By Natalie Krebs, Iowa Public Radio, KFF Health News

Even by rural hospital standards, Keokuk County Hospital and Clinics in southeastern Iowa is small.

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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 to quit or retire.

“There’s a chunk of workers that were lost and won’t come back,” said Joanne Spetz, who directs the Institute for Health Policy Studies 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, below the projected need for an aging population.

That could have lasting effects on care, particularly in states like Iowa with significant rural populations. Experts say the problem has been building for a while, but the effects of the pandemic accelerated the shortages by pushing many doctors over the edge into early retirement or other fields.

Keokuk County Hospital has 14 beds, which makes it one of Iowa’s smaller hospitals. (Natalie Krebs/KFF Health News/TNS)

“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 Medical Society.

“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 patient-to-physician ratio.”

A 2022 survey by the Centers for Disease Control and Prevention found a significant jump in health workers who reported feeling burned out and wanting a new job, compared with 2018. The number of people in health care has grown since the start of the pandemic, said Janette Dill, 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 Association of American Medical Colleges projected last year that the U.S. faces a shortage 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 Michael Dill, 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 a priority 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 signed a bill into law 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.

Keokuk County Hospital needs three physicians to staff its emergency room but has just two. (Natalie Krebs/KFF Health News/TNS)

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 more expensive, 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 feel unsafe 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 reporting higher levels 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 scheduling flexibility 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 IPR , NPR , and KFF Health News .

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Olivia Rudgard, Bloomberg News

Cities around the world trying to limit driving have faced objections — namely that the measures would limit personal freedom, cost too much, destroy commerce or have negligible effects on air quality.

Now the first data from these experiments in New York, London and Paris is trickling in. They offer some clues about whether cutting speed limits, charging traffic for entering a city center and penalizing drivers of the most polluting cars can reduce congestion and improve air quality, without causing too much disruption.

These lessons are helpful because cities, where problems with traffic and poor air quality are frequently more severe than in less urban areas, are often moving more quickly in restricting vehicle emissions than countries or states. In Europe, cities are outpacing laws and national regulations to cut traffic pollution, according to the think tank Transport & Environment. In total, 35 cities have committed to introducing “zero emissions zones” — where diesel and gasoline-powered vehicles will be banned.

Still, early results from some cities show reducing traffic is not enough. Take Oslo, which has pioneered lower speed limits, car-free zones and improvements to public transport, walking and cycling. Norway’s widespread adoption of electric cars has also helped reduce smog. But the city still suffers from high levels of particulate pollution from tire wear, wood-burning stoves and dust from gravel and salting on icy roads.

While restricting fossil-fueled vehicles won’t solve those problems, there is evidence that it helps clean the air and has other benefits too.

Here’s what policy makers and city dwellers can learn from other early adopters.

New York

The city introduced a policy on Jan. 5 charging cars up to $9 a day to enter certain parts of Manhattan. Travel time data from the first three months of the charging zone suggests commuting times are down on some of the busiest routes, in particular the bridges and tunnels that connect Manhattan with New Jersey, Brooklyn and Queens.

A site run by student brothers Joshua and Benjamin Moshes has been tracking travel times based on Google Maps traffic data on various routes affected by the New York congestion pricing since the policy was introduced in January. They found travel times have also dropped during weekends, while there’s been little change on other routes going from one part of Manhattan to another. That suggests people are choosing to take public transport or cutting out less urgent travel, they say.

In Boston and Chicago, which the Moshes use as a control, traffic levels have not changed significantly. A separate review released in January by the traffic data provider Inrix echoes their findings, while a Bloomberg analysis released around the same time found fewer private cars and more taxis on the road.

Paris

Mayor Anne Hidalgo introduced 50kph (30 mph) speed limits on the city’s outer ring road in October, despite opposition from France’s transport minister and conservative opponents.

A report from the city’s urban planning department found that the new, lower speed limit, introduced on Oct. 1 last year, has already had some positive effects. In the following five months, air quality improved by 12% and traffic accidents dropped by 17%, compared to the same period in the previous year. There are also signs that congestion is lower.

