Illinois and Iowa may be neighboring states, but their governments and their governing principles couldn't be more different. Iowa has, in recent years, become a pretty reliably Republican state. Illinois, despite the southern and western parts of the state being populated mostly by people of good sense, is dominated politically by the Chicago metro area, making it a blue state.
In recent months, we've seen a lot of stories of productive people bailing out of blue states and heading for red ones, which is a good idea if stable employment and a decent economy are among one's goals. In the case of these two Midwestern states, though, this is having a really bad effect on healthcare: Physicians' Assistants, or PAs, are leaving Illinois for Iowa, citing Illinois's lengthy licensing process.
Illinois Department of Financial and Professional Regulation leaders discussed audit findings with members of the Legislative Audit Commission at the Illinois Capitol last week.
State Sen. Chapin Rose, R-Mahomet, said physician assistants recently told him they were going to Iowa to get licensed, because the process took six months in Illinois.
“That’s six months of lost wages to those individuals. It’s also six months of lost productivity to the state of Illinois. It’s six months of lost tax revenues to the state of Illinois. If they go to Iowa, we’ll never get them back. At the end of the day, it’s six months of less health care to the constituents that we all represent,” Rose said.
State Rep. Natalie Manley, D-Joliet, said she also met with the PAs.
“Is there anything we can do to think outside the box, like a temporary license or something that can be issued so we don’t lose this talent?” Manley asked.
Or you could just streamline the process. Iowa does it much faster, and there doesn't seem to be any adverse effect from improperly vetted PAs.
Illinois is trying to fix this.
IFPR Secretary Mario Treto Jr. said his agency is working to implement a new licensing system.
“The creation of a license for six months might create more work in terms of balancing the implementation of that new system that we might find resolution within those six months,” Treto said.
Treto said he hopes to have the agency’s new system for licensed professionals fully implemented by the end of the year.
How many healthcare professionals will they lose in that time?
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PAs and Nurse-Practitioners (NPs) are becoming primary healthcare providers in many places, which makes it easier to staff small clinics. Our own tiny local clinic is overseen by an NP, who is also my primary doc. She's great. Knowledgeable, sensible, practical, and efficient. (She also has warm hands, which I like in a doc.) Many small towns and local clinics across the country are staffed by NPs and PAs. And Illinois looks to be driving them away.
I'm sure Iowa is glad to have them. Our oldest daughter is an NP, and she is the chief provider in two eastern Iowa emergency rooms, in addition to running her own clinic in the small town she lives in. She can do almost anything an MD can do in Iowa, including prescribing drugs. She's making a fantastic living, and there's another draw for Iowa: The cost of living is much lower, particularly where real estate is concerned.
Illinois under JB Pritzker is a real mess. But this licensing fiasco is hurting something Democrats love to talk about for hours on end: Their healthcare system. And all due to excessive licensing timelines and, very likely, a boatload of bureaucratic hooraw.
If Mario Treto Jr. wants ideas for a PA licensing program, he'd better just look to the west. Iowa seems to be doing it better.
Editor’s Note: The 2026 Midterms will determine the fate of President Trump’s America First agenda. Republicans must maintain control of both chambers of Congress.
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