On Monday afternoon, University of Iowa Health Care hosted a ribbon cutting for its new clinic in Urbandale, which opened in September. The Business Record sat down to check in with Dr. Denise Jamieson, University of Iowa vice president for medical affairs and the Tyrone D. Artz Dean of the Carver College of Medicine, and Brad Haws, CEO of the clinical enterprise and associate vice president at University of Iowa Health Care, while they were in town for the event.

This interview has been edited and condensed for clarity and length.

Iowa is one of the worst states for physicians per capita to residents. What is your reaction to that, and what is the University of Iowa doing to help combat that shortage?

Jamieson: We’re No. 44 in the country in terms of physicians per capita. It’s not the place we want to be. At the University of Iowa, we are doing a lot to educate and train the next generation of physicians and other health professionals and trying to keep them in the state. We’re the only M.D. school and the only academic medical center in Iowa. A large proportion of our medical students are from Iowa. Last year, 70%, next year, 80% of our medical students are from Iowa, so we hope that students with Iowa ties will be more likely to do their residency in Iowa. We are also trying to expand our residency training spots, because where you do your residency is a good predictor of where you might practice, so the more residents we can train, the higher likelihood that they’ll stay in Iowa. We’re also trying to do things like loan forgiveness through a state-sponsored program, and we have a rural track called CRISP, where medical students can choose to do the CRISP program, and then they have special rotations. They have special mentorship within rural Iowa and then, if they stay for the residency, the last year of their residency, they start getting loan repayment. And if they do residency elsewhere and come back, they start loan repayment when they move back to Iowa. There are a lot of efforts to try and keep physicians in Iowa. Almost half of all physicians in Iowa receive some or all of their education and training at the University of Iowa. 

I think it will help to have improvements in reimbursement rates. For example, I think that would help because we’re below the national average in terms of our Blue Cross Blue Shield rates. 

Haws: In addition to the training, we’re trying to make it attractive and easier for physicians to practice in rural areas, and so the training opportunities that we’re trying to provide, like the CRISP program, are focused on rural opportunities. We partnered with the governor and made an application to the federal government for additional funding for residencies. If approved, those would be dedicated to hard-to-recruit specialties and hard-to-recruit to geographies. The other thing that we’re doing to make it easier is we provide an electronic medical record. We use a system called Epic, which is the national standard, and we provide that for about 10 rural hospitals. We have a waiting list of hospitals that would like to get on that, which makes the care coordination between a local environment and our environment easier. It also, believe it or not, is a recruitment tool. Physicians, when they’re looking at where to train or where to practice, they want to know that there’s state-of-the-art electronic capabilities. You can also start doing video telemonitoring kinds of things across that medical record, and so we’re trying to enhance the care. What happens sometimes in a local hospital is they get worried that “I could keep this patient, but there’s a chance that something could go wrong, and if we’re not equipped, then I’m going to send them,” when a lot of the time they could stay and be safe, and they could really stay and be safe if they could connect to a specialist like we have in our facility, and so some of that teleconnection would also enhance the ability to stay local.

Are you using AI to record interactions between the doctor and the patient?

Haws: The listening service we call Ambient Voice Recognition. The device in the visit can actually distinguish between the patient, the provider, even a nurse, and then they can actually go through and document what was talked about, what the treatment protocols were, and create the note, and that makes the physician much more effective, and they don’t have to go home at night and spend two hours after dinner doing the medical record. It really helps their work-life balance. It’s almost becoming the standard nationally.

Jamieson: I was recently in a national meeting, the AAMC, American Association of Medical Colleges, and there were a lot of sessions on AI usage in the health care setting, and I was surprised that we are ahead in terms of the AI technology that we’re using for clinical purposes. So both that technology as well as another technology that combs through the medical record and makes a summary for you, in addition to the other technology records, the ambient listening records, and we know nationally that when you implement these tools into the medical record, pajama time goes down and physician happiness goes up, and burnout goes down. There’s a national metric for burnout that’s used across the country. And we actually surveyed our providers who used that technology, that ambient voice technology, before and after, and we saw a measured improvement in our physicians regarding burnout, so it’s pretty powerful in terms of the effects that it can have and quickly. It’s all voluntary, so not everybody uses it. One of our challenges is trying to get everybody to use it.

We recently published a story about robotics being used in medical settings. What medical technology are you really excited about right now?

