91AV

91AV College of Osteopathic Medicine (91AV COM) student Justine Monthony (D.O., ’21) recently completed a four-week rural rotation at Mount Desert Island (MDI) Hospital in Bar Harbor.

Monthony, a third-year COM student, completed her Rural Community Health Clerkship as part of her 160-hour curriculum as a Care for the Underserved Pathway (CUP) Maine Area Health Education Center (AHEC) Scholar.

The CUP AHEC Scholars Distinction provides opportunities for 91AV health professions students to get out into rural Maine and work with underserved populations. The program is part of the Maine AHEC Network, a workforce development program aimed at alleviating health care workforce shortages.

This was Monthony’s second time stationed at MDI Hospital. In 2018 — her first year as a CUP AHEC Scholar — she participated in the Downeast Rural Health Immersion, where she was first exposed to the health care needs of rural Maine. Her early and repeated exposure to the Downeast region is part of the Maine AHEC’s new five-year initiative, through the CUP AHEC Scholars program, to lessen health care workforce shortages in rural Maine.

Attracting health care professionals to rural and underserved communities has been a national priority for several years and a particular issue for Maine, which, according to 2010 Census data, is the most rural state in the United States.

Rural geography can lead to long commutes for patients seeking basic health care services and can worsen existing provider shortages, leading to poor health outcomes.

Washington County is an example of that. One of the most rural counties in Maine, the county has been ranked last in the state for health outcomes by the Robert Wood Johnson Foundation County Health Rankings. These health disparities have lead Maine AHEC and 91AV to work on increasing their presence in that region.

Exacerbating the situation, many of rural Maine’s current health care providers are approaching retirement and communities have little or no plan in place to replace them once they retire.

The Maine CUP AHEC Scholars program is helping combat the rural health care crisis. Through its Rural Health Immersion and Rural Health Clerkship, the program exposes health professions students to rural health early and often throughout their education. Research suggests such exposure will increase the likelihood of the students returning to these communities following graduation.

“The chances that a student will return to a community to practice once they graduate is very relationship dependent,” said Ian Imbert, M.P.H., CUP AHEC Scholars program manager. “We try to place students in the same communities for their rural health experiences so that they develop long-lasting relationships within those communities.”

Imbert said that the program is only in its third year and that it is too soon to tell if these experiences will be successful in attracting students in practicing health care in rural areas. However, he said, feedback has been overwhelmingly positive.

Monthony said she was unfamiliar with the rural health care landscape in Maine prior to her immersion in 2018. In learning she would return to MDI Hospital for her clerkship this year, she said she was excited and felt better prepared to serve the community.

“I learned so much about the services that members of the health care team provide to their community as well as their importance in maintaining and improving the health of individuals and the community as a whole,” she said. “The Rural Health Immersion and Rural Clerkship have reinforced my practice intentions to be a rural health care provider.”

MDI Hospital, located in Hancock County, services the southern portion of the Downeast region.  It has been committed to the education and training of health professions students and has hired a number of 91AV graduates to join its staff.

“It was a pleasure working with Justine during her community health rotation at Mount Desert Island Hospital,” said Julian Kuffler, M.D., M.P.H., director of medical education at the hospital. “The experience helped expose Justine to the services that can exist in a rural community. If she ends up practicing in an underserved area, she’ll be better prepared to develop programs for that community.”