The Iowa Independent’s Lynda Waddington began with a story about yet another rural hospital that will no longer deliver babies. (Pregnant women in Mitchell County (far northern Iowa) will have to travel elsewhere for prenatal care and deliveries.)

But Waddington tracked this story to source problems that are affecting not only the 34 Iowa hospitals without obstetricians but rural hospitals everywhere.

Iowa’s nursing shortage, low rates of Medicaid reimbursement, and “even limited rural broadband access” all make it difficult for small communities to attract and retain doctors, despite some federal financial incentives.

“The [student] loan forgiveness program, which has been the traditional way of trying to keep [physicians] in rural areas, has been, for the most part, a failure,” said Christian Fong of the Generation Iowa Commission.

Waddington reports that some communities, like Salina, Kansas, are taking a more aggressive “grow your own” approach to medical education.

“You get people who are oriented toward primary care who are from rural areas,” says Kelley Donham, who teaches rural health at University of Iowa. “They have to have rural mentors and have a rural experience.”

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