Subsidizing doctor travel would aid rural health care access, study shows

As Iowa faces workforce shortages in nursing and other areas, a new University of Iowa professor-led study has shed light on a possible tool to combat predicted losses in rural specialty health care.

The study found that providing a subsidy to cardiologists for their travel to rural areas would help maintain necessary health care access as the number of specialists leaving the practice outpaces those entering.

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 wish and hope that suddenly the magic cardiology fairy will invent a bunch of cardiologists — that’s not going to happen,” Gruca said. “So we have to be proactive and start thinking about what is facing our state as a whole, especially the rural areas, and we have to do something about it now, before it happens, because once it happens, there’s not some quick fix.”

Gruca said there are just under 200 cardiologists practicing in Iowa, almost all based in urban areas. Nationally, about 2,000 cardiologists are leaving the practice due to retirement or other reasons every year, with about 1,500 graduates entering into the job field annually, leaving unfilled positions.

The number of cardiologists in the U.S. is predicted to decline by as much as 10% in coming years, and rural areas will see the most impact, Gruca said. In Iowa, specialists utilize visiting consulting clinics to reach rural residents, but traveling can be costly and time consuming for the in-demand physicians.

The study looked into how to maintain the level of care given to Iowans across the state with these numbers in mind and figuring out how to encourage specialists to continue practice in visiting consulting clinics.

“The pullback is not going to be in cities, necessarily, the pullback in care is going to be in rural areas,” Gruca said. “This is just to keep (the level of health care access) where it is. Otherwise, it’s going to shrink and shrink, and when people have to travel too far to get care, they put it off, and bad things happen.”

Researchers looked at solutions developed by other countries to see what would work in the rural U.S. Australia turned out to be dealing with the same issues as Iowa. The country has employed two policies: hiring physician specialists from out of the country, which Gruca said wouldn’t be helpful here, and paying doctors for their travel to rural areas to provide care.

Researchers found it would cost $430,000 a year, or about $80 for each visiting clinic day, to maintain the level of care that was present in 2019 as cardiologists retire or leave. They used Carver College of Medicine data and developed a mathematical formula to see how much it would cost to fund doctor travel to outside clinics, Gruca said, assuming physicians get paid nothing to travel.

“That sounds like a really big number, but it really isn’t, compared to hiring just one cardiologist to try to boost health care in the state. They cost a lot of money,” Gruca said. “So this would be kind of a systemwide solution, and it would restore access and keep access in all the different cities that are currently enjoying that improved access in their own hometowns.”

The subsidy would pay cardiologists per minute for their travel, which Gruca said can be seen as lost time and money due to their inability to work while driving. Paying them for their travel could make it easier for them to travel more, helping in keeping the state level in terms of care.

Gruca said the study didn’t dive into who would pay this subsidy, whether it’s through employers, insurance companies or the state or federal government. Instead, it focused on the fact that it must be done if Iowans are going to continue having access to necessary health care.

The visiting consultant clinic network has worked for decades, but as the number of cardiologists decreases with fewer people to fill the gaps, Gruca said more needs to be done to keep the network running into the future.

“Just because something’s gone on forever, doesn’t mean it’s going to keep going on,” Gruca said. “We have to take some steps to look at what’s happening, project what’s going to happen to the future and then make sure that people who live in rural areas have equitable access to health care.”