Iowa: A State of Poor Mental Health

Iowa: A State of Poor Mental Health

iowa poor mental health, mental health iowa, mental health des moines,   The Register had an article this week decrying the lack of mental health services in Iowa in general, and Des Moines in particular.  Mercy has decided to shutter its outpatient clinics for adult mental health, leaving 8000 patients without a provider.  Some of Mercy’s providers have retired, some went elsewhere, and some started their own private clinic.  The Register asked what would happen to the patients, which is a good question.   A better question is, why can’t Iowa recruit physicians, particularly psychiatrists?   The only “new” physicians I know who come to Iowa are from Iowa.  I interviewed Dr. Lee Hieb last week, and during the breaks we discussed this very issue.  She was from Iowa, and decided to come back and start her practice.  I know I have tried to recruit physicians to my practice.  The only ones that have ever expressed an interest are physicians originally from Iowa.  Don’t get me wrong, the big medical groups can recruit foreign physicians, and out-of-state physicians, but my experience is once the physician gets his loans paid off, they leave.  This revolving door doesn’t help our physician shortage.   The University of Iowa has a preference to recruit foreign students and students outside of Iowa.  They may deny it, as I have heard and read.  But the strict truth is they recruit outside of Iowa so they can get more money per student, since the students outside of Iowa don’t get a discount on their education.  For the University, it’s a straight forward economic decision that hurts Iowa and makes it difficult to recruit quality physicians to Iowa.   Iowa also has the lowest reimbursement rates for medical services of all the US states and territories.  Iowa is behind Washington D.C., Guam, and Puerto Rico.  Dead last.  Of course, Iowa is lauded for providing excellent care for less money.  This fact has more to do with the attitude of Iowans, rather than any program the government has set up.  Iowans don’t go to the doctor as much, and we are more self-reliant.  Plus, the physicians from Iowa will go the extra mile for our patients.   So why not reimburse excellence?  Simple.  It’s called the SGR, and it’s a great way to screw over quality physicians.  The SGR is based not on outcomes, or quality health care, but cost of living.  So bad physicians in New York, with a higher cost of living, get paid more than great physicians living in Iowa.  Both Sens. Harkin and Grassley have said they will look into why Iowa gets such poor reimbursement rates.  They know why.  I’ve told them both, personally, face to face, what the problem is, but neither have done anything about it.  When a physician is looking for a place to practice, reimbursement is important.  Physicians don’t really care about money, but when you have half a million in student loan debt, it’s a matter of survival.  Why practice in Iowa, when you can get twice as much in Nebraska or Missouri?   And part of reimbursement is taxation.  Iowa has one of the highest tax rates in the US, rivaling states like New Jersey, New York, and California.  When a physician is looking at settling somewhere, why spend an extra $24,000 to $50,000 just to live in Iowa, a state with a middling school system, bad roads, and terrible weather, when they can go to South Dakota, a state with middling schools, bad roads, terrible weather, and NO state income tax?  I have had two physicians agree to join my practice, but when they added up the numbers, the tax is the reason they went elsewhere.   Iowans pay dearly for the lack of physicians in the state.  Wait times for my particular specialty can stretch to six months just to see a doctor.  And if you have an emergency, just go to Mercy’s ER and wait there for hours trying to get help.  It’s just insane.  And now they closed the outpatient mental health clinic.  There isn’t a viable way for the physicians left to absorb 8000 patients.   Unless Governor Branstad and the legislature lower state income taxes, increase Iowans going to Iowa medical schools, and our Representatives and Senators replace SGR, Iowans will always have a shortage of all physicians.   What’s your take on the subject? (And, as always, visit our Sponsors!)   Doc J. Patrick Bertroche cropped-WebFrame-Final_01.gif