Unlike many of his peers, Dr. Peter Goth, emergency and critical care director at The Aroostook Medical Center in Presque Isle, always was drawn to rural medicine and rural life.
A native of Kentucky, Goth spends two weeks each month working at TAMC in Presque Isle, overseeing some of the most advanced hospital treatment in The County, and two weeks living in the midcoast town of Bremen, where he farms and raises sheep.
“I never wanted to live in an urban area,” said Goth, who has been working at TAMC for 10 years. Practicing in rural settings, “you can have a work-life balance,” he said.
Most physicians end up working in cities and suburbs, while recruiting doctors and other health professionals is a struggle in America’s rural communities, which are home to about 20 percent of the country’s population but only 10 percent of doctors.
Amid that shortage and concerns about health care cost and quality, Dr. Dora Anne Mills sees opportunities in rural communities for the next generation of doctors, dentists and other health professionals.
Mills, the former head of the Maine Center for Disease Control and Prevention and current vice president of clinical affairs at the University of New England, was in Aroostook County at the end of May with a group of 15 medical, dental and pharmacy students from UNE. They were on a rural health immersion tour that included intubation training and hospital rounds at TAMC, dental varnishing at Van Buren Elementary School, lunch with senior citizens in Madawaska and a paddle down the Aroostook River.
“One of the biggest barriers in going into rural health is students feel like it’s a big risk,” said Mills, a pediatrician and public health specialist who grew up in Mt. Blue and whose grandparents had a potato farm in Ashland.
Rural immersion trips let students experience what it’s like to work and live in a place like Presque Isle early in their education, before they consider training sites, Mills said. They also let health students learn to work interprofessionally, “to work as a team” — something that’s badly needed in health care, Mills said
Medical errors in hospitals contribute to an estimated 250,000 deaths annually, making them the third leading cause of death, after cancer and heart disease.
“If you do a root cause analysis, poor teamwork leads to 80 percent of medical error deaths,” Mills said.
“The most common medical error deaths are from infections, many of them from urinary tract infections,” Mills said. Those infections can lead to life-threatening conditions like the blood infection sepsis, and they can often be traced back to failures of communication or coordination.
“Why did they have a urinary-tract infection?” Mills said, outlining a hypothetical case of someone who died of sepsis. “They had a catheter placed after surgery and it was there for seven days. Why did they have it placed for seven days when it could have been taken out after three? The doctor forgot to order it to be taken out.”
Interdisciplinary training is something that UNE and other schools are trying to offer their students more often, so future doctors, nurses and other health professionals are comfortable working together. That’s important in hospitals and in clinics. Almost two-thirds of UNE’s medical students go on to work in primary care, and they’ll have to collaborate with everyone from cancer specialists to behavioral health counselors, Mills said.
During their visit to TAMC, the 15 students practiced rapid sequence intubation on mannequins altered to represent different injuries, under the guidance of Goth, who pioneered a training system for the procedure.
“It’s a team-approach,” Goth said. “The best way is to have a pit crew of nurses and doctors.”
At the Madawaska Seniors Center, the medical and pharmacy students also had a chance to get to know people who could be their future patients. Danielle Beard, a medical student, said in UNE’s newsletter that it was “eye-opening” to talk with senior citizens while taking health assessments and sharing lunch.
“A common theme was that many individuals had to travel more than 30 miles in order to access their primary care provider, and many of the individuals stated that they had trouble affording foods that met their nutritional needs,” Beard said.