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Jack Forbush is a family physician and founder of Osteopathic Center for Family Medicine in Hampden, one of a shrinking number of independent medical practices in Maine.
Augusta keeps asking why Maine can’t find a doctor, a plumber, or an electrician. Here’s part of the answer.
If you’ve ever tried to find a primary care physician, optometrist, dentist, accountant, attorney, electrician, plumber, or contractor in rural Maine and been told they aren’t taking new customers — and then called the next one, and the one after that, and heard the same thing — you already know who bears the cost of that shortage. Not the people with connections. Not the people who can drive to Portland or fly to Boston. The people who bear that cost are the ones with the fewest options and the least power to create new ones.
Maine has a small business problem, and the Legislature may be about to make it worse for the communities that can least afford it.
The Appropriations Committee recently voted, along party lines, to advance a 2% surtax on adjusted gross income above $1 million. The intent, presumably, is to ask more of those who have more. That is a reasonable instinct. But the structure of this tax doesn’t work the way it sounds.
Small businesses — medical practices, dental offices, law firms, accounting firms — are typically structured so that gross revenue flows directly through to the owner’s personal tax return. A rural family practice or a contractor running a crew of four billing $1.1 million is not a millionaire’s enterprise. That revenue covers staff wages, rent, equipment, insurance, and overhead before the owner takes home a dollar. The business hits the threshold. The owner, who may earn a fraction of that, pays the surtax. When stacked on Maine’s existing income tax and high-earner surcharge, the cumulative hit approaches 9%.
The people who absorb that cost are not faceless corporations. They are the receptionist, the dental hygienist, the paralegal, the electrician’s apprentice — the staff whose jobs depend on whether the business stays open. And they are the patients, clients, and community members who lose access when it doesn’t.
Professionals and tradespeople choose where to build a practice or a business. Physicians, dentists, attorneys, accountants, electricians, plumbers, and contractors — especially those early in their careers and carrying significant debt — weigh their options before committing to a state. Maine already faces steep headwinds: rural geography, an aging population, and service reimbursements that often don’t cover the actual cost of care.
The professionals most likely to leave, or to never come, are not the ones with institutional backing. They are independent practitioners who employ local people, serve underinsured patients, and keep their doors open in places where no one else will. When the math stops working for them, it is not a wealthy enclave that loses a luxury. It is a rural town that loses its only doctor, its only dentist, its only attorney doing estate planning for working families.
This is not an argument against asking more of those who earn more. It is an argument about who actually gets hurt when a policy doesn’t work as intended.
You cannot close the gap in access to care, skilled trades, legal services, and professional services in rural Maine by making it harder for the small businesses that provide those services to survive. The people harmed by that outcome are not the owners. They are the patients who can’t get an appointment, the families who can’t find an attorney, the employees who lose a job — the people this tax was intended to help.
That deserves an honest accounting before this passes.