As we attempt to rein in this country’s skyrocketing health care costs, part of the focus is — rightly — on encouraging more people to sign up with primary care providers and receive preventive care rather than showing up at the emergency room for more costly treatment.
But Maine faces a provider shortage. Each of the state’s 16 counties has regions designated as “federally underserved,” meaning there is less than one primary care physician for every 3,500 patients. And if the Maine Legislature passes a Medicaid expansion bill when it reconvenes in January, about 50,000 more Mainers will have insurance and could be looking for primary care providers.
So how can this state ensure it has enough providers to care for all Maine patients?
One way for Maine to attract and retain new primary care providers is by extending loan repayment programs for nurse practitioners.
Nurse practitioners can legally practice independently, order lab tests and write prescriptions. Their education, while requiring an advanced master’s or doctorate degree, tends to cost significantly less than medical school, thereby allowing them to pay off their school loans faster.
Maine is an aging state, meaning more patients are going to need more medical attention. But new medical school graduates with more than $100,000 in debt — and a looming reality of tens of thousands of dollars in costs annually to pay for malpractice insurance — are finding themselves drawn to more lucrative specialties in other states, leaving a void in the number of providers here in Maine. We have more patients and fewer physicians.
How can we deal with this problem? First we need to help ensure that all Mainers have access to primary care, so we can prevent costly hospital admissions and emergency room visits. Nurse practitioners, with a focus on prevention and health promotion, can safely and cost-effectively fill this gap.
Nurse practitioners have either a master’s or doctoral degree, in addition to a four-year bachelor’s degree. The Institute of Medicine estimates that three to 12 nurse practitioners can be educated for the same cost of one physician.
Currently, through the Finance Authority of Maine, the state supports loan repayment programs for physicians but not for nurse practitioners. So nurse practitioner students looking to repay their loans often move to states with repayment programs, such as Washington and Alaska. Once practitioners move out of state and establish connections with their new communities, they will be less likely to come home to Maine.
FAME currently has a program for primary care physicians working in underserved areas that forgives 50 percent of their debt each year. If we could extend that program to nurse practitioners, $55,000 in loan forgiveness could potentially retain three to 12 nurse practitioners working in primary care in rural areas for every doctor we help.
The federal State Loan Repayment Program could fund such a program. This federally funded grant program matches state money one to one for states with loan repayment programs designed to help primary care providers working in underserved areas. Unfortunately, Maine is not a member of the program.
I’m not arguing for the end of loan repayment for physicians. Rather, nurse practitioners and physicians should have equal access to loan repayment options.
It’s only fair to patients.
Hazel Groce of Portland is a second-year student pursuing a Master of Science in nursing at the University of Southern Maine.