Experts say it’s not just the pay that keeps new doctors from setting up shop in rural Iowa, it’s the pressure of being on their own and on call at all hours.

Bill Lever is president and CEO of Unity Point Health which has hospitals and clinics in Cedar Rapids, Des Moines, Dubuque, Fort Dodge, the Quad Cities, Sioux City and Waterloo. He says most young doctors just starting out want to be around other doctors, rather than starting up a solo practice in a small town.

“Most of them want to be in practice with someone else and they want enough technology — you know, imaging services and so forth — around them, ” Lever says. “So the role that critical access hospitals play, providing that kind of place where physicians feel comfortable, ‘I have the resources necessary,’ — that’s the real key.”

Lever says advances in tele-medicine will also help.

“Tele-health will be a great boon to supporting medicine in rural Iowa because we’ll be able to link that primary care physician in rural Iowa to specialists here in Des Moines or other places in the state,” Lever says. “So then you won’t have this feeling: ‘I’m out here. I have this situation I don’t know what to do with.’ (Instead that doctor will say): ‘I have somebody I can consult.'”

Lever’s hospital just donated $50,000 to a foundation raising money for grants that will help pay off the college debt of new doctors who choose to practice in rural Iowa.

“Loan repayment is important to get physicians to see, ‘I can make a career out of medicine without being bankrupt,'” Lever says. “That’s important, but once again in practice, you’ve got to support them in terms of that practice environment.”

Being on call 24 hours a day, seven days a week, 365 days a year isn’t attractive to new doctors, either, and Lever says smaller hospitals in rural areas can provide emergency services so primary care doctors in rural Iowa get some time away from the practice of medicine.