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Education Partnership Aims to Attract Doctors to Rural Maine

Patty Wight
Medical student Caleb Swanberg says he plans to set up practice in Maine's Aroostook County, where he was born and raised.

PORTLAND, Maine - Maine has one the highest concentrations of physicians in the nation, according to the Association of American Medical Colleges.  But recruiting those doctors to set up shop in rural areas is a challenge.  An education partnership between Tufts University and Maine Medical Center is designed to change that. Saturday, 34 medical students will celebrate their graduation, and the hope is they will ultimately set up practices in communities that really need them.
He didn't realize it at the time, but the seeds for Caleb Swanberg to become a doctor were planted early.  He grew up on a small farm in Caribou, and witnessed his grandparents' experience a revolving door of doctors that came and left the area.  

"They would go through doctors every one, every two, every three years," Swanberg says. "And I saw the problems with that.  I saw them get frustrated with every couple years going to a new doctor, trying to establish that relationship."

It wasn't until college that Swanberg realized he wanted to practice medicine - rural medicine. "My hope is to sit in a community and stay there, and be a community's doctor."

Swanberg is just the kind of student the Maine Track Program looks for.  It's a partnership between Tufts University and Maine Medical Center that emphasises clinical training in rural areas.  Students spend the first two years at Tufts, but come to Maine every other week to work at small town primary care practices.

The last two years are in Maine, where students can sign up for something called a Longitudinal Integrated Clerkship, which Swanberg says flips typical medical school training on its head.  

Credit Patty Wight / MPBN
Dr. Robert Bing-You, the vice president for medical education at Maine Medical Center.

"Traditional medicine training is broken up into blocks," he says. Six weeks in psychiatry, "eight weeks in medicine," eight weeks in surgery. "Some would argue it's a little disjointed."

In the longitudinal training, medical students instead focus on patients - a small group of them - that they follow for nearly a year. "If you see them in the primary care office and they need to be referred to a surgeon, then you go to that referral," Swanberg says. "And you may actually scrub in on that surgery. And then if they have a post-op complication in the hospital, you help the medical team manage that."  

It's training that prepares students like Swanberg for the challenges and broad experience needed to practice rural primary care.  And, says Dr. Robert Bing-You, of Maine Medical Center, it encourages students in the program to choose rural medicine as a career path.
"Many studies have shown that you're much more likely to stay and practice in the state where you're from, and particularly where you've done your training," Bing-You says. "If you've done your training in a rural area, you're more likely to practice - or think about practicing - in a rural area."

Bing-You says since the Maine Track program began six years ago, about 30 percent of students that graduate from Maine residencies stay in the state. The goal is to increase that retention rate to 75 percent.  

Bing-You says the program can accomplish that, not only through rural clinical training, but also by attracting more students from Maine through tuition incentives. "So for approximately half the students entering the Maine Track, we want to provide half-tuition support over their four years of training."

Bing-You says the hope is that by easing the debt burden, students might be more open to considering primary care, which is less lucrative than other specialties.

Caleb Swanberg says cutting his debt load in half is a huge help, and he fully intends to practice in Aroostook County after completing a residency in Utah. The challenges of rural health care, he says, are also what make it so attractive.

"The challenges are that your specialists are so much further away," he says. "In Aroostook County, some patients have to drive four hours to find a cardiologist.  So as their primary care doc, you have to think long and hard before you refer anybody. Sometimes you have to do the leg work and do a lot of the initial management for some complicated problems.  And, as a primary care doc, that's fun."  

The first graduating class from the Maine Track program will complete residencies next year.  That's when program officials can begin to track its success at encouraging graduates to practice medicine in rural Maine.