Wanted: Primary medical and dental professionals

As children, many of us can remember lining up domino tiles with the goal of watching the chain reaction as they all fell down when given the slightest touch of a finger to the first one in line. The brief excitement when they toppled over was quickly replaced by the disappointment of knowing how long it would take to stand them back up again.

For several communities across Maine, particularly those in rural areas, a domino-like effect is occurring that is adversely impacting our residents, but there is no joy in witnessing the fall.

The closure of the mills in Bucksport, Madison and Jay had a cascading and devastating effect on hundreds of workers, their families, neighboring businesses and towns. Nursing home closures, such as in Calais caused layoffs, moved sick and elderly residents farther away from friends and loved ones, and reduced revenues, which in turn affected property tax rates. And hospitals that closed in Brunswick, Sanford and Boothbay caused anxiety among those who depended on their services, among other impacts reported in the news.

Maine’s Community Health Centers, which provide high quality primary medical, dental and behavioral health services to one in every six Mainers (approx. 210,000), are not immune from these and other adverse events because they, too, are part of the fabric of the communities they serve.

For years, our Health Centers have informed and alerted the public and elected officials to the primary medical and dental professional shortage which has developed into a crisis. That fact became abundantly clear a couple of months ago when Hometown Health Center’s Canaan site was forced to close because of their inability to recruit and retain enough clinicians to serve their community. As a result, 1,300 patients lost their medical home.

Fortunately, HHC’s other four locations invited the displaced to become new patients, but it is unclear how many will be willing or able to travel the distance to the other practices.

To make matters worse, HHC’s dentist, who provides oral health services to 1,053 patients at the Dexter site, just submitted her resignation because she is moving out of Maine to start a dental practice in another state. She will be missed, and recruiting another dentist could take months or even years.

HHC isn’t unique, however, with such hiring challenges, as all of Maine’s Health Centers are faced with the same dilemma. In 2015, 90 percent of Maine’s Health Centers lost at least one employed provider or the opportunity to recruit new providers. That is the result of a number of factors, including a lack of National Health Service Corps support; difficulty competing with other states and hospitals to offer competitive salaries and benefits; and Maine’s lack of incentives (like other states in the Northeast Region offer) to attract and retain skilled providers.

Thankfully, despite these barriers, the Maine Legislature responded by passing a couple of bills during the past few years that have helped to address the crisis. One of those modest, but critical initiatives created a Primary Care Professionals Tax Credit Program, modeled in part, after a similar program that existed for dentists. It authorized a state income tax incentive for up to five physicians, nurse practitioners and physician assistants who had outstanding student loans and who commit to practice in medically underserved areas.

Health Centers in Patten, Fort Kent and Vinalhaven were fortunate enough to have providers awarded under the program; others, however, weren’t so lucky. DFD Russell Medical Centers, with sites in Monmouth, Leeds and Turner, had three providers apply, yet none were awarded due to the limited slots available to participate.

According to the Department of Health and Human Services, in the first two years of the program, they received 18 applications, 14 of which were from Health Centers. We expect the number of applicants to increase this year.

Mainers shouldn’t lose access to affordable, high quality medical and dental care because the state lacks the ability to compete for clinicians. That is why we urge members of the Legislature to expand this vital program and make these incentives permanent by passing, LR 1640: “An Act to Strengthen Efforts to Recruit and Retain Primary Medical and Dental Professionals in Rural and Underserved Areas of Maine,” sponsored by Sen. Troy Jackson.

The bill, which has bipartisan support, modestly increases the number of medical professionals who could receive support from five to 10, restores the dental tax credit which expired last year, and makes both benefits available permanently. Such targeted investments by the Legislature in programs that have demonstrated their value like these are not only wise, they are necessary.

Don’t take my word for it, though. Here’s what a nurse practitioner from Katahdin Valley Health Center had to say in 2014 before the Legislature enacted the original law:

“I was raised in Aroostook County and went to college in Connecticut. I wanted to provide health care to the people from my home area and new providers were needed there. I was hired by Katahdin Valley Health Center, and had a significant amount of student loan debt. I have had to think about relocating somewhere that I might be able to get help with my student loans, but I didn’t want to because I am finally back home near my family. To address these challenges, the Legislature can pass ‘An Act to Create a Tax Credit for Primary Care Professionals Practicing in Underserved Areas.’”

That bill passed, and she was one of the providers who was awarded a tax credit. She has stayed in Maine as a result.

We understand and appreciate that there are many competing priorities this session, but we also know that programs such as the medical and dental professionals’ tax credits are not only working for the providers who directly receive the benefits from them, they are also supporting others down the line — the patients, local businesses and communities they live in.

Vanessa Santarelli is CEO of the Maine Primary Care Association, an organization that works to strengthen and sustain Maine’s Community Health Centers and its primary care system, particularly in rural and underserved areas.