Off the Beaten Track

FEATURE-January 2013
By Genevieve Morgan
Photographs by Matt Cosby

Maine Grows Its Own Kind of Doctor.


Those who live or work in the west end of Portland do so, often literally, in the shadow of Maine Medical Center, the largest hospital in our state. Less obvious is that Maine Med has a teaching tradition that reaches back to its founding in 1874, when it was the proving ground for many an up-and-coming doctor at the Bowdoin Medical College in Portland (which closed in 1924).

Through the years, doctors continued to train at Maine Med, but only after they graduated from the short white coats of a medical student. In those days, bright young Mainers (like Chad Szylvian, the almost-doctor sitting across the table from me), who had dreams of practicing medicine and the stratospheric grades to make it happen, were most likely to go out of state for their educations. That all changed five years ago. That’s when Maine Medical Center began a partnership with Tufts University School of Medicine and created Maine Track, a competitive four-year program in which Tufts medical students spend their third and fourth years studying in 40 medical centers scattered across Maine. The hope is that these young doctors will like the challenges of caring for a rural population and come back after their residencies to practice medicine in Maine for good.

Szylvian is one of 36 inaugural students who will take home a joint MMC-TUSM medical degree this spring. He will also add MPH to the already impressive string of letters following his name, as he is concurrently pursuing a master’s in public health. Born and raised in Brewer, he is the son of an electrician and a member of a family that has lived in Maine “forever.” Szylvian’s parents still live in the house he grew up in.

“I’m the first one in my family to go to college, let alone medical school,” Szylvian says, digging into his fruit plate. “But I knew early on that medicine was something I really wanted to do…I guess I had a calling.” He is chipper for someone who’s just finished an eight-hour night shift in the ER and will soon go home to work on a presentation. Plus, he’s a newlywed. He admits he won’t see his pillow, or his wife, for many, many hours to come. That neither his face nor his conversation show signs of sleep deprivation is a result of efforts on the part of Maine Track faculty to turn down the fire hose of pressure on medical students, and also of Szylvian’s natural tendency toward balance. “I know the things that keep me sane and I make time for them, like being outside, which is so much easier to do here.”

Szylvian aced Brewer High School, where he was salutatorian, a member of the football team, and a jazz pianist, before going to Boston College. There he majored in Biology and minored in Theology, studying the usual pre-med requirements with a dollop of Comparative Ethics and Buddhism on the side—subjects that go a long way toward explaining his Zen temperament and the dual MD/MPH.

Not only did Szylvian have the sagacity to know what he wanted to do with his life by age seven, he had the math and science chops to achieve it by his junior year of college. “But that’s when I got cold feet,” he says. “I’d never considered doing anything else but something inside me started to have questions. But then I heard about Maine Track. It was the first year they were offering it, and I knew I wanted to come back to Maine, so I did the paperwork.”

Now on his final lap before graduation, he has the credentials for a plum residency in a major metropolitan area (known as a primary market in hospital-speak; Maine is a tertiary market). Many an aspirational young doctor has left his small-town upbringing in the rearview mirror, but Szylvian is committed to returning to take care of people here—wherever he ends up in residency. “I like the lifestyle better here and I like the idea of serving the people of Maine, particularly in the area where I grew up where there aren’t as many doctors.”

He’s hit on something important. The nation is facing a rising shortage of primary care doctors. In our state, which is home to a largely rural and aging population (in ten years one in every five Mainers will be a senior citizen) the shortage could soon reach crisis level, especially in the underserved areas west of I-95 and north of Bangor. Maine Track was developed as a way to encourage more physicians to forge the kind of strong links that will bring them back to practice, ideally in the older, poorer, and sicker populations outside the urban centers.

The program gives preference to legal residents of Maine and to those who can demonstrate strong ties to the state. It provides incentive in the form of tuition relief: a $25,000 annual renewable scholarship for up to 20 students per class. This is a big deal considering that tuition for an out-of-state private medical school is substantially higher than most Mainers’ annual salaries. It’s not a requirement that Maine Track graduates come back to Maine, but it is a strong intention of the program, which was designed in part to help stop the state’s brain drain.

“The Maine Track program is self-selecting because of the lifestyle decisions you have to make,” Szylvian offers as further explanation. “Not everyone wants to live in a rural area or do rotations at a small hospital. For me it was easy; I prefer the kind of life that Maine offers and I’m more interested in having meaningful work than a huge career. I guess I’m more of a humanist than an opportunist.”

“It’s a pretty rarified group that gets into Maine Track,” adds Dr. Peter Bates, academic dean. “The academics and clinical training are as challenging as the regular track at TUSM, so you have to be a top-notch student, but you also have to want to provide care in all kinds of medical settings. Our students tend to be both. They want an A-list medical education and they want to make a real difference in people’s lives.”

