Study shows subsidizing doctor travel will help rural access to health care

As Iowa faces workforce shortages in nursing and other fields, a new study led by a University of Iowa professor reveals a possible tool to combat the projected loss of rural specialty health care.

The study found that subsidizing the travel of cardiologists to rural areas would help maintain necessary health care services because more specialists leave the practice than enter it.

The study was conducted by University of Iowa marketing professor Tom Gruca, University of Oxford associate professor Jason Bell and Arizona State University assistant professor Sanghak Lee.

“You can’t just hope and hope that a magical cardiology fairy will suddenly invent a bunch of cardiologists — that’s not going to happen,” Gruca said. “So we have to be proactive and start thinking about the issues that we face across the state, especially in rural areas, and we have to act now before something happens because when it does, there’s no quick fix.”

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Gluka said there are fewer than 200 cardiologists in Iowa, almost all in urban areas. Nationally, about 2,000 cardiologists leave the practice each year due to retirement or other reasons, and about 1,500 graduates enter the workforce each year, leaving open positions.

Gruca said the number of cardiologists in the United States is expected to decrease by 10% in the next few years, with rural areas being the most affected. In Iowa, specialists use visiting consulting clinics to reach rural residents, but travel can be expensive and time-consuming for doctors in urgent need.

The study explores how to maintain the level of care for Iowans across the state given these numbers and identifies how to encourage specialists to continue visiting counseling clinics.

Tom Gruca is a professor of marketing at the University of Iowa. (Photo courtesy of University of Iowa)

“The scaling back of health care services won’t necessarily happen in cities but in rural areas,” Gruca said. “It’s just about keeping (levels of health care access) constant. Otherwise, it’s going to keep shrinking and when people When they have to travel great distances to seek treatment, they put it off and bad things happen.”

Researchers looked at solutions developed in other countries to see what might work in rural America, and it turns out Australia is dealing with the same problem as Iowa. The country has adopted two policies: bringing in physician experts from abroad (which Gruca says won’t help here) and paying doctors to travel to rural areas to provide care.

The researchers found that maintaining 2019 levels of care as cardiologists retire or leave would cost $430,000 per year, or about $80 per clinic day. Gruca said they used data from the Carver School of Medicine and developed a mathematical formula to see how much it would cost to fund physician travel to outside clinics, assuming the physician was not paid for the trip.

“That sounds like a really big number, but compared to just hiring one cardiologist to improve health care in the state, it’s not. They cost a lot of money,” Gruca said. “So this will be a system-wide solution that will restore and maintain access to all the different cities that are currently enjoying improved access in their home states.”

The subsidy will be paid for every minute cardiologists travel, which Gruca said could be viewed as a loss of time and money since they can’t work while driving. Paying for their travel makes it easier for them to travel more, helping to maintain state standards in care.

Gruca said the study did not delve into who would pay the subsidy, whether through employers, insurance companies or the state or federal government. Rather, it focuses on the fact that this is necessary if Iowans are to continue to receive necessary health care.

A network of door-to-door consultation clinics has been running for decades, but with the number of cardiologists dwindling and fewer people available to fill the vacancies, Gruca said more needs to be done to keep the network running into the future. .

“Just because something lasts forever, doesn’t mean it will continue to last,” Gruca said. “We have to do something to look at what’s happening, predict what’s going to happen in the future, and then make sure that people who live in rural areas have equitable access to health care.”

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