Health care networks across the state have been working over the past few years to expand cancer services and make it easier than ever to get care closer to home. New facilities are being equipped with the latest technology, more services are coming to community hospitals, and a shift to telemedicine is expanding access. And a number of hospitals have affiliations with some of the top cancer research institutions in the country.

But there’s just one problem: Getting doctors to come to Maine.

Maine is a high-need state when it comes to cancer care: The state’s cancer incidence — or rate of new diagnoses — and death rates are consistently one of the highest in the nation and well above the national average, according to data from the U.S. Centers for Disease Control and Prevention.

Cancer is also the leading cause of death, with more Mainers dying each year from cancer than from heart disease — a reversal of the national trend.

So what’s causing this?

“That’s part of the puzzle,” said Dr. Scot Remick, the chief of oncology for the MaineHealth Cancer Care Network.

There are nine hospitals in the network, including Maine Medical Center in Portland, Franklin Memorial Hospital in Farmington and Stephens Memorial Hospital in Norway.

MaineHealth also has a coordinated system with St. Mary’s Regional Medical Center in Lewiston, which includes oncology, cardiology and general surgery services, and is partnered with MaineGeneral Medical Center in Augusta.

“The fundamental explanation more than any other is basically cancer is a disease of aging. And this is the oldest state in the country,” Remick said.

Plus, during the pandemic, many people fell behind on their routine and preventative screenings for cancer. A spokesperson for Northern Light confirmed that because patients postponed cancer screenings at the beginning of the pandemic, “we are now seeing an increase in the number of patients with cancer needing care.”

A representative of Central Maine Healthcare, the parent company of Central Maine Medical Center, said they are also seeing an increased need for oncology services. It’s why they invested nearly $34 million into a new cancer care center.

The demand for cancer care services is already high — and likely to grow. And with that, services need to grow as well.

But recruiting young professionals to Maine is “a nightmare,” Dr. Jeffrey Barkin, a psychiatrist and the president of the Maine Medical Association, said Friday.

“The workforce considerations are profound. Just like Maine is the oldest state population-wise, the physician demographics track that, too.”

The pandemic has only compounded those issues, he said. Like the health care workforce as a whole, when COVID hit, many doctors near retirement age — who were at high risk for severe illness from COVID — decided to retire early.

The providers who continued to work through the pandemic are “wickedly burnt out,” Barkin said.

A survey of nearly 21,000 health care workers at 124 institutions across the country in the latter half of 2020 published by the Mayo Clinic found that one in five doctors said they plan to leave their practice within two years. An even higher percentage of nurses said they plan to leave. A third of physicians said they want to reduce their work hours within the next year.

As of last month, there were 77 actively practicing oncologists in Maine, according to the Kaiser Family Fund.

“COVID has disrupted staffing in a crazy way,” Barkin said. States are all in competition with each other for a limited workforce. High-paying traveling jobs are luring doctors and nurses away from permanent positions.

It’s something that Remick and Michael Bianchi, the vice president of MaineHealth’s cancer care network, said they’re seeing as well, and it’s made hiring for open positions next to impossible.

Take MaineHealth’s growing cancer risk and prevention program, for example. Remick said the clinic is focused on heritable risks of cancer, or genetic risks. Finding these links through genetic testing can be key to prevention and “we have a growing demand,” he said.

The clinic is staffed by six genetic counselors and a single medical oncologist who specializes in genetics. Remick said that for the better part of four years, MaineHealth has been working unsuccessfully to hire a second medical oncologist for the clinic.

They just cannot find anyone of that expertise who will come to Maine.

While that’s a “very niche area of expertise,” Remick said, it is reflective of the larger challenges that oncology as a specialty faces.

“Cancer care in particular is highly complex. So it’s really rare to see a person out of training who really is going to be comfortable practicing general medical oncology,” he said.

The “explosion of medical science” in oncology has made the job of general medical oncology — which involves the diagnosis and treatment of most cancers, rather than a specific type — incredibly complex.

“More often than not, young physicians coming out of training are highly specialized,” and focus on a particular type of cancer, such as breast or lung cancer.

“It’s a lot to keep up with, you know, each disease, each cancer type in and of itself is almost a specialty of its own. That’s how complex it’s getting,” Remick said. “So you have that challenge of just the breadth of knowledge and the breadth of skills that are required to be able to provide that type of care.”

He said he’s found that older physicians with more experience tend to be more comfortable in that role, but “it’s going to be a problem as the workforce ages.”

It’s even harder to find people who are young and early in their careers willing to practice in a largely rural state. In addition to being drawn to larger metropolitan areas, like New York or Boston, where there are larger hospitals that are more fast paced, young professionals are considering things such as work opportunities for their partners, good school systems and health care access for themselves and their families, as well as the cost of living.

And that’s tough in a rural state like Maine.

“They don’t want to be in a rural location, and some of our locations are very rural,” Remick said.

Barkin said this makes it “hard to grow programs. It’s hard to recruit and retain in Maine.”

That’s the “recruitment slog and challenge we’re up against,” Barkin said, leaving Maine in a tough spot because “in order to convince young doctors and their families to come here, we have to have good, healthy communities. And in order to have good, healthy communities, we need them to be here.”