October 28, 2021

Primary care key to rural health matters

In the Bangor Daily News’ weekend edition of Feb. 24-25, an article by Diana Bowley was published, titled, “Rural Maine facing doctor shortage: Small hospitals struggling to recruit, keep physicians as exodus mounts.” The report focused on Piscataquis County’s problems with attracting and retaining physicians, indicated by the recent announcements by as many as five of the local doctors that they would be leaving the area.

As a nurse-midwifery student at Yale Unversity’s School of Nursing in New Haven, Conn., and as a native of Piscataquis County, I feel compelled to respond to this article, as I think it points out not only some serious problems with the present moment in rural health care delivery but also some perhaps heretofore unseen opportunities for new directions in the provision of primary care.

The place of the physician in rural areas has a long history, with the image of the country doctor evoking fond memories of a friendly person who made house calls and was always available when needed for a minimal cost. Those old-time doctors were what we would now call “family physicians,” or “general practitioners,” the numbers of whom have been declining steadily in recent decades as more and more medical students opt for specialties.

Family practice no longer garners the same respect that it used to, so that success in the field is measured by the specificity to which one narrows one’s expertise. Unfortuately, rural folks lose out in this picture, since practicing according to their specialized training means that physicians gravitate toward areas of higher population density. At least two of the five physicians leaving the Dover-Foxcroft area are doing so to join specialty practices, which says to me that they did not find the professional stimulation that they needed here.

As a student preparing to become a certified nurse-midwife, I will be an advanced practive nurse holding a master’s of science in nursing, qualified and licensed to provide primary women’s health care, complete pregnancy, birth, and postpartum care for healthy women, as well as to prescribe birth control and other pharmaceuticals as needed. My colleagues in advanced practice nursing include family nurse practitioners, who are qualified to provided most of the primary health care that family physicians can provide, at a cost- and time-effective rate. Advanced practice nurses average twice the time for client visits, and we are cheaper for heatlh care facilities to hire.

I am also one of many future and present advanced practice nurses who is interested in working in rural health care, perhaps in the state or county which I call home. At present the Federal Department of Health and Human Services and the Maine Office of Rural Health both activitely recruit health care providers interested in primary care to work in underserved areas like Piscataquis County. I hope that those in charge of finding health care providers in Dover-Foxcroft keep their eyes open to these opportunities for hiring interested, dedicated, and highly-qualified people, who may not be physicians but who are certainly prepared to deliver the type and quality of care that our area needs so badly.

Perhaps in the future we can measure the “health” of our health care system in Piscataquis County by the numbers of primary care providers of all kinds who are working and living there, not just by the numbers of physicians we manage to hold on to.

Kate Plummer, a native of Abbot Village, is a student at Yale University’s School of Nursing.

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