Med school at UM eyed by Martin College seen as solution to dearth of rural doctors

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Worried about the persistent scarcity of physicians tending to Maine’s rural population, Sen. John Martin, D-Eagle Lake, wants the state to revisit the possibility of creating a medical school at the University of Maine that would concentrate on training family practitioners.

Martin is seeking state funds to update a study undertaken in the mid-1970s that concluded the state should start a medical school. The remedy for the dearth of rural doctors is a rural medical school because of the close correlation between where physicians study and where they end up practicing, according to Martin.

Despite a shortage of rural physicians a quarter century ago, the issue raised a firestorm of controversy. Then-Gov. James Longley vetoed legislation in 1975 that would have established a medical school at UM.

Martin, speaker of the House of Representatives at the time, said in an interview Tuesday, “We passed it in the Legislature, but couldn’t override the veto.”

The problem today, as it was back then, is “getting doctors into rural areas,” Martin said. “We need to create a medical school that not only attracts students to rural areas, but makes them want to stay. And that will only happen if it’s in a rural area.”

He envisions the school concentrating on training primary-care physicians, and encouraging its students to intern in a rural area.

Martin decided to revive the idea of a UM medical school after he toured the University of Kentucky’s College of Medicine last summer as a member of the National Advisory Committee on Rural Health.

While the college is located in Lexington, a city with a population of about a quarter of a million, it has a strong rural health emphasis, said Vikki Franklin, a spokeswoman for the medical college. The school’s Center for Rural Health, which is located in eastern Kentucky, an area considered part of rural Appalachia, focuses on training family physicians.

The medical college also sends its students into rural areas for their clinical rotations “in the hope that because of the exposure, they’ll end up practicing in those areas after they complete their training,” Franklin said.

Martin said that “if we’re going to save rural America, we have to stop people from having to run to the cities for medical care.”

He is banking on federal money to provide the start-up funding and a significant portion of ongoing funding.

Because of the available federal funding, and the tuition that would eventually flow in, he doubts that the school would be a drain on taxpayers. But he wants to revisit and update the 1970s study to see if his hunch is correct.

To get the federal money, he said, the program must be set up “in conjunction with a hospital,” such as Eastern Maine Medical Center or St. Joseph Hospital in Bangor.

When asked if his hospital was interested, Norman Ledwin, head of EMMC, said, “Absolutely, yes.”

The “capability, expertise, talent, and training” is already in place for it to become a teaching hospital, he said. EMMC geared up for the possibility in the mid-1970s when the establishment of a medical school at UM was last debated.

“That is the basis for the level and quality of our expertise here today,” Ledwin said.

Because they were unaware of the details of Martin’s proposal, St. Joseph Hospital officials declined to comment.

On the university side, Martin said he has only discussed the idea with Terry MacTaggart, chancellor of the University of Maine System. He could not be reached for comment.

In contrast to Ledwin’s openness to Martin’s ultimate goal, UM officials sounded more cautious.

“We applaud Sen. Martin for his interest in finding ways to address Maine’s health care needs, and we agree that it makes sense to pursue a course that involves careful consideration of the potential benefits and drawbacks before making a commitment of resources,” UM President Peter Hoff said in a written statement.

The long-running paucity of rural physicians is well known.

There has been a “pretty serious problem for many, many years” when it comes to finding primary-care physicians willing to work in rural Maine, said Jim Harnar, spokesman for the Maine Hospital Association, which has a task force on recruiting and retaining rural doctors. “People in rural Maine often have to travel great distances” to get the treatment they need.

Residency programs, such as the Family Practice Center in Bangor, an arm of EMMC, and those associated with Maine Medical Center in Portland, Central Maine Medical Center in Lewiston, MaineGeneral in Augusta and Waterville, supply physicians for the state, he said. And the medical school at the University of New England in Biddeford is another source.

Rural practices can be rough on physicians.

Harnar said that rural doctors tell the hospital association that their “on-call” schedules can be demanding geographically because of the scarcity of other physicians in their area. This fact also means that they are on call often because there are few doctors to share the call schedule with, he added.

Then there are the problems of “professional isolation” working in rural areas and the levels of compensation, Harnar said.

Studying the idea of a medical school in Bangor certainly has merit, he said. “Experience has shown that doctors often choose to work where they do their training or residency.”

Currently, to provide a path for Maine residents to become physicians, the state reserves 20 slots at medical schools across New England: 10 at the University of Vermont; five at Dartmouth College; and five at the University of New England in Biddeford.

But because of the close correlation between where people study to become physicians and where they do their residencies and where they eventually end up working, Martin wants a medical school in rural Maine.

Studies on the feasibility of a medical school in Maine were undertaken in 1965-66 and then again in 1974-75.

The earlier study recommended that Maine set up regional medical centers before establishing a medical school. The author of the report said this would cut the distance between patients’ homes and doctors’ offices significantly.

The second study called for the establishment of a medical school at UM. It ran into fierce opposition in the State House and the Blaine House.

At one point in early 1975, Gov. Longley called on the entire UM board of trustees to resign, in part because of its support of the medical school idea.

Longley accused the trustees of “promoting a medical school at a time when there are serious questions in the minds of most citizens of this state whether a medical school is feasible and can be afforded at this time.”

The medical college proposal came at a time when Longley sought to cut or at least hold down state spending. In 1975, while the trustees asked for an additional $20 million in state funding for university programs, Longley proposed just $200,000 in new spending.

The House of Representatives endorsed the medical-school legislation on a 71-59 vote, while the Senate backed the proposal by a single vote. Both margins were far short of the two-thirds majorities needed to override Longley’s veto in June 1975.