.W.A., or Innovative Opportunities for Workforce Action, in December of last year and published its report a day before the governor’s address.
“We are absolutely thrilled that the governor is promoting this because it’s something that is known to increase and be associated with providers practicing where they trained,” Taylor said.
Doubling loan repayment programs
Medical school can often leave students saddled with large debts. Nationally, students graduate with an average of $227,000 in debt, and students graduating from private universities like Des Moines University can graduate with up to $400,000 in debt, according to the Iowa Medical Society.
To help attract students to rural parts of the state, Reynolds announced a proposal doubling the state’s investment in loan repayment programs for physicians who practice in rural Iowa, bringing the total investment to $10 million in fiscal 2025.
Currently, the state has three different loan repayment programs for doctors looking to have their loans repaid by the state. The programs include a Health Care Related Loan Repayment Program, a Mental Health Practitioner Loan Repayment Program, and a Rural Iowa Primary Care Loan Repayment Program currently hosting $3.6 million in state funding.
Reynolds’ proposal would combine the programs into a new Health Care Professional Incentive Program that would receive $10 million, more than double the state’s current investment, and would be open to any physician willing to practice in rural Iowa, including specialists.
“That’s a game changer for rural communities and our entire state,” Reynolds said in her Condition of the State address in January.
Taylor, of the Iowa Medical Society, said the program would help the state become more competitive in attracting doctors to practice in the state.
“It’s not just an Iowa issue, but that means that all across the country, all of our states — our different health care systems, provider groups — we’re all competing to get qualified, compassionate, wonderful practitioners, and they have put competitive loan repayment programs in place,” Taylor said. “So, simply speaking, if we don’t have something like this, we won’t be competitive at all.”
Taylor said aligning the program with the places of the greatest need, like rural communities, will help address the needs of communities across the state.
“Looking at what types of physicians and where we should make this available is absolutely a good thing,” Taylor said. “We can more closely align the needs of providers across the state and the needs of the communities.”
Medical student Moe said the large amounts of debt medical students incur during their training can make it difficult for physicians who want to practice in rural areas. He said that having a competitive set of incentives will bring candidates in. Moe said it “can be a really helpful way of keeping people here in the state.”
Wessel-Kroeschell said the program could be helpful to combat the shortage, although urban areas are also seeing a shortage in physicians.
“Medical school is very expensive — keeps a lot of people from going,” Wessel-Kroeschell said.
Despite Iowa’s physician shortage, Davison is looking to stay in the state. Having only moved to Iowa within the past decade, she said she appreciates the “Iowa Nice” she’s experienced since she’s lived in the state.
“It seems like there’s kind of a little niche for everyone to feel comfortable in the space and just feel like they belong here,” Davison said of Iowa City and the UI. “So, that’s something that I’ve really come to enjoy about [Iowa City].”