Testimony in Support of LD 503

An Act To Continue the Doctors for Maine's Future Scholarship Program

Peter Bates, M.D.

Chief Academic Officer at Maine Medical Center

&

Academic Dean for the Maine Track Medical School Partnership

Senator Volk, Representative Fecteau and distinguished members of the Joint Standing Committee on Labor, Commerce, Research and Economic Development, I am Peter Bates, M.D., and I am the Chief Academic Officer at Maine Medical Center (MMC) and the Academic Dean for the Maine Track Medical School Partnership we have with the Tufts University School of Medicine (TUSM). I am here today in strong support of LD 503 “An Act To Continue the Doctors for Maine's Future Scholarship Program.”

Background

Like many rural states, Maine has a shortage of physicians. This challenge is exacerbated by the age of our physician workforce. In more than half of Maine’s counties, and particularly our rural counties, the physician workforce exceeds an average age of 55. This shortage presents particular challenges as we seek ways to improve the health of our rural communities.

While there are many reasons for the shortage, two stand out in particular: 1. Maine is one of only 6 states that does not have a state-sponsored medical school; and 2. The cost of private or out-of-state tuition at medical school oftentimes  requires students to accrue large debt if they pursue a career in medicine at all.  The average medical school student in the US graduates with $190,000 in debt.

In an effort to address this problem in an innovative way, in 2008, Maine Medical Center (MMC) partnered with the Tufts University School of Medicine (TUSM) to found a unique program designed to serve Maine students close to home. The TUSM MMC Maine Track program is based on the highly successful program in Washington State, and it was founded with three goals in mind:

·       To address the shortage of physicians in Maine, and particularly physicians in our rural areas;

·       To make available access to high quality and affordable medical education for Maine’s best and brightest students; and

·       To develop and innovative curriculum focused on rural medicine and community-based education to best meet the needs of our state.

The unique MMC/TUSM partnership offers a rigorous training program that exposes students to rural clinical practice from day one and provides students firsthand experience providing care in local communities throughout the state including such towns as Madison, Caribou, Belfast, Wiscasset, Richmond, and Norway.  Most importantly, in an effort to ensure that Maine students have access to medical education at a cost on par with that of a state school, Maine Medical Center guarantees that at least 20 Maine students in each class receive scholarships that cover approximately 50% of their tuition – or the equivalent of in-state tuition in those states that have their own medical schools. The goals are to ensure that these students have access to affordable medical education, and by graduating with less debt, they will be more likely to enter primary care and other specialties that are not lucrative but extremely important to serving a population, and to ensure that Maine students stay in Maine to serve our population in the future.

The Doctors for Maine’s Future Program

In 2009, I came before the 124^th Maine Legislature’s Joint Standing Committee on Education and Cultural Affairs in strong support of LD 853, “An Act to Encourage Maine Residents to Attend Medical School and Practice in Maine.” The bill became law, and it appropriated approximately $3 million to fund a scholarship program at FAME for Maine students who attend medical school in a Maine-based program.  I am here today to tell you that the Legislature’s investment is paying off with huge dividends, and to ask for your support in investing in Maine’s future by setting aside the funds to support these scholarships in perpetuity.

Details

The Doctors for Maine’s Future Scholarship program included in the bill before you today provides tuition scholarships of $25,000 per year, per qualifying student at UNECOM and Maine Track, or a total of $100,000 over the course of completing a four-year medical school program. This represents approximately half of the tuition costs for four years at the Tufts Medical School.

And this is a unique public private partnership between the State and the medical schools. The Doctors for Maine’s Future program requires that Maine Medical Center and University of New England privately raise dollar for dollar matching funds to support additional medical students. For example, if 16 students (4 per medical student year) qualify for state-funded scholarships at any one time, Maine Medical Center raises and matches private funds for another 16 students for the same program.

As I mentioned earlier, Maine Medical Center is committed to providing scholarships for at least 20 Maine students per year. The Doctors for Maine’s Future scholarships provide an important incentive for our philanthropic donors as they see the State invest its scarce resources in the future health of our communities.

Results!

Has it worked? In a word – Yes! Though we have only one class of Maine Track students that has graduated, completed residencies and some of whom are now practicing (while others complete further training), the unique program, with a foundation of rural health care and affordable medical education,  has produced results are even better than we hoped:

·       64% of the practicing graduates have chosen to practice in Maine. This is comparable with the most successful rural focused medical education in the country.

·       We have seen a 40% increase in Maine applicants since the program was founded (6th fastest growth rate in the US),

·       65% of our students call Maine “home”,

·       27% of our graduates complete a residency in Maine (this would be higher if we were able to secure federal support to expand the number of residency spots), and

·       More than 50% of graduates pursue a primary care specialty (Internal Medicine, Family Medicine, and Pediatrics).

One example is Dr. Marya Spurling. Dr. Spurling grew up on Little Cranberry Island from a family with a long line of local lobsterman. She attended Mount Desert Island High School and after completing the Maine Track program chose a family practice residency in Anchorage, Alaska. She now happily practices primary care in Skowhegan. If her name and background sound familiar it is because many of you met her last Thursday when she volunteered her time as Doctor of the Day here at the Capitol. She couldn’t make it today due to clinical responsibilities but her testimony is included with mine in the packet before you. In it she highlights how access to the Doctors for Maine’s Future Scholarship provided funding for half of her medical school tuition, and deemed it a critical program for aspiring young doctors from Maine. She still graduated from medical school with a student debt burden nearing $160,000 which would have been nearly doubled without access to the program. You also have before you the success story of Dr. Chad Szylvian. He grew up in Brewer, completed residency at Eastern Maine Medical Center, and now practices in Bangor within the EMHS system as a family medicine physician.

Four classes have graduated since our first class entered in August 2009 and my colleagues here today, Dylan Wingfield (Brewer) and Alex Fiorentino (New Gloucester), members of our fifth graduating class will shortly be providing comments about their respective backgrounds and experiences from the Maine Track program as Doctors for Maine’s Future scholars.

The outcomes we are seeing a result of the Maine Track and UNECOM programs—practicing in primary care, practicing in a rural community, and practicing in an underserved area are desperately needed if we hope to grow and maintain access to necessary primary care for your constituents throughout Maine. In many areas across the country, medical student choice and interest in these important outcomes have fallen well below the thresholds necessary to maintain the physician workforce in primary care and underserved settings, threatening to enhance an existing workforce maldistribution. Students with the ability to access successful debt reducing programs like the Doctors for Maine’s Future Scholarship program are much more likely to later practice and remain in primary care, and more importantly, stay in Maine. We also now have clear evidence that our student selection process and curriculum are just as important in producing local primary care physicians.  MMC, TUSM and the Maine Track community hospitals believe that the financial support of medical education scholarships through the Doctors for Maine’s Future program is a strategic investment by the State of Maine in our future health care workforce and, in turn, the health of our communities.

Finally, I recently became aware of the sincere interest expressed within the 128^th Maine Legislature to study ways to address current and impending workforce shortages. I am sure those discussions will include initiatives with evidence-based policy options, not only for the healthcare workforce but across all industries and professions. The groundbreaking and already successful data driven public-private partnership policy model contained in LD 503 should serve as an excellent example during those discussions and I respectfully urge you to vote Ought to Pass during a future work session.

Thank for allowing me the extra time to speak with you today. I will be more than happy, and proud to answer any questions about our program and its success. Thank you.