DES MOINES (AP) — A budget proposal Gov. Terry Branstad made last month to attract more physicians to Iowa’s less populated areas by forgiving medical school debt is welcome news to longtime surgeon Dr. Phil Caropreso.
Caropreso, who practices in Keokuk in southeast Iowa, said such an offer might lure natives from rural parts of the state to work in their home communities without having to worry about making enough to pay off massive debts.
“We need any help we can get and honestly in this time, financially there’s a big need for money,” said Caropreso, 66. “If you come from a rural area, you’re more likely to return and (it helps) if you sweeten the deal along the way.”
Branstad’s plan, announced in January, responds to a persistent problem in Iowa, which ranked 40th for the ratio of doctors to residents, according to a 2011 report from the Association of American Medical Colleges. The report listed Iowa as having 6,300 doctors.
Neighboring states Wisconsin, Minnesota and Nebraska all ranked higher.
Citing his experience as president of a medical school, Branstad has proposed a series of reforms. He wants to spend $2 million annually to pay off student loans for up to 20 students who commit to working five years in a rural part of Iowa — jobs that can often pay less than other physician positions. He wants to spend another $2 million a year to provide matching grants to hospitals to create more medical residencies. And he wants to revise rules governing medical lawsuits in Iowa, which he said will make the state a more attractive place to practice.
In his budget address, Branstad, who was president of Des Moines University, an osteopathic medical school, from 2003 to 2009, called these “sensible reforms.”
Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, said these were proven strategies to boost the number of doctors in a region. She noted that there is a national doctor shortage, which is expected to grow as physicians retire and the elderly population grows.
“It’s a clear indication the governor is very sensitive to this issue. I think Iowans should be really impressed that he’s identified this,” Mitchell said. “There’s strong evidence at the federal level that loan forgiveness and putting more training programs in your state do help address state needs.”
A key issue, according to Branstad, is keeping more of the doctors that train in Iowa at Des Moines University or the University of Iowa. The state ranks 39th for retaining doctors who went to medical school in Iowa. Branstad said the state must increase doctor residency positions.
“If they go out and do their residency elsewhere, a lot of them go to Ohio and Michigan, guess what, a lot of them get jobs at those hospitals and a lot of them stay,” Branstad said. “If we have the residency here, they’ll get jobs here, they’re more likely to stay. You don’t want to break the chain.”
Branstad’s plan drew praise from Dr. Victoria Sharp, the director of the Rural Iowa Scholars Program at the University of Iowa. She said that loan forgiveness could make a huge difference for students interested in a rural practice.
Sharp noted the average debt load for a University of Iowa medical graduate was $155,000.
“It will help because they can say I want to be a general surgeon in a small town and I won’t have to worry about that,” said Sharp, who is also president-elect of the Iowa Medical Society.
Programs to provide the residency dollars and the loan forgiveness are already in place, but Branstad would need legislative approval for the budget allocations, and lawmakers haven’t yet acted.
The Legislature also hasn’t acted on Branstad’s proposal for a “certificate of merit” program to screen medical malpractice lawsuits in an attempt to limit frivolous suits.
House Majority Leader Linda Upmeyer, R-Clear Lake, said she thought the governor was “probably on the right track” with the proposals.
“Opportunities to keep more doctors in the state and make it more attractive are absolutely fine to consider,” Upmeyer said. “We know we’ve got a population that wants access to health care. “
Caropreso, who serves on the Advisory Council for Rural Surgery for the American College of Surgeons, hopes these efforts convince more students to follow in his footsteps. He said he tells medical students that small town medicine is a fulfilling way of life.
“I’ve got deer walking through my yard, I’ve got eagles living in trees, it’s fabulous,” he said. “I go half a mile down the street to see my patients. I don’t have to drive 25 minutes to an hour on a freeway. My patients, they know me, we have a bond.”