Szylvian agrees completely. “We’re a tightly knit group because we have the same core values: we came here to learn how to help people; we want a good life; and we love our home state.”

As if on cue, his friend and classmate Kristi Larned, slides into the booth beside him. Larned was born in South Carolina, but moved to Lyman when she was six and her father was restationed. He is in the Air Force, as is her only brother—who, as we speak, is on a jet headed home from deployment. “My parents brought us up to understand that there is a world of people out there, not just us,” she says, referring to her family’s culture of service.

Larned is smart and caring in a disarming way that bodes well for her bedside manner. Halfway into the interview, I’ve told her my life story, not the other way around. When I call attention to this, she nods happily. She loves that part of the job. It’s one of the reasons she chose to spend her third year in a nine-month longitudinal study at Stevens Memorial Hospital in the town of Norway, rather than the usual peripatetic six-to-eight-week rotations through different specialized fields.

“Being sick is scary, so seeing a familiar face when you go to the doctor is important. It builds trust. We Mainers don’t necessarily like to open up to strangers, especially about our personal lives or health troubles, but if you have a regular doctor who sees you through thick and thin, it’s different. It’s a relationship. You can go deep with that person and understand how to not only treat their concern, but to educate them about options and choices,” says Larned. “Longitudinal study is a microcosm of everything. You see it all.”

And you see it under the tutelage of seasoned mentors in a relationship that echoes the traditional medical apprenticeships of long ago. This immersion into rural communities and hands-on primary care is a unique feature of Maine Track, a way to try on the stethoscope of a small-town family doctor before opting in for life. Since many of our small-town doctors will be retiring over the next decade or so, this training facilitates an important passing of the torch.

Larned has been sure about practicing primary care ever since she was 15 and traveled to Guatemala as a medical missionary with her church youth group. She spent 10 days there providing first aid to impoverished Mayan people and teaching basic hygiene and disease prevention.

“It had a huge influence on me,” she muses. “And now I want to serve the needs of our state, because I want to help the people I grew up with. The people of this state are my people and I can’t find them anywhere else in the world.”

One place you can find a special few is the village of Islesford (year-round population is 75) on Little Cranberry Island, a short boat ride away from Mount Desert Island and one in a chain of pretty pine-strewn islands clustered in Frenchman’s Bay. Marya Rose Spurling, another Maine Track fourth-year, was born here and shaped her dreams at the stern of her father’s lobster boat.

Spurling went to elementary school in a one-room schoolhouse, graduating in a class of two from the eighth grade. Growing up on an island meant that everyone’s lives were interdependent and all hands were expected on deck during medical emergencies. Her dad’s boat was fired up more than once for a fast steam to the mainland and a medical facility. But she is quick to shrug off any notions of island life as austere. I ask her to describe an average day.

“On Saturday mornings when I’m home, we’ll have a pancake breakfast; I’ll visit my Nana and get the mail. Then I’ll do the rounds, see friends and check in, go to the library and say hi to Cindy. If it’s warmer weather, I’ll meet my dad at the dock. Then we usually have a big potluck or something for dinner. It’s a lot of fun.”

Helping her community and others like it is why Spurling would like to be an island doctor, traveling by boat to provide regular medical care to the year-round residents on all the offshore islands. “Medicine is exciting and interesting and I really like helping people,” says Spurling. “It’s pretty simple.” When I ask her why she would stay in Maine, her answer is equally succinct. “I would rather be closer to my family.”

Spurling extends her concept of family to the rest of the people in the state. She spent her third year doing a longitudinal study in Farmington and fell in love with the people there, and she also enjoyed her stays in Fort Kent and Lincoln. Today I’m meeting her in Lewiston, where she’s just starting a rotation in neurology at St. Mary’s Regional Medical Center. She is a woman who makes friends easily and finds contentment in solitude, two necessary traits for doctoring in isolated areas; but it is her natural ability to bond with Maine people that is her gift, a gift from her communal island upbringing.

“There’s a special connection when you meet other people from Maine. When patients learn where I’m from, they relax a little,” she grins conspiratorially. “It’s like we’re all related because we’re all from here.”

I walk away from our meeting floating on a little buoy of optimism for the future of healthcare in our state. When Maine Track launched, there was a question about whether the state could provide enough candidates with the magic combo of grit, grades, and idealism for the program to succeed. Applications have almost tripled since then and ideas are bouncing between faculty and program planners about how to cultivate future Maine Track students at the elementary and high school levels. The program, along with advances in telemedicine that allow for remote diagnoses, could set the stage for the kind of healthcare we’ve all been waiting for: more thoughtful, more accessible, more individualized care provided by trusted doctors who share not only a deep love of our state and its people, but the background, principles, and education to create a vertically integrated system—one based on the benefits of small-town doctoring transformed for a new generation.

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