Hidalgo, who has said she won’t seek re-election next year, isn’t finished with her plans to reduce car traffic and encourage walking and cycling in Paris. In addition to charging higher parking fees for SUVs, the local government has reserved one lane on the main highway encircling the city for public transport and carpooling. Her office also banned motorized through-traffic from the center of the city in November. Local workers, residents and taxis are still able to drive into the zone, but anyone passing through to go somewhere else will be fined €135 ($153) once enforcement begins.

London

The city’s ultra-low emission zone has been in place for over five years. The restrictions, which place a daily charge on driving old gasoline or diesel vehicles, initially covered a small area of the city center. It was subsequently expanded to cover an almost 600 square mile area, making it the largest in the world. London has had a separate congestion charging zone, which means almost everyone who drives into the city’s core must pay, since 2003 (electric cars are exempt until December this year).

When London mayor Sadiq Khan announced the expansion in 2022, the decision was met with warnings that high street shops would wither away and small businesses would struggle to survive.

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ULEZ, as the area is known for short, became a contentious topic in local elections, and Khan’s opponent, from the right-wing Conservative Party, made it a central part of her pitch to voters in the mayoral election last year. (Khan won).

In March, the mayor’s office released data suggesting that ULEZ had a positive impact on air quality, while causing little disruption to shops in the outskirts of London, an area which was only included in the zone in August 2023. In particular the change has cut emissions of nitrogen oxides, air pollutants linked to lung problems, asthma and inflammation, by between 33% and 39%, while footfall and spending in shops has not dropped, according to data from Mastercard Inc.

Almost 97% of vehicles driven within the zone are now compliant with the emissions standards, the report said. Vans, which were much more likely to be caught up by the changes, have been slower to switch, but over 90% are now compliant, compared with just 12% in 2017, before the zone was introduced.

“Everyone in the capital is now breathing cleaner air because of ULEZ,” said Christina Calderato, Transport for London’s director of strategy, commenting on the report.

©2025 Bloomberg News. Visit at bloomberg.com. Distributed by Tribune Content Agency, LLC.

Even if you’re new to stargazing, no doubt you’ve seen the seven bright stars that outline the Big Dipper, and this time of year they’re easy to find. As soon as it’s dark enough after sunset, look high in the northern sky near the overhead zenith for the nearly upside-down Big Dipper.

Believe it or not, the Big Dipper, as bright and well-known as it is, is not an official constellation. Back in the 1930s, astronomers from around the world got together and agreed on a standard set of 88 constellations — and the Big Dipper wasn’t one of them. You would think the most famous star pattern known would rate the title of constellation, but instead, it’s what astronomers call an asterism.

(Mike Lynch)

The Big Dipper, my favorite asterism, is actually part of the official constellation known by its Latin name as Ursa Major, or in English as the Big Bear. Ursa Major is one of the largest constellations in the heavens, and the Big Dipper is the brightest part, making up the rear end and the tail of the bear. This is a great time to see the nearly upside-down Big Bear because it’s so high in the sky. Even if you’re stargazing in a light-polluted urban or suburban locale, you still have a really good chance to see all of Ursa Major. It will take a bit of work and a little bit of imagination, though. I also highly recommend a comfortable lawn chair to lie back on. That will make it much easier on your neck and back.

Start your celestial Big Bear hunt using the Big Dipper. The handle of the dipper outlines the unusually long tail of the bear, and the four stars that outline the pot are the bear’s rear end. Look just to the lower left of the pot section for three dimmer stars forming a skinny triangle that allegedly outlines the Big Bear’s head. That’s one of the dimmest parts of the Big Bear, so once you’ve seen that, the rest of Ursa Major should be easy. From that skinny triangle, look to the upper left for two stars right next to each other that should jump right out at you. These are called Talitha and Al Kapra, and they mark the bear’s front paw. Between the front paw stars and the triangular head is a star that makes up the bear’s knee. Once you spot that, you’ve seen one of the front legs of Ursa Major. Unfortunately there are no stars that make up the other front leg. To see that second front leg, you really have to put your imagination in overdrive.

