But the hospital started restricting certain birth control options and fertility treatments based on with the Roman Catholic Church, she said. At the same time, her unit was as other obstetricians left and retired.

At one point, Quinn said, she was seeing up to 50 patients a day.

“That is twice what a normal OB-GYN will see in a day,” she said. “I knew I was going to miss something, because there’s no way somebody can function at that level.”

In spring 2024, Quinn decided to leave — not just Mason City, but Iowa entirely.

At the time, the state Supreme Court banning abortion as early as six weeks of pregnancy, with very few exceptions.

It was the last straw for Quinn, who in Minnesota and moved her family there. Minnesota has for abortion.

“I could either stay and ruin myself and my career and my mental health and my relationship with my children, or I could go and continue to practice OB, which had always been my dream,” she said.

A few months after Quinn moved away, Iowa’s abortion ban went into effect on July 29, 2024.

A Severe Shortage

After the Supreme Court overturned Roe v. Wade in 2022, multiple states, including Iowa, .

Coupled with existing OB-GYN shortages, the laws have put doctors under increasing strain and surveillance, for miscarriage, ectopic pregnancy, premature membrane rupture, and other pregnancy problems. Some physicians fear these laws could drive these much-needed doctors from certain states and dissuade other OB-GYNs from moving in and establishing a practice.

Iowa has the among states, according to a KFF analysis of 2021-22 from the .

Studies show that insufficient maternity care is linked to and increased infant and .

Stress on Those Who Remain

Rural hospitals in Iowa have been struggling to find more OB-GYNs.

The , a 49-bed hospital in a rural college town, has been trying to recruit an OB-GYN, and a family practice doctor with obstetrical training, for more than a year.

The hospital has seen a dramatic jump in deliveries after a neighboring hospital in 2024. The additional deliveries have been stressful for its two existing obstetrical-unit doctors, said , an executive with the center.

Back when patient volume was lower, it was easier for doctors to be on call over the weekend, he explained.

“You just kind of had to hang out at home, be by the phone,” he said. But recently, the on-call doctors have been delivering “five babies on Saturday, six babies on Sunday,” Cavazos said. “It becomes more stressful.”

An enacted last May increased Medicaid reimbursement rates for maternity care, so OB-GYNs could be paid more for caring for pregnant patients. The new law also directs federal funding toward a project to set up additional medical residency slots, including OB-GYN residency slots, in the state. Medical residents tend to stay and in states where they complete their residency.

These things could help, said , chair of the Iowa section of the American College of Obstetricians and Gynecologists. But the state’s abortion restrictions are still a red flag for some OB-GYNs when deciding whether to practice in Iowa, she said.

“They understandably do not want to put their licenses and their livelihood at risk when it comes to taking care of patients,” Solheim said.

At her previous job in Quad Cities, Solheim performed an abortion on a patient who had life-threatening complications, she said. It spurred many phone calls from hospital administrators.

They peppered her with questions about her decision, Solheim recalled. “Did I have enough evidence? Was her blood count low enough that her life was in danger? Should we have waited until her blood pressure got lower?”

Solheim recently stopped delivering babies to focus on gynecology and outpatient care, saying she had become exhausted working in Iowa hospital units that didn’t have enough obstetricians.

Recent data on residency applications shows that state abortion bans may be influencing the next generation of doctors.

Fewer medical students to OB-GYN residency programs in states that restrict or ban abortion, according to from the Association of American Medical Colleges.

For E., a fourth-year medical student in Iowa, the law weighs heavily on her decision of where to apply for OB-GYN residency, and, ultimately, practice. She worries about how Iowa’s law will affect her ability to practice evidence-based care.

E. is her middle initial — Ñî¹óåú´«Ã½Ò•îl Health News and NPR are identifying her that way to prevent her comments from jeopardizing future job opportunities.

“I’m seriously questioning whether Iowa is a state that I want to practice in, in the long term, and it breaks my heart because I know that there is such a need,” she said.

A Mixed Picture

It’s still unclear whether abortion bans are driving doctors out of state.

One in Idaho found that two years after the state enacted its highly restrictive abortion law, 35% of the state’s 268 OB-GYNs had stopped practicing obstetrics.

But , analyzing federal data two years after the 2022 Dobbs decision, failed to find significant departures of OB-GYNs from states with abortion bans.

“We were surprised, and we cut the data in every possible way that we could,” said , an assistant professor at the University of California-Berkeley’s School of Public Health, and the study’s lead author.

While numbers don’t show a systemic exit, it’s possible some OB-GYNs are adapting how they practice so they can stay with their patients, she said.

“We’ve heard anecdotally, and through qualitative research, that they’re really highly committed to those patients,” Staiger said.

She said how OB-GYNs feel about .

“What we can’t observe is anything about the quality of care that the providers are able to provide, about provider satisfaction with job, about provider safety,” Staiger said.

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Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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The 14-bed hospital, in Sigourney, doesn’t do surgeries or deliver babies. The small 24-hour emergency room is overseen by two full-time doctors.

CEO Matt Ives wants to hire a third doctor, but he said finding physicians for a rural area has been challenging since the covid-19 pandemic. He said several physicians at his hospital have retired since the start of the pandemic, and others have decided to stop practicing certain types of care, particularly emergency care.

