Physician ed | Students weigh in on a new medical school program designed to draw docs to rural Maine

A new medical school program designed to alleviate Maine’s physician shortage is now in full swing. Last month, 32 students were inducted into the Maine Medical Center-Tufts University School of Medicine Medical School Program.

Under the partnership, the students will spend their first two years at Tufts, followed by their third year and part of the fourth at Maine Med. They’ll also perform clinical work at rural hospitals and medical offices across Maine, work that officials hope the students will resume post-graduation.

“Perhaps the most important goal we hope to accomplish is raising the aspirations of students in our state,” Peter Bates, Maine Medical Center’s vice president of medical and academic affairs and the interim dean of the program, said in a press release. “Each year, we see some of Maine’s best and brightest students leaving the state and not returning — or choosing another career path. This is a rare, historical opportunity to boost medical education in Maine, and do so in a fiscally responsible manner.”

Right now, the Maine Hospital Association is recruiting for 206 physician openings at its member hospitals — 87 of those in primary care — which represents only a partial tally of the doctor shortage in Maine. The association recruits for those jobs through its Maine Recruitment Center, which represents all but nine of the association’s members. The tally doesn’t include nonmember hospitals, community health centers or openings at private practice groups, according to Jane Ham, director of the center. Of the primary care openings, 50 are in family practice, which Ham describes as the “lynchpin” of the specialty and a key to medical accessibility in rural areas.

The Maine Med-Tufts program also offers scholarships to Maine residents to reduce tuition to a level comparable to in-state tuition at a regional medical school at a public university. The savings amount to roughly $100,000 over four years, according to the release. Each year, 20 positions in the program will be reserved for Maine students.

Mainebiz e-mailed with three members of the program’s inaugural class about why they signed up and what they hope to accomplish. The students are: Marya Spurling, 23, of Little Cranberry Island; Margaret Griffith, 25, a Bowdoin College grad from Lexington, Mass.; and Jamie Saltsman, 26, who grew up in suburban Maryland and studied out of state, but developed a love of Maine visiting his grandparents’ cottage in Southwest Harbor over the years.

Mainebiz: Tell us about yourself.

Spurling: I grew up on Little Cranberry Island in the Cranberry Isles. I went to the island’s one-room school until the eighth grade and graduated with one other student in my grade, and then went to Mount Desert Island High School in Bar Harbor. My father is a lobsterman and also grew up on the island, as did his father (also a lobsterman). I believe I’m the ninth generation of my family in the Cranberry Isles, and it’s a pretty small and tight community of about 80 year-round residents.

I went to Gordon College in Massachusetts and graduated in 2008, then spent the rest of the year lobstering with my father as his crew while I applied to medical schools.

I wanted to be a doctor as a child, and because of this interest my father took me on trips to Ecuador with the Hancock County Medical Mission, where he would serve as a translator for medical teams each winter. Those trips really catalyzed my interest in medicine, and especially international and rural medicine. Eventually I want to do primary care, probably in family practice.

Griffith: After graduation I moved to Baltimore, Md., where I worked in a pancreatic cancer research lab at Johns Hopkins. It’s too early to tell what specialty I will go into, but if I had to pick right now I would go into some kind of primary care.

Saltsman: I attended the University of Michigan for my undergraduate education and received a master’s degree in public health from the Johns Hopkins Bloomberg School of Public Health in 2008. Between pursuing my BA and MPH degrees, I worked in a mobile examination center for the National Health and Nutrition Examination Survey, a large CDC sponsored public health survey. I’m not sure what type of medicine I will practice, but I am currently interested in primary care fields including family medicine and pediatrics.

Why did you enroll in the program?

Spurling: I thought the program was a perfect fit for my goals. Originally I didn’t want to go back to Massachusetts for school and would have chosen a medical school that wasn’t in such a big city, but when I heard about this program I knew I had to apply because I felt that it was the perfect program for me, and likewise I thought I was a really good candidate.

Griffith: First, MMC seemed really eager to make the program great and made it clear that there would be a lot of opportunities for first-rate medical experiences. Second, even though the program was new, it had ties to a very reputable institution, Tufts. I was also really excited by the chance to be a part of shaping something new like this. Lastly, I always feel at home in Maine so attending school there was very appealing.

Saltsman: First of all, I love Maine. While I’m not from the state, I grew up visiting my grandparents’ cottage in Southwest Harbor at least once every year, and never wanted to leave when my time was up. Since I was young I have thought I would like to someday live and work in Maine. The Maine Track program will help me get on track to do that with my medical career.