There are two curved lines of stars that outline the Bear’s back legs, but the one in the foreground is much easier to see. Unless you’re in the dark countryside I wouldn’t even bother with the other back leg. Its stars are just too faint. To see the back leg in the foreground, go back to Talitha and Al Kapra (that make up the front leg) and gaze to the upper right of those stars for two more stars right next to each other. Those are Tanis Borealis and Tanis Australis that make up the back paw. They’re not quite as close to each other as Talitha and Al Kapra, but they’re still in a pretty close embrace. From Tanna Borealis and Tanis Australis look for two more stars that form a curved line to the lower right that links up with the bright star Phecda and the corner of the Big Dipper’s pot (or the rear end of Ursa Major). Once you see this rear leg, you’ve done it. You’ve just seen the Big Bear, one of the largest constellations in the heavens.

The seven stars that make up the Little Dipper are the same seven that outline the Little Bear, otherwise known as Ursa Minor. The Little Dipper is not nearly as easy to see as the Big Dipper, especially if you’re viewing from light-polluted areas. The best way to see the Little Dipper, or Little Bear, is to find Polaris, the North Star, at the end of the handle of the Little Dipper, or the end of the tail of the Little Bear. Polaris is not the brightest star in our sky, but it is a very significant one because it shines directly above the Earth’s North Pole. As the Earth spins on its axis once every 24 hours, it appears to us that all of the stars in the sky whirl around the North Star in the same period. I call it the “Lynchpin” of the sky. Use Dubhe and Merak, the two bright stars in the pot of the Big Dipper, as pointer stars to Polaris. The North Star should be about three of your fist-widths at arm’s length to the lower right of Dubhe and Merak.

The Little Dipper will be below the Big Dipper in the early evening this time of year and is nearly standing on its handle. Polaris is at the end of the handle. The next-brightest stars you see to the upper right of Polaris are Kochab and Pherkad. The line between these stars makes up the outer edge of the Little Dipper’s pot, opposite the handle. Your mission, and it’s not an easy one, is to find the four very dim stars between Polaris and Kochab/Pherkad that make up the rest of the pot and handle of the Little Dipper.

Ursa Major and Ursa Minor, the Bears of the sky, have quite a story. I’ll cover that “tale of the tails” in a future Skywatch column.

Comet Swan Update: Comet SWAN is a new comet that was discovered this past March. It was hoped that it would become visible this week, maybe even with the naked eye. Unfortunately, there are strong indications that the comet is breaking up as it nears the sun, making it extremely hard or impossible to see. Hopefully, a new comet will show up in the near future that will put on a show… Fingers crossed!

Mike Lynch is an amateur astronomer and retired broadcast meteorologist for WCCO Radio in Minneapolis/St. Paul. He is the author of “Stars: a Month by Month Tour of the Constellations,” published by Adventure Publications and available at bookstores and adventurepublications.net. Mike is available for private star parties. You can contact him at mikewlynch@comcast.net.

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What could be better than ending April with a picture book about nature awakening in spring? We’ve got one today, along with the history of a local comedy club and a debut novel from a poet.

(Courtesy of the University of Minnesota Press)

“One Spring Up North”: by John Owens (University of Minnesota Press, $17.95)

What fun this wordless picture book will be for the little ones. Freelance illustrator Owens adds to his previous books, “One Summer Up North” and “One Winter Up North,” to give us a story-in-pictures of a family’s adventures in the Boundary Waters inspired by his travels in that beautiful northern landscape. In detailed, colored-pencil illustrations, he depicts spring awakening, beginning with a wolf pack traveling across the last of the ice on a lake. A mother bear leads her two cubs into the woods and turtles sunbathe on a log. As the parents and a child canoe, they see fish jumping and early-blooming wildflowers on shore. At night they snuggle in a tent.

This book, which is done in dreamy pastels with lots of blue, invites the little ones to use their imaginations to make up their own stories using Owens’ pictures as inspiration.