Another rural hospital is down the road, about a 40-minute drive east. Washington County Hospital and Clinics has 22 beds and is experiencing similar staffing struggles. “Over the course of the last few years, we’ve had not only the pandemic, but we’ve had kind of an aging physician workforce that has been retiring,” said Todd Patterson, CEO.

The pandemic was difficult for health workers. Many endured long hours, and the stresses on the nation’s health care system prompted more workers than usual .

“There’s a chunk of workers that were lost and won’t come back,” said , who directs the at the University of California-San Francisco. “For a lot of the clinicians that decided and were able to stick it out and work through the pandemic, they have burned out,” Spetz said.

Five years after the World Health Organization declared covid a global pandemic and the first Trump administration announced a national emergency, the United States faces a crucial shortage of medical providers, for an aging population.

That could have , particularly in states like Iowa with significant rural populations. Experts say the problem has , but the effects of the pandemic accelerated the shortages by pushing many doctors over the edge .

“Some of them made it through covid like ‘Let’s get us through this public health crisis,’ and then they came out of it saying, ‘OK, and now? Now I’m exhausted,’” said Christina Taylor, president of the .

“Iowa is absolutely in the middle of a physician shortage,” Taylor said. “It’s a true crisis for us. We’re actually 44th in the country in terms of .”

A 2022 survey by the Centers for Disease Control and Prevention found a who reported feeling burned out and wanting a new job, compared with 2018. The number of people in health care has , said , an associate professor at the University of Minnesota’s School of Public Health, but the growth has not happened fast enough.

“We have an aging population. We have a lot of needs,” she said.

The projected last year that the U.S. of up to 86,000 physicians by 2036 — if lawmakers don’t invest more money in training doctors.

These shortages could push more people to seek care in ERs when they can’t see a local doctor, said , director of workforce studies at the AAMC.

“We’re already at a point where tens of millions of Americans every year can’t get medical care when they need it,” said Dill (no relation to Janette Dill). “If the shortage is sustained or gets even worse, then that problem gets worse too, and it disproportionately negatively impacts the most vulnerable amongst us.”

Iowa lawmakers made addressing the shortage in the current legislative session. They introduced bills aimed at increasing medical student loan forgiveness and requesting federal help to add residency training slots for medical students in the state.

Last year, Gov. Kim Reynolds that drops the residency requirement for some doctors who trained abroad to get a medical license. Lawmakers in at least eight other states have approved similar changes.

Patterson, of the Washington County hospital, appreciates that Iowa lawmakers are trying to increase the pipeline of doctors into Iowa but said it doesn’t address immediate shortages.

“You have a high school student who’s graduating right now; they’re probably nine to 11 years away from entering the workforce as a practicing physician. So it’s a long-term kind of problem,” he said.

For nurses, workforce experts say, the projected national outlook isn’t as dire as in recent years.

“Nursing education is back up. Nursing employment rates are back up. I think, for that workforce, we’ve largely nationally recovered from all the dislocations that occurred,” said Spetz, of the Institute for Health Policy Studies.

But getting nurses to move to the places that need them, like rural communities, will be difficult, she said.

Some rural hospitals in Iowa say an even bigger challenge right now is finding nurses to hire.

Some of that can be traced to the pandemic, said Sara Bruns, nurse manager at Keokuk County Hospital and Clinics. She recalled that some covid patients in critical condition died when they couldn’t be transferred to larger hospitals with more advanced intensive care unit equipment, because those hospitals didn’t have the staff to take on more patients.

“We had to make the horrible decision of ‘You’re probably not going to make it,’” Bruns recalled, saying many patients were then listed as DNR, for “do not resuscitate.”

“That took a big toll on a lot of nurses,” she said.

Another problem is persuading the area’s young nurses to stay, when they would rather live and work in more urban areas, Bruns said.

Her hospital still relies on contracts with travel nurses to fill some night shifts. That’s something the hospital never had to do before the pandemic, Bruns said. Travel nurses are , adding stress to a small hospital’s budget.

“I think some people just completely got out of nursing,” Bruns said. The pandemic took a special toll “because of the hours that they had to work, the conditions that they had to work.”

Policymakers and health care organizations can’t focus only on recruiting workers, according to Janette Dill at the University of Minnesota. “You also have to retain workers,” she said. “You can’t just recruit new people and then have them be miserable.”

Dill said workers report feeling that patients have been more disrespectful and challenging since the pandemic, and sometimes workers at work. “By ‘unsafe’ I mean physically unsafe. I think that is a very stressful part of the job,” she said.

Research has shown health workers of burnout and poor mental health since the pandemic — though the risks decreased if workers felt supported by their managers.

Gail Grimes, an intensive care nurse in Des Moines, felt more supported by her employer during the worst parts of the pandemic than she does now, she said. Some hospitals offered pay bumps and more to keep nurses on staff.

“We were getting better bonus pay,” Grimes recalled. “We were getting these specialized contracts we could fulfill that were often more worth our time to be able to come in, to miss our families and be there.”

Grimes said she’s seen nurses leave Iowa for neighboring states with better average pay. This creates shortages that she believes affect the care she gives her own patients.

“A nurse taking care of five patients will always be able to provide better care than a nurse taking care of 10 patients,” she said.

She thinks many hospitals have simply accepted staff burnout as a fact, rather than try to prevent it.

“It really is significantly impactful to your mental health when you come home every day and you feel guilty about the things you have not been able to provide to people,” she said.

This article is from a partnership that includes , , and Ñî¹óåú´«Ã½Ò•îl Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).