Additionally, through my public health work and personal exploration of the field of medicine, I have developed a strong interest in health disparities and rural medicine. Unlike most medical school programs, the Maine Track has a strong focus on rural medicine. In fact, our exposure to rural medicine in Maine began on the third day of orientation, when we were each sent to different rural sites in the state to shadow physicians in order to get a feeling for practicing medicine in rural Maine.

Finally, as medical school class sizes are increasing (and with good reason to fill physician shortages), I was hoping to find a program that would allow me to be part of a smaller learning community, where I could feel more like an individual. With only 30 of us in the Maine track, I already feel the camaraderie of the small group.

Did concern about Maine’s shortage of doctors in rural areas prompt your interest?

Spurling: I was aware of this issue, but honestly didn’t realize how serious the situation was until I began to apply to medical schools and learned how disadvantaged we are in Maine in terms of health care. I grew up in rural Maine, so I had no real point of comparison.

Griffith: No.

Saltsman: I think more than the physician shortage in Maine in particular, it is the shortage of physicians in rural areas throughout the United States — and the resulting public health problems — that attracted me to the program. The potential of this program to help me address this problem with my career is an important reason why I’m here.

Do you think you’ll stay in Maine to practice post-graduation?

Spurling: I’ve always felt that if I practice medicine in this country, it will be in Maine, or in a rural and underserved area. Maine is really my home, so that’s where I’ll always come back to.

Griffith: I am not sure. I could certainly see myself being very happy staying in Maine.

Saltsman: While I realize it is a long way off, I do think that I will stay in Maine after graduation.

What do you envision as your first job in the field upon graduation?

Spurling: I’m not sure. I’m really not looking for anything that’s super high-paying; that’s definitely not my priority. I’ll go where I’m most needed that fits my skills, and where I can do the most good.

Griffith: Not sure.

Saltsman: While this depends a lot on the area of medicine in which I choose to practice, I hope that my first job in the field will be somewhere where I can have a strong impact in my community. The physicians who I consider my role models concurrently work for patients’ health in their clinics and for public health in their communities.

Was the scholarship assistance offered through the program a deciding factor in your decision to enroll?

Spurling: It was a big deal, but I knew this program was for me anyway. This scholarship makes a big difference in freeing me up to practice in places where I’m needed but that can’t afford to pay a very high salary. I’m so grateful for the opportunity to graduate with significantly less student debt.

Griffith: No, while it would have been nice, I had the impression that I was not likely to receive assistance because I am not a Maine resident.

Saltsman: No. As I am not a resident of Maine, I have not received a scholarship.

What are the biggest challenges to practicing in rural Maine?

Spurling: When I was in Rumford during orientation the biggest thing that was mentioned when we discussed this was the issue of transportation and distance to the doctor or the hospital, especially for older patients. Another problem was the lack of specialty care in rural areas. Most specialists are either in Bangor, Portland, or Augusta. Lack of dental care was also an issue. It really demonstrates the point that there cannot be one simple solution to the problem of the lack of healthcare in Maine. This program is a really great start, but it’s going to take a big team effort from all disciplines, and not just in the medical field.

Griffith: I think there are the obvious challenges to practicing in a rural place such as proximity to patients and fewer resources. One of the biggest challenges for the physician is furthering his or her own medical education in a rural setting and not having a group of doctors for peer support.

Saltsman: I think the greatest challenge to practicing medicine in rural Maine may also be the greatest opportunity, which is that there is not ready access to a variety of resources (including specialists, specialized imaging, and other diagnostic and treatment methods) that are available in more urban areas. This requires physicians, especially primary care doctors, to address a wider range of issues in their patient population. While this is a significant challenge, many rural physicians with whom I have spoken feel that this challenge is a major contributor to their professional happiness and feel privileged to play a greater role in their patients’ care.

What part of the curriculum are you most looking forward to?

Spurling: The clinical experiences at the rural sites and getting to know other areas of the state.

Griffith: The possibility for longitudinal study where we might get to follow a patient from, say, the internist setting to the psychiatrist setting or obstetrics setting across disciplines, because ultimately what makes medicine worthwhile and interesting to me is following individuals and helping them through that journey.

Saltsman: I’m really looking forward to getting back up to Maine to complete clinical rotations both in Portland and in rural areas of the state. In addition to simply starting clinical work, I look forward to working with the faculty at Maine Medical Center who are very enthusiastic about the Maine Track program.

Interviews by Jackie Farwell