Owens will introduce his book at 2 p.m. Saturday at Red Balloon Bookshop, 891 Grand Ave., St. Paul

(Courtesy of Coffee House Press)

“No Names”: by Greg Hewett (Coffee House Press, $18)

For the last song, I find myself moved. I mean moved the way I hear people are moved by religion to do things they might not otherwise do, like shake on the floor or handle poisonous snakes. My body starts vibrating, vibrating but no shaking of twisting hips like Elvis. The crowd goes nuts. They want me, I want them. They start grabbing at me, pawing me, hitting me. It’s crazy, it’s like those ancient Greek cults Pete talks about, the ones that rip their god apart. Like that, except the god part. –– from “No Names”

Greg Hewett (Courtesy of Coffee House Press)

Sometimes a reviewer is defeated in trying to find words to express the depth, complexity, thoughtfulness and love in a story. That’s the case with this debut novel from Greg Hewett, who’s published four poetry collections.

Four kids in a Rust Belt city divided by the Heights and the Flats (like St. Paul?) form a punk band almost by accident as they practice in a public park led by childhood best friends Pete and Mike. It’s the 1970s, and they’re inspired by the red-hot Ramones. When the young men are surprised by an offer to record they’re asked the name of their band and all they can think of is No Names. The foursome blaze across the underground music scene, make one recording, and are never heard from again.

Fast forward to 1993, and Mike has been living as a hermit on an island in the Faroes archipelago for 15 years, supported by classical pianist and friend Daniel. Back in the No Names’ hometown a young man named Isaac finds the band’s single recording in his mother’s dusty attic and is mesmerized by their sound. Isaac is so obsessed with the band that he writes a letter to Mike that sends the former No Names member into the tragic past he has been trying to put behind him. When Isaac and Mike finally meet, Mike has a revelation about Isaac that turns all the characters’ lives upside-down.

Then the story becomes the entanglement of Mike, Isaac ad Daniel. There is some gay sex and heroin use,  especially when they are in Denmark, but the love between Mike and Pete, especially, transcends the physical. There’s also a tender story about mother-son love between Isaac and Mariko, Pete’s Japanese mother who adds a woman’s perspective to the narrative.

Moving from the United States to Europe and Daniel’s island, from the ’70s to 2018, the characters each make their way to some enlightenment. Music, and what it does to them and audiences, is a big part of the story, from the No Names punk to Daniel’s classical piano.

This is a novel that can’t be described. It has to be read.

(Courtesy of the Minnesota Historical Society Press)

“Home Club: Up-and-Comers and Comebacks at Acme Comedy Company”: by Patrick Strait (Minnesota Historical Society Press, $24.95)

The baton had been passed. Twin Cities comedy was no longer just the slow end of an earlier golden age. It was now the rapid birth of a new one. And Lee was at its center. — from “Home Club”

Fans of stand-up comedy and those who know nothing about the current comedy scene will enjoy this well-researched history of Acme Comedy Company, a Minneapolis-based incubator for new comedians founded in 1991 by Louis Lee, a soft-spoken Chinese immigrant who knew how to foster new comedians while being a smart and forward-looking businessman. Comedians who consider Acme their home club (“a sacred space where comedians first cut their teeth”), credit Lee with always putting comedians first, “a mentality that has endeared him to top performers since the vey beginning,” Strait writes. This book is as much about Lee as it is about laughter.

Among comedians that call Acme home are Chad Daniels, Greg Coleman, Tim Slagle, Ryan Stout, Jackie Kashian, Brandi Brown, J. Elvis Weinstein and David Crowe.

Lee arrived in the United States as a teenager who didn’t speak English. He worked in restaurants, lost all of his family’s money, and “nearly died while trying to keep the club open through personal, professional, and even global hardships,” Strait writes.

Lee came on the comedy scene just as Scott Hansen was ending his reign in the 1980s as owner/king of comedy clubs, with venues around the Twin Cities. There were some hard times for Lee but he persevered and created a club that is nationally known. There are chapters on Acme’s involvement with the TV show “Last Comic Standing,” Lee’s relationship to his comedians (they weren’t supposed to talk to him when they were newbies but he knew who they were), and how Zoom kept the club going during the pandemic.

Filled with lots of sometimes irreverent interviews with Acme comedians, “Home Club” honors Louis Lee and Acme, which has reverberated with laughter for more than 30 years

The author has been writing about stand-up comedy in the Twin Cities for nearly two decades, including his previous book “Funny Thing About Minnesota… The Rise, Fall, and Rebirth of the Twin Cities Comedy Scene.” His writing concentrates on what makes stand-up an art form and the people who have taken it to new heights.

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