Even by rural Iowa hospital standards, Keokuk County Hospital and Clinics is small.
The 14-bed hospital sits in the southeastern part of the state in Sigourney, the county seat. It doesn’t do surgeries or deliver babies. Two full-time doctors work in the hospital’s small emergency room.
Matt Ives, the CEO of the Keokuk County hospital, is working on hiring a third, but he said finding doctors in the rural area has been challenging since the pandemic.
Five years after the first COVID cases were confirmed in the state, Iowa is now facing a major shortage of medical providers.
“We did have a couple retire during the time frame, and then we've had some physicians that completely wanted to get out of certain types [of care], especially emergency room type of care,” he said.
About 40 minutes east, rural Washington County Hospital and Clinics, a 22-bed hospital, is experiencing similar struggles.
“Over the course of the last few years, we've had not only the pandemic, but we've had kind of an aging physician workforce that has been retiring,” Todd Patterson, the hospital’s CEO, said.
The COVID-19 pandemic was hard on Iowa’s health care workers. Many doctors, nurses and support staff endured long hours, and that led to a lot of people leaving the workforce.
Five years after the first COVID cases were confirmed in the state, Iowa is now facing a major shortage of medical providers.
'It’s a true crisis’
“Iowa is absolutely in the middle of a physician shortage,” Christi Taylor, the president of the Iowa Medical Society, said. “It's a true crisis for us. We're actually 44th in the country in terms of patient-to-physician ratio.”
The problem, which stretches nationwide, has been building for a while, Taylor said. But the pandemic accelerated it by pushing many doctors over the edge into early retirement or other fields.
“Some of them made it through COVID, like, 'let's get us through this public health crisis,' and then they came out of it and saying, ‘ok, and now — now I'm exhausted,’" Taylor said.
Iowa lawmakers have made addressing the shortage a priority in the legislative session. They’ve introduced bills aimed at student loan forgiveness and increasing the number of residency slots for medical students in the state.
"The number one indicator of where somebody will ultimately practice is where they did their residency program,” Taylor said.
The challenges of recruiting and retaining workers
But Iowa is facing more than just a shortage of physicians. Keokuk County hospital’s biggest challenge is finding nurses.
Sara Bruns, the hospital’s nurse manager, said during the pandemic, some of their critical COVID patients died when they couldn’t transfer them to larger facilities with more advanced intensive care unit (ICU) equipment due to their lack of bed space.
“We had to make the horrible decision of 'you're probably not going to make it,'” she said. “You have to be a DNR [do not resuscitate], and... that took a big toll on a lot of nurses.”
It's hard to persuade the area’s young nurses, who would rather live and work in more urban areas, to stay, Bruns said.
The hospital still relies on some contract traveling nurses to fill night shifts. That's something she said they never had to do prior to the COVID pandemic.
“I think some people just completely got out of nursing. I think it did take a toll... because of the hours that they had [to] work, the conditions that they had to work,” she said.
According to Janette Dill, an associate professor at the University of Minnesota’s School of Public Health, policymakers and health care organizations can’t just focus on recruiting new workers.
“It really is significantly impactful to your mental health, when you come home every day and you feel guilty about the things you have not been able to provide to people."Gail Grimes, ICU nurse in Des Moines
“You also have to retain workers,” she said. “You can't just recruit new people and then have them be miserable.”
Since the pandemic, Dill said health care workers report feeling that patients have been more disrespectful and challenging to work with and sometimes workers feel unsafe at work.
“By unsafe I mean physically unsafe. I think that is a very stressful part of the job,” she said.
A Centers for Disease Control survey from 2022 saw a significant jump in health care workers reporting feeling burned out and wanting to seek a new job as compared to 2018.
Nurses like Gail Grimes say this is why they’re trying to unionize.
Grimes works as an ICU nurse in Des Moines. She said she felt more supported by her employer during the worst parts of the pandemic than she does now.
“We were getting better bonus pay. We were getting these specialized contracts we could fulfill that were often more worth our time to be able to come in to miss our families and be there,” she said.
Grimes said she sees nurses leave Iowa for neighboring states that have better average pay. This creates shortages that she feels affects how well she can care for her patients. Hospitals just anticipate staff burnout, rather than trying to prevent it, she said.
“It really is significantly impactful to your mental health, when you come home every day and you feel guilty about the things you have not been able to provide to people,” she said.
Grimes said nurses would like to feel like they have more respect from their employers and the general public and want their concerns to be heard.
