Iowa lawmakers approved a bill requiring at least 80 percent of students admitted to University of Iowa’s Carver College of Medicine and the College of Dentistry to be Iowa residents or attended an Iowa college or university for their undergraduate degree.

The bill passed the Iowa Senate on April 14 and is awaiting Iowa Gov. Kim Reynolds signature.

The bill, House File 516, has the intention of getting more physicians trained at the university who would potentially want to stay and practice within the state. According to the Association of American Medical Colleges, Iowa is 44th nationwide in physicians per capita.

Iowa Sen. Mike Klimesh, R-Spilville, voiced his approval for the bill. He said accepting more Iowans into the programs will provide the state with more physicians who want to practice in rural parts of the state that are currently becoming healthcare deserts.

“We want to make sure we have a good fit, so that we have doctors, psychiatrists, psychologists, medical professionals graduating from University of Iowa programs that want to stay in practice in Iowa and help to provide the staff and doctors that we need to fill those healthcare deserts that we see opening up,” Klimesh said.

Iowa Sen. Sarah Trone Garriott, D-Windsor Heights, said she understands wanting to encourage Iowa residents to get their education in-state, but she does not feel comfortable assigning a minimum requirement, as she does not want the university to lower their standards in the case that in-state students do not meet the 80 percent marker.

“I think it’s entirely possible to encourage, incentivize participation of specific groups, but I do get concerned when there are hard line numbers,” she said.

According to an analysis from the Legislative Services Agency, an estimated 70 percent of students in the colleges of medicine and dentistry are already in-state residents.

Klimesh said the 80 percent number would not ask the university to lower their requirements of admission, rather offer admission to Iowans before out-of-state students of the same caliber.

“It simply says that if there’s an Iowan that meets the same requirements, as opposed to an out of state individual, we like to offer it to an Iowan,” he said.

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Trone Gariott said there are better ways to incentivize people to stay in Iowa, including making sure that physicians are adequately paid for their services, especially in rural communities, and creating more medical residency spots within programs.

She also referenced the proposed bill, Senate File 360, which would criminalize the administration of mRNA vaccines in the state, as a potential deterrent for young physicians.

“We need the legislatures to stay in their lane and stop meddling with health care when they don’t know anything about it,” she said.

Trone Garriott said also did not agree with the connotation that only people who are born and raised in Iowa want to live in Iowa. She said she wants to encourage everyone to stay in Iowa.

“We know that when you have a student who comes to an Iowa university or is part of an Iowa residency program for medical school, they are more likely to stay in Iowa, even if they grew up or live somewhere else,” she said.

She said the university should not only want Iowans in their programs, rather the best possible students, in order to have the best program.

“We just want our medical school to be the best and to have the best students, so that we can have the best physicians who will practice in our state,” Trone Garriott said.

Trone Garriott said she views the bill as an affirmative action, something Republicans have vehemently opposed.

“They want everything to be based on merit, and then they contradict themselves,” she said. “I wanted to point that out, as this is giving preference to a specific group based on identity rather than merit. So, I think it’s doing exactly what they say they oppose.”

Klimesh said the bill is not an affirmative action policy, rather a plan to get more students in the university’s program who will want to stay in the state after graduation.

“I consider it an affirmative Iowan bill, not affirmative action… It just goes back to all the concerns that we have, in both the House and the Senate, about making sure that we are getting professionals who want to practice in rural America,” Klimesh said.

Iowa’s physician shortage

According to data compiled by Greg Nelson, assistant dean for clinical education programs and Director of continuing medical education at Carver College of Medicine, Iowa has a net loss of 73 physicians in 2023.

The prior 10-year average net gain is 16. This data is representative that Iowa’s physician shortage is getting worse.

The reasons for attrition of Iowa physicians include 46 percent who relocate outside Iowa, 36 percent who retire, and 18 percent who leave for other miscellaneous reasons.

Also, according to data collected by Nelson, up to 66 percent of relocating physicians attributed their choice, at least in part, to “family factors.”

This was the case for Spencer Dempewolf, who chose to leave the state of Iowa for his residency program in emergency medicine. Dempewolf matched to the Medical College of Wisconsin in Milwaukee.

He said the decision to leave was not because he doesn’t want to practice in the state of Iowa, rather that he and his wife have plans of returning and felt it was a better time than ever to live in a mid-size Midwest city outside of Iowa.

“The people at MCW really reminded me of all the things I love about the people here at Iowa, in addition to them having a good program as well,” he said.

Dempewolf said he wants to come back to Iowa and practice after his residency program to be close to his family and because he feels indebted to the place that made him who he is today.

“I see practicing in the state as a way of giving back, and I think that’ll lead to a much more fulfilling career for me to eventually come back and serve the people who kind of made me who I am,” Dempewolf said.

Kendall Cornick matched into the UI residency program with the specialty of pediatrics, and said she picked the program for personal reasons but eventually plans to leave the state to practice.

Her fiance has a career in Iowa, but she said if he didn’t, she would have opted to leave the state.

Cornick is one of the 41 graduates who matched to a residency program within the state of Iowa, making up 25 percent of the class.

She stated the proposed bill banning administration of mRNA vaccines, and changes in LGBTQ+ care for pediatric physician’s in the state, as reasons she is deterred from practicing in Iowa.

She said House File 516 may work in theory, but Iowa does not provide the proper support for physicians at this time.

“I think it’s less about where you came from, but about where you’re going,” Cornick said. “So yeah, you may come from Iowa, but if you’re going to stay in Iowa, are you going to be supported as a physician? And I think the atmosphere around science, medicine, and evidence-based practices is what needs to change.”

Dempewolf agreed there may be better solutions to attract physicians into the state. He said the requirement may bring more students into graduate programs who are willing to practice in the state, but the quality of education may decrease if a variety of perspectives is lost.

“I have a ton of great insight and perspective that I can draw from classmates that aren’t from Iowa, and I think it makes me a better physician, or a better future physician, and better able to see the bigger picture in terms of medical care in America,” Dempewolf said.

Dempewolf said a balance should be found between the diversity of thought and promotion of in state student acceptance.

“I think there’s a balance to be struck there, because you also want to promote, like, diversity of thought and idea and background in a medical school class, because there’s a ton of value in that as well,” he said.

He also said the state should do a better job of taking care of physicians on the back end, making Iowa an attractive place to move to along with making it a place people want to stay.