OXFORD — Hoping to find a doctor in Oxford County? Good luck.

A recent report of county health rankings shows that Oxford County has just one primary care physician for every 1,490 residents, the worst ratio in the state.

“Some places just don’t accept new patients because there’s nowhere to put them,” said Dr. William Medd, a practitioner of internal medicine at Stephens Memorial Hospital in Norway.

By comparison, the statewide average is one doctor for every 694 residents. In neighboring Franklin County, there is one for every 532; in neighboring Cumberland County, it’s one for every 474 – three times better than in Oxford County.

“It has been very difficult to recruit primary care physicians to Oxford County,” said Deborah Deatrick, of MaineHealth. 

Medical institutions struggle to staff medical positions, and a report from Tufts University claims that there are 200 open doctor positions in Maine at any one time.

One institution that has felt the impact of the shortage is Stephens Memorial Hospital, said Tim Churchill, president, Western Maine Health.

“It [the shortage] ties our hands in terms of delivering the right care in the right way in the right location,” said Churchill. “That shortage really results in having patients who shouldn’t end up in the [Emergency Department] ending up there, instead of having a problem diagnosed much earlier than would otherwise be the case.”

Churchill said that the only answer is to get more doctors in Oxford County who can treat more patients.

“Clearly, from our perspective, the only way to really deliver appropriate care is to have enough primary care physicians and or providers,” said Churchill.

Churchill said that the problem extends far beyond the borders of Oxford County.

“This is not just a local problem,” he said. “This is a national crisis, but it is particularly acute in rural areas.”

Doctors spread thin

The reasons behind the doctor shortage are complex.

Over the past 25 years, the number of doctors choosing primary care positions in traditional office settings has dwindled, and they are able to see fewer patients, said Medd.

A certain percentage of doctors choose to become specialists. That option has become more attractive over recent decades, said Medd, because the pay is better, and better pay is needed to cope with spiraling medical school costs.

In addition, more hospitals are hiring doctors to act as hospitalists, who treat the river of patients flowing through the hospital at any given time. A hospitalist might see far more patients a year than a traditional family doctor, but he or she will not get to know the complete story about any particular patient’s health.

Medd said that this trend further reduces the ability of a person to easily access routine or preventive healthcare.

“You can’t call and make an appointment with a hospitalist,” said Medd.

The shift toward hospitalists and specialists has changed the way that patients think about their health care system.

Rather than having convenient access to a primary doctor, patients tend to wait until they are experiencing a problem, and then treat that problem.

“The patient has become more oriented toward going to a ‘left ear doctor,’ or a ‘right foot doctor,'” said Medd.

That’s not necessarily a problem when there are also plenty of primary care physicians available.

“It was fine until the shortage occurs,” said Medd. “And then suddenly you have a major issue.”

Medd said that another negative factor has been the recent shift to electronic health records. The systems that contain the data have less flexibility, he said, and require doctors to spend more time entering data than they should.

“Instead of four patients an hour, you might not even be able to do three an hour,” said Medd. “That’s another factor that’s reducing the supply.”

Finally, Medd said that the growing number of women in the field has consequences for rural areas, like Oxford County.

“You have a lot more women in medicine, over 50 percent now, and you have a lot of marriages that are dual professionals — physicians and physicians, physicians and business people, physicians and lawyers.”

Medd said that spouses of doctors may have more trouble finding ideal career opportunities in rural areas; in these cases, the couple tends to end up in a city where both can find good jobs in their fields.

Also, said Medd, women doctors are more likely to take extended periods of time off to have and raise children.

“Women are more involved with raising their family,” he said.

Filling the ranks

Churchill said that SMH is hoping to make a dent in the shortage.

He said that simply offering more pay to primary care physicians is not going to fix things.

“It’s not simply a matter of paying more; it’s having a health care system that encourages medical students to go into primary care.  Once that takes place we hope they see some appeal practicing in rural Maine or Oxford County, or Norway specifically.”

Churchill said that SMH is continually working to create an environment in which doctors can be comfortable. This can mean making sure that top-quality equipment and support staff are available to facilitate best medical practices.

The other part of the puzzle is letting doctors know that Norway can be a good place to work and live.

“Our challenge is getting them here to check us out. Generally, if we do, we have a pretty good chance of having them decide to practice here,” he said.

Part of that effort has been active participation in the MaineTrack program of Tufts University, which holds slots for medical students from Maine. The students complete some of their training at hospitals in rural Maine.

“We see that as an investment that’s very important,” said Churchill. “That’s something that we have felt as an institution and as a board.”

Right now, SMH is hosting a handful of medical students who are working their way through the program. The program’s sponsors hope that they will make connections in the community, and eventually settle down in the area.

“We have been thrilled with the students we have here now,” said Churchill.

The big question mark hovering over the students in the program is whether they will, in fact, set up shop in Maine later in their careers.

Churchill said that it will take seven years for these early batches of students to begin settling down.

Then, he said, “we see if this program really works. But the response from our physicians has been great.”

Chris Anderson, one of the students in the program, said that the program has made an impact on him.

“I’m definitely staying in Maine,” he said.

Anderson said that staying in Maine was always his intent, but that the program has strengthened his attachment to practicing primary care in a rural setting.

“It definitely pointed me in that direction,” said Anderson. “I wouldn’t feel so strongly if I wasn’t in the program.”

Anderson said that those who don’t currently have a primary care provider can have a very difficult time identifying one, as doctors with full workloads stop accepting new patients.

The end result, said Anderson, is worsened health for Oxford County residents.

“It’s important to have those regular checkups and to have a doctor who knows you really well,” he said. Otherwise, “little things that could be caught early are missed and become big problems.”

“We need to bring back the recognized value of your own doctor,” said Medd. “The public and the medical world is finally waking up to this value.”

He said that countries with universal health care plans, like England and Canada, emphasize primary care, in part because it reduces the overall cost burden to taxpayers.

The bottom line, said Medd, is that patients need access to primary care physicians.

“If you wake up and you don’t know what’s wrong and you’re sick, you have to have somebody to call. You need to know a doctor who knows you, too.”

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