UNE Forms a Pipeline to Western Maine to Address Healthcare Shortages

A group of ten UNE healthcare students recently participated in a rural health immersion to western Maine, in Oxford County, as part of a pipeline program to alleviate healthcare workforce shortages in rural communities.

A group of ten UNE healthcare students recently participated in a rural health immersion to western Maine, in Oxford County, as part of a pipeline program to alleviate healthcare workforce shortages in rural communities.

Ten healthcare students from UNE’s College of Osteopathic Medicine, College of Pharmacy, College of Dental Medicine, and Westbrook College of Health Professions Physican Assistant and Bachelor of Science in Nursing (BSN) programs recently attended a long weekend rural health immersion in Oxford County of Western Maine and Carroll County of Northern New Hampshire. The experience, which is coordinated and funded by UNE’s Center for Excellence in Health Innovation and the Maine Area Health Education Center (AHEC), is a pipeline activity created to reduce healthcare provider shortages in rural Maine and to strengthen UNE’s relationships with healthcare centers around Maine. The October immersion experience was the fourth time that a rural health immersion has been offered to UNE students but the first time that a group had gone to Oxford County; last May a weeklong immersion was held in Maine’s midcoast region of Knox and Waldo Counties; last March a weeklong immersion was held in Franklin County; and in May of 2016 the first weeklong immersion was held in Maine’s northern most county, Aroostook County.

“So far, we’ve had over 50 students participate in the immersion experience, and the data that we’ve collected from them suggests that these students are more interested in practicing in a rural or medically underserved area after participating in the immersion” says Karen O’Rourke, Director of the Maine AHEC, located within UNE’s Center for Excellence in Health Innovation. “This corresponds to the literature which shows that early and often exposure to rural health is the most effective strategy to increasing rural provider retention. This is is precisely why we’ve created the rural health immersion, to provide opportunities for our students to get exposed to Maine’s more rural communities, so that they are more likely to become a rural healthcare provider after graduating.”

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

Attracting healthcare professionals to rural and underserved communities has been a national priority for several years and a particular issue for Maine partly due to the fact that, according to the 2010 Census Data, Maine was the most rural state in the United States. Rural terrain can lead to long commutes for patients seeking basic healthcare services and can exacerbate provider shortages, leading to poorer health outcomes. This is a particular problem in Maine where nearly 1/3 of all of Maine’s providers work in Cumberland County, leaving many of Maine’s larger and more rural communities underserved. In order to help alleviate healthcare workforce shortages in Maine’s more rural counties, the Maine AHEC has strategically located three AHEC centers around Maine in Aroostook, Franklin, and Penobscot counties. “Oxford County is one of the Maine’s counties with the fewest healthcare providers in the State, with only about 2% of the providers living in that area. We were able to utilize our western Maine AHEC center, which covers Oxford County, to help connect with area hospitals for this immersion.”, says O’Rourke.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Maine and New Hampshire provide a contrasting picture of health and well being, despite neighboring one another. According to the United Health Foundation, New Hampshire ranked 6th in overall health rankings, whereas Maine did not fair as well, ranking 22nd. “These health disparities became apparent to the students rather quickly” said Ian Imbert, MPH, the project coordinator of a prestigious four year Josiah Macy Jr. Foundation grant in UNE’s Center for Excellence in Health Innovation, which aims to enhance team-based care and improve patient outcomes. “The immersion experience provided them an opportunity to see first-hand the effects of healthcare access and funding for prevention programs. In Maine, the decision not to expand Medicaid has created access barriers that have effected the health of our communities, whereas the expansion of Medicaid in New Hampshire has created additional funding to provide much needed services to its underserved populations.” Indeed, the Robert Wood Johnson Foundation’s 2016 county health rankings, for example, show that Carroll County in New Hampshire ranked 4 out of 10 in health outcomes, while Oxford County in Maine did not fair as well, finishing close to the bottom, 14th out of 16.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

It’s predicted that some of the health challenges that Maine’s more disparate Counties face would be improved if there were more providers who lived and worked in those areas. According to the Robert Graham Center and the Nursing Workforce Forecast, Maine will need an additional 120 primary care physicians and 3,200 nurses in the next decade in order to maintain current rates of healthcare utilization. Moreover, the Maine Department of Labor projects a shortage of 170 dentists. Research shows that students are more likely to practice rural medicine if they have a personal connection to a rural area, so, the rural health immersions aim to provide opportunities for students to connect to rural Maine and hopefully alleviate healthcare provider shortages.

