Winter 2018

Maine Attraction

One of the first Maine Track graduates shares why she’s committed to rural care.

By Marya Goettsche Spurling, M13

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Illustration: Cristina Spano

It seems like just yesterday that my class of 32—the first class to graduate from Tufts’ Maine Track Program—was getting off the boat at Cow Island in Casco Bay for team-building orientation. Eager and nervous, we shared tents and built makeshift rafts together, quickly becoming a family that went on to support each other through the marathon of medical school. When we finally reached commencement and scattered near and far toward our next steps, we vowed, “See you back in Maine!” Today, nine of my 14 classmates who have completed their residencies have made good on that promise and are now practicing in the Pine Tree State.

I trained in many rural parts of the state, from the western Maine town of Norway to Fort Kent, on the northern border with Canada. The one-on-one instruction I received from my attending physicians was invaluable. But beyond clinical knowledge, I gained perspective. Medical students and residents are often expected to pursue opportunities at high-resource, technically advanced medical centers; competition and pressure can be fierce. This training prepares physicians to practice in similar settings (larger cities rich in specialty care and the latest innovations) and not in small community hospitals and rural clinics—a pipeline that doesn’t address the needs of the resource-poor parts of the country in dire need of improved access to medical care, which represents much of Maine.

After finishing my residency in Alaska—mostly in Anchorage, with turns in rural and bush settings—I began practicing full-spectrum family medicine in Skowhegan, Maine, in October 2016. I’m employed by an independent, critical-access hospital, and my patients range from prenatal to 95 years old; I even care for five generations of one family! Though I predominantly see people in my office, I also oversee all aspects of my patients’ care. If someone goes into a nursing home, I attend to him there; if another person goes into labor, I deliver the baby at the hospital, and so on.

Somerset County is a challenging place to work: One-quarter of the children in our county are living below the federal poverty level, and unemployment rates are tied for highest in the state. Our health outcomes as a whole are the third lowest in the state, and there are fewer health-care workers per capita in our county than the state average. But it’s not all grim. In my short time as a physician in the community, I’ve witnessed several health triumphs, including a patient who altered his lifestyle to reverse diabetes and a father struggling with drug addiction who sought and stuck to a treatment plan to regain custody of his children. On the state level, Maine just approved a ballot measure to expand Medicaid, which will allow physicians to better serve more of
the population.

What I like about primary care is the long view—seeing an individual or a family over time, observing health changes and illnesses progress or regress—a view that is so often obscured by the daily frustrations of our current health-care structure. My hope for the future is that doctors and patients will work together to create a truly equitable system offering high-quality care to all, and that Maine will continue to raise, train, attract, and retain dedicated physicians in the places where they are needed most.

Maine native Marya Goettsche Spurling, M13, grew up on Little Cranberry Island—which has a year-round population of around 70 residents—and now works for Skowhegan Family Medicine, a department of Redington-Fairview General Hospital.

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