Maine Seeks to Provide Rural Health Care Services Despite Rough Weather and Terrain
In 1993 and 1994, Maine developed a five-part strategy to improve the distribution of primary care providers in underserved areas.
The strategy included upgrading statewide needs assessment, providing statewide coordination and integration of recruitment programs, developing a variety of retention programs, reducing practice barriers and promoting service expansion. It also included establishing a loan program for practitioner debt consolidation, start-up, and capital costs.
The project, which did not receive funding for the implementation stage, was part of the Robert Wood Johnson Foundation (RWJF) national program Practice Sights: State Primary Care Development Strategies.
- The state created four work modules covering needs assessment, recruitment and retention, policy and financing, and the loan fund to address the various initiatives of the project.
RWJF supported this project with a grant of $99,595 from May 1993 to July 1994.
Of Maine's 1.2 million residents, 55 percent live in rural areas, and more than 200,000 in designated Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs). Five of the state's 21 HPSAs have no private primary care physicians, and three others have less than the equivalent of one full-time private provider. Mountainous terrain, harsh winter driving conditions, and a complete lack of public transportation systems in rural areas combine to make travel extremely difficult for both patients and providers. Primary care practitioners concentrate in the more urban areas of the state. This has resulted in critical shortages of rural physicians, particularly family practice physicians willing to do obstetrics.
Under the planning grant (ID# 022273), Maine developed a five-part strategy to improve the distribution of primary care providers in underserved areas:
- Upgrade statewide needs assessment by expanding participation criteria for programs aimed at underserved areas and develop a computerized database of practitioners, sites, health status statistics and service needs.
- Provide statewide coordination and integration of recruitment programs aimed at physicians and mid-level practitioners.
- Develop retention programs including practice management and financing services, a practice site capital financing advisory service, a locum tenens program to provide coverage and primary care case management.
- Implement financing and policy changes to reduce practice barriers and promote service expansion.
- Create a bond-funded loan program through the Maine Educational Loan Authority to provide practitioner debt consolidation and practice start-up loans and finance capital construction.
The project worked jointly with the Generalist Physician Initiative site at the University of New England College of Osteopathic Medicine in Biddeford, ME.
- The state created four work modules covering needs assessment, recruitment and retention, policy and financing, and the loan fund to address the various initiatives of the project. Consultant teams from the Muskie Institute at the University of Southern Maine provided staffing for the effort.
AFTER THE GRANT
Although Maine had developed an extensive plan for Practice Sights, the state's policy environment made progress difficult, and it was denied implementation funding. The state planned to continue its efforts on a smaller scale.
GRANT DETAILS & CONTACT INFORMATION
Maine Practice Sights
State of Maine Department of Health Services (Augusta, ME)
Dates: May 1993 to July 1994
Report prepared by: Robert Narus
Reviewed by: Molly McKaughan
Reviewed by: Marian Bass
Program Officer: Michael Beachler