The students who participated in the Western Maine rural health immersion came from a broad array of backgrounds, some growing up throughout the country in areas like Maryland and Pennsylvania while about a third of the students had grown up in New England or had spent time previously in rural Maine, either through extended family or while vacationing. Most students had some experience working with underserved populations in the past but for a few it was their first opportunity to experience rural underserved healthcare. One student from UNE’s College of Dental Medicine, Nicole Caron, from Massachusetts, reflected after the final day of the immersion, “This trip introduced me to a bunch of different rural communities that all had one thing in common, extraordinary healthcare providers who work every day to improve the health of their patients and their communities, despite the obstacles they may face in rural areas. I have been inspired and I hope that I am able to practice dentistry just like the professionals that we interacted with this weekend.”

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

During the immersion, the students experienced a variety of activities in underserved areas in Oxford and Carroll Counties, such as meeting with providers of Memorial Hospital in Conway, NH, and Bridgton Hospital in Bridgton, ME, for a tour of the hospital facilities; a tour and discussion with providers at Sacopee Valley Health Center, a Federally Qualified Health Center in Porter, ME and at White Mountain Community Health Center, a rural community health center in Conway, NH; a trip to Conway Oral Health in Conway, NH to talk about dentition in rural communities; and a tour of Hannafords pharmacy in Bridgton, ME. “This was the first time that an immersion cradled two states”, said Imbert “which allowed the students to think about health policy, and the effect it can have on populations..”

A pharmacy and an osteopathic medicine student work together to collect a blood pressure from a community member at the Fryeburg Fair.

A pharmacy and an osteopathic medicine student work together to collect a blood pressure from a community member at the Fryeburg Fair.

The students attended the Fryeburg Fair, Maine’s largest agricultural festival, where they helped staff the first aid centers. The students created care kits, consisiting of basic, yet essential health care products, like toothpaste, toothbrush, soap, band aids, and more, to hand out to people at the fair. They also worked along paramedics to take blood pressures and provide basic health education on oral health, exercise, and nutrition. “This event gave me the opportunity to meet and talk with people who live in rural communities in Maine”, said Minh Tam Hua, a second year pharmacy student. “I feel that we as health professional students should create more health screenings in rural areas to educate the community about many of the diseases that we saw. If we all stand together and contribute our part, we will be able to help reduce the number of chronic diseases that are taking place in these rural areas.”

Students conducted a Worksite Health ScoreCard at the fair to assess it's performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Students conducted a Worksite Health ScoreCard at the fair to assess it’s performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Jen Van Deusen, MEd, Director of Curriculum in UNE’s College of Osteopathic Medicine, has participated in all four immersions and once again helped to lead the western Maine immersion. “It’s amazing to see the students perceptions of rural health change throughout the trip. And when they return to the classroom I see how excited they are to share what they’ve learned with their peers, creating a ripple effect.”

The full team of students who attended the Midcoast Maine immersion included two medical students from UNE’s College of Ostepathic Medicine Taylor Ouellette and Rodger Carter; two pharmacy students from UNE’s College of Pharmacy Kelly Banks and Minh Tam Hua; two students from UNE’s Nursing Department Katherine Clark and Lesley Lafland; three students from UNE’s College of Dental Medicine Nicole Caron, Brittany Malia, and Kimberlee Sell; and one student from UNE’s Physician Assistant Department Rachel Moore. You can read more on each students experience here.

The group roasts marshmallows on their last night together in Oxford County.

The group roasts marshmallows on their last night together in Oxford County.

The trip was graciously supported by Maine’s Area Health Education Center (AHEC), the Josiah Macy Jr. Foundation, and UNE’s Center for Excellence in Health Innovation. The Maine AHEC has continued to prioritize experiential learning in rural communities for graduate healthcare students and their commitment to the rural health immersion proved to be invaluable for the success of the trip. The Josiah Macy Jr. Foundation grant that also helped fund the experience is a four-year grant awarded to UNE in 2015 from the Josiah Macy Jr. Foundation and aims to improve health care and education in rural areas. Dora Anne Mills, MD, MPH, FAAP, Director of UNE’s Center for Excellence in Health Innovation, helped create the immersion experience.

 

FMI: Contact Ian Imbert, MPH, (207-221-4625 or iimbert@une.edu)

 

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