Access to emergency care should never be out of reach – regardless of where you live. However, while politicians in Washington talk a lot about working to increase access to health care, residents in rural areas of Maine continue to face the stark reality of hospital closures, doctor shortages, and the challenges that follow. But make no mistake – the looming physician crisis isn’t unique to Maine, it’s affecting Americans everywhere.
It’s far past time that those in power do something about it and prevent patients in Maine from facing additional barriers to getting the care they need from doctors they trust – without having to drive 40 miles to the nearest hospital.
In Maine, there are about 311 physicians, 86 nurse practitioners, and 47 physician assistants per 100,000 residents. The recommended level of physicians per 100,000 residents currently stands at 283, and reports show Maine will need to increase its number of physicians to keep pace with the national average for doctor-patient population ratio. As the Association of American Medical Colleges (AAMC) projects, the United States will face a shortage of nearly 122,000 physicians by 2032.
Rural regions in Maine and across the country are most at risk. Currently, 60 percent of areas in the U.S. with doctor shortages are rural, and about 60 percent of Maine’s residents live in those kinds of areas. Oxford, Sagadahoc, and Somerset counties all experience the lowest physicians per capita.
There is no one factor to blame for this looming crisis, but aging of both the state’s population and physicians are a driving force.
Maine residents are, on average, the oldest in the country and the state’s aging continues to outpace others. While the national average age has grown from 37.2 to 38.2 since 2010, Maine’s average has gone from 42.7 to 44.9.
Moreover, doctors in the state are aging swiftly too. The mean age of Maine’s licensed physicians is 52. And, 34.6 percent of doctors in the state are 60 or older, meaning they’re heading for retirement soon!
These two factors are a recipe for disaster. As residents across the state of Maine get older, they will need more care – care that’s often more specialized. In turn, as physicians age, they will retire, and contribute to the state’s growing physician shortage — hurting supply and demand.
“We do not know what to do. We do not know where to go. We are in such dire need of help,” said Janey Flaherty, a Maine resident struggling to find care for her elderly mother amid the shortage.
Another large part of the doctor shortage is that it is becoming harder and harder for independent physicians to stay in practice. This is largely due to the barriers the larger systems are putting in place, such as denying payment or access to health care for patients who choose to have a doctor out of network. It becomes a business decision, not a career choice for these doctors. Many are leaving the field altogether because of these frustrations – thus creating an even larger gap in the supply/demand chain. What a shame.
I often wonder who will replace these physicians when the time comes, if anyone, and how we can make sure patients continue to have access to the quality care they both need and deserve. The answer may lie in Direct Primary Care (DPC) – an affordable alternate to insurance-based medical care. This model allows physicians to practice medicine as they see fit, without the tentacles of oversight of non-medical insurance companies.
A number of efforts to avoid the shortage exist, including programs like Maine Track and Rural Internal Medicine Maine (RIMM) Track that aim to keep Maine students who train in Maine practicing in Maine, the Central Maine Medical Center Family Medicine Residency’s practice of conducting home visits, and efforts to lower the high cost of medical training. However, it can’t all be up to physicians and medical schools.
Leaders in Maine – and Washington, D.C. – must focus on addressing the emergency currently in front of them, and steer clear of policies and proposals that would only make it worse — particularly as the year comes to close and dangerous government benchmarking could be included a surprise medical billing compromise. It takes seven to 15 years to train a doctor, but this crisis is happening now. Let’s not make it worse.
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