Mental Health in Rural Iowa: Psychiatry department increases opportunities for residents to practice in smaller communities

Shea Jorgensen

Shea Jorgensen, MD, is a third-year resident in the psychiatry residency program. After graduation, she intends to return to her native northern Iowa to practice. 

By Francie Williamson, Communications Coordinator, Department of Psychiatry

As she nears the end of her third year of residency at University of Iowa Hospitals & Clinics, Shea Jorgensen, MD, is beginning to envision her future in psychiatry, including a return to her native northern Iowa.

“Growing up in a small town was definitely the kind of thing that made me who I am,” Jorgensen says.

Iowa, like the rest of the United States, is grappling with a shortage of psychiatrists, and the need is felt most acutely in rural settings.

Psychiatrists by County in Iowa“I can definitely see this huge need that we have,” Jorgensen says.

Recently, she has been spending one weekend each month working at a 34-bed inpatient unit in Mason City.

“There’s just two psychiatrists up there and that’s covering this huge area,” Jorgensen says. “I have lots of family and friends in that area that have approached me because they know I’m a psych resident, asking ‘what do I do?’ or ‘who do I go to?’”

Returning to northern Iowa for practice just feels right, she says.

“I’ll be able to go and really address a need, especially in an area where they feel like my people, where I grew up, and those are the people I feel I just relate well to from my own background.”

Increasing residencies

With the goal of improving rural mental health care, Iowa Gov. Kim Reynolds in her 2019 Condition of the State Address called on legislators to increase the number of psychiatry residency slots. There are only three psychiatry residency programs in the state, and UI Hospitals & Clinics is home to one of them.

The Department of Psychiatry at UI Hospitals & Clinics ended up receiving a grant from the Iowa Department of Public Health as well as permission from the Accreditation Council for Graduate Medical Education (ACGME) to match an additional two residents in the Department of Psychiatry this year.

“It was through tremendous efforts and collaborations that we were able to expand the training program from seven categorical residents a year to nine per year,” says Alex Thompson, MD, MBA, MPH, clinical professor and vice chair for education in the Department of Psychiatry.

Peg Nopoulos, MD, chair and department executive officer of psychiatry said before this year there had not been an increase in the number of residents the department offers each year in decades.

“Governor Reynolds had advocated for four more. It came down to two more spots,” Nopoulos says. “We are hoping eventually for more, but we are really grateful for these two.”

Jorgensen says she thinks it’s “awesome” that more residencies will be available in the coming year.

“I think it’s what our state needs,” Jorgensen says. “We have such a shortage of psychiatrists. And I think it would be even better if we could get people exposed to areas where they could go rotate somewhere and say, ‘I could see myself living here and working here.’ And if we can use that to keep more people in our state that would be huge.”

More opportunities

Thompson says regardless of the state’s commitment to mental health services in rural areas, he is determined to evolve the residency program, so it looks different than it has the past 20 years, “so it’s not just this one-size-fits-all kind of thing.”

 “High quality community experiences in rural settings, I want to make that available for every resident who comes,” Thompson says. “It’s just a great experience.”

Alex Thompson
Alex Thompson

For example, Thompson envisions that third year residents doing their outpatient work will practice telepsychiatry, which tends to involve patients in more rural areas.

“And all residents coming in have to do four months of some primary care experience,” Thompson says. “Maybe they do it in a rural area and that turns into a longer relationship throughout their residency with that community.”

Residents could also opt to follow a public and rural psychiatry track, which Jorgensen has been helping to develop. This track would offer certain electives—like rotations in areas like Waverly or Muscatine— mentorships and specialized lectures.

Only 11 other psychiatry residency programs in the United States currently offer rural psychiatry tracks, and Jorgensen said many of them are still in their infancy. But some, like at the University of New Mexico, have been going on for nearly 30 years.

“They have been able to show an increased retention rate (of psychiatrists) in rural areas,” Jorgensen says of the program at the University of New Mexico. “Thirty-seven percent was the retention rate for the rural track and the traditional track was about 10 percent. So they have been able to keep people in the rural areas, which is the goal.”

Jorgensen says looking at what other states are doing has given her ideas of what UI should develop, “like boundary setting in a rural area would be very different than here where you’re less likely to see your patient (out in public), and you would have to be learning more about Medicaid services and what the region services have.”

‘A thousand Shea Jorgensens’

Thompson says he’s excited about developing different experiences that increase the reach of the psychiatry residency program.

“Really what the Legislature wants is 1,000 Shea Jorgensens,” Thompson says. “Because they really are the epitome of the people that are going to provide the best care in rural areas.”

Jorgensen says after she leaves residency, she would like to continue helping aspiring rural psychiatrists.

“My goal is to have a site set up that would be where residents would rotate,” she says. “I would love to have residents come work with me wherever we end up, to be able to teach them and expose them to what it’s like to be in a community setting.”

That includes purchasing acreage with a little house nearby, so residents could live on site while they do their rotation.

“I’d like to stay affiliated with the university,” she adds.

Tuesday, March 3, 2020