Haws: We do have a lot of robotic capabilities in our operating rooms. In fact, some would say that’s the standard, a recruitment tool. When trainees are looking about where they want to go, they think robotics are the way of the future, and they want to go to a place where they can learn and train. And then when they’re in practice, they want to have the robots to be able to do that. We believe it’s better clinically to have that capability. The imaging is much clearer, and then the dexterity of the machine is actually better than our own wrists. It can change the angles more easily than the human hands. Some physicians say it’s less fatiguing, because they’re not in such a hunched over position over a table. It’s a win-win-win as we go forward.

Jamieson: The technology I’m most excited about is AI. I think that is going to revolutionize how we practice medicine. We’re only seeing the tip of the iceberg. There’s so much more that we can be doing, and people get concerned – “Is it going to replace my role as a physician or as a caregiver?” And I would say it’s not going to replace you. It’s going to enhance what you do, and it’s going to help and assist you with many of the things that we do manually now. So I think we’re going to see a lot of changes in the next 10 years.

In addition to what you talked about, what other changes do you foresee happening?

Jamieson: I think one of the things that it’s going to do is not just help you record, but also diagnose and come up with, help you, assist you with treatment plans in the near future, aggregate a whole lot of information very quickly, so that you can have the best information at your fingertips. I think there’ll still be a role for clinical judgment and clinical decision making, but it’ll give you the very best information in order to be able to be able to do that, and very quickly.

Haws: We want people to practice at the top of their license. I’ll give you two examples. For a radiologist that’s reading an MRI, a high percentage of that is going to be kind of routine. And I think AI is probably almost as good as a physician, or even as good. If that could be done and then overseen by the radiologist, that frees up their time to spend on the really complicated things that the computer or the AI is not as good at doing. It won’t replace them. It will just make them more effective and able to focus on the things that really require their top of license. If you’re a patient, you might need to go to four or five specialists, but when you’re talking about AI, they can bring the expertise of all four or five specialists to bear in that single instance. It’s not schedule-bound. It’s not as dependent on the physical facility, and so I think it is a way that my peers are saying this will actually expand the effectiveness of the physicians and where we have a shortage, this will help us expand access to providers to maybe replace or fill in the gap for services that are needed.

Is there one piece of legislation or policy that you think could help health care providers right now?

Haws: The way we get paid for doing telemedicine visits is not assured or guaranteed going forward, so it makes it hard for an institution to say, “I’m going to invest in that technology or that equipment,” because in six months or a year, it may not be paid for in the same way and not affordable. Even just as recent as the [federal] legislation [passed this week], they’re extending the telemedicine reimbursement so that people don’t have to travel to get care and it provides more effective ways for people to be seen.

What are your goals for growth in Iowa?

Jamieson: Our mission is to serve 3.2 million Iowans, and we do that in a variety of ways. We do that through cutting-edge research that helps Iowans. We do that through education and training and we do that through clinical care. We’re the only academic medical center in Iowa, so we provide a level of care that’s not available anywhere else in the state. For example, we’re the only comprehensive cancer center in the state, so we provide a level of cancer care that’s above and beyond what anyone else can provide. But our mission is not to provide all the care for the state. Our mission is to facilitate care across the state, and so that means partnering with other health systems, other hospitals, other clinics, to provide the care that Iowans need, and to provide that care close to home. We really want to develop, for example, a Comprehensive Cancer Network that helps all Iowans and includes other health systems, other hospitals, other clinics, because we think that’s what’s best for Iowans to be able to get their care, whether it be cancer care or other care closer to home.

What is your cancer care plan?

Jamieson: [Iowa has] the second highest cancer incident rate in the nation. However, if you look at our survival rate, we’re about in the middle, so we do a good job of treating patients with cancer. That brings up the fact that we have a lot of cancer survivors all across the state. So another piece of our cancer plan, in addition to diagnosing cancer, screening for cancer, getting patients the care that they need, is to help cancer survivors with care that they might need and link them to care. We’re thinking of different ways that we can get into communities and ensure that cancer survivors are linked to care.

Haws: We tend to go to places where we have been able to research and document that there’s a need, so there aren’t enough providers of that type in that community. Sometimes the communities ask us to come because they can’t get access to care locally like they would like to and so they’ve asked us to come and provide care. Sometimes there’s a little bit of a misconception that we use taxpayer dollars or state-funded dollars to go and do that. Our clinical mission, providing clinical care, is self-sustaining, and so we would be just like another entity, and we commit to provide services in places despite the fact that we’re doing it on our own, with our own means and our own funding to go and do that, because we feel so strongly about the mission to provide care where needed.

Editor’s note: This article was updated at 10:02 a.m. to correct Brad Haws’ title.