May 22, 2018
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Shortage of health care providers prompts Maine schools to place students in rural clinics

By Meg Haskell, BDN Staff

BAR HARBOR, Maine — Like much of the rest of the nation, Maine faces a critical shortage of doctors, nurses, dentists, pharmacists and other health care providers. On Friday,

at a conference appropriately titled “Growing Our Own,” state officials and health professionals explored ideas for attracting young Mainers into health care fields and retaining them to serve in the state’s rural communities.

Key to persuading young professionals to live and practice in under-served areas, said guest speaker Ted Wendel of A.T. Still University in Mesa, Ariz., is placing them in rural practices, both during their professional educations and in their post-graduate clinical residencies.

“They need to get out of the academic medical centers and into the communities,” Wendel said. “They need to do more than just show up and practice. They need to be committed to the community.”

In addition to requiring dental and medical students to serve in rural centers, Wendel said A.T. Still University uses telemedicine and other computer-based systems to make it easier for students in Arizona’s rural areas to stay connected with their Mesa-based peers and university faculty. Students and residents who hail from rural communities not only will be more knowledgeable about the medical needs of that community, but also are more likely to stay there to practice, he said.

Maine already has a jump on these ideas, according to health professions educators at the conference, but developing a workable statewide network of clinical placements is a challenge.

Dr. Peter Bates of the three-year-old Maine Medical Center-Tufts University School of Medicine Medical School Program in Portland, said the school places students in 40 teaching sites throughout the state. Students in the MMC-Tufts program may choose from primary care specialties such as internal medicine or pediatrics, which typically pay less than other specialties but are in especially high demand in rural areas. By the end of their first year in the four-year program, Bates said, students are connected with clinical sites within a two-hour drive of Portland, including small rural hospitals, regional outpatient centers and private primary care practices.

Because the nine-month clinical rotations constitute an essential part of students’ formal academic education, each site must designate an on-site physician to serve as adjunct faculty. Other professionals must step up, too, to serve as mentors, Bates said.

In far-flung rural communities where students typically are housed with local families, Bates said, “they need a trusted mentor to inspire them and show them how to succeed.”

At the University of New England, which has campuses in Portland and Biddeford, students from many health disciplines find placements in rural hospitals and medical practices, said Dr. Marc Hahn, dean of UNE’s College of Osteopathic Medicine. UNE’s new dental school also is partnering with federally subsidized health centers to place students in clinical practices, he said.

Since its founding in 1978, Hahn said, the College of Osteopathic Medicine has been a primary educator of the medical work force in Maine and New England.

Of the 124 students starting their osteopathic training at UNE this fall, 23 are from Maine. UNE Associate Dean Ken Johnson said the medical school processes thousands of highly competitive applications from all across the country each year, but gives some preference to Maine applicants who express an interest in primary care and have some work experience in a health care setting.

The conference agenda included sessions on developing a stronger primary care work force of nurse practitioners and physician assistants in rural areas, as well as substance abuse and mental health specialists.

Organized and sponsored by the Maine Office of Primary Care and Rural Health and Bangor-based Penobscot Community Health Care, the event drew about 100 participants from across the state.

Charles Dwyer, director of the primary care and rural health office, said health professionals may hesitate to work in rural areas of Maine because they want strong professional and social communities. But educational programs that make a point of attracting students who are from rural areas, and placing students in rural clinics as part of their educations, he said, are part of the solution.

Programs like those at UNE and MMC-Tufts, Dwyer said, “provide opportunities for students to fall in love with our rural communities,” and can help reverse the growing shortage of providers.

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