UNE medical student uses internship to address potential health care desert

A University of New England College of Osteopathic Medicine (UNE COM) student is addressing health care challenges in underserved communities around Maine through a research internship with the Maine Rural Graduate Medical Education, or MERGE, Collaborative.

Alexa Bigelow, a member of the Class of '27 at Maine’s only medical school, received the internship to complete a needs-based research study focused on perinatal health care access across the state. 

This year marks the second year of the MERGE Collaborative internship program, which aims to grow the medical workforce in rural Maine by increasing access to high-quality rural graduate medical education training.

“This internship gives medical students the opportunity to return to their rural hometown communities and spend the summer engaging with their local health care system," said David McLellan, program manager of MERGE Collaborative. “Interns reviewed the community health needs assessment for their county, studied the literature, and interacted with community leaders to determine which actions could best support the rural patient population.”

Bigelow, originally from Gardiner, Maine, focused her research on the progression of birthing unit closures across the state and its impact on maternal health care access, comparing Maine's situation to that of other rural states like Iowa.

"As of 2008, we've lost 10 birthing units in the state of Maine," Bigelow said. "Maine is at risk because we are not set up geographically like these other states are."

Bigelow's project mentor, Thomas Gearan, M.D., said that the MERGE Collaborative usually tries to align interns with specific counties for more localized projects, but Bigelow's project focused on the entire state of Maine rather than a single county.

He praised her work ethic and passion for the subject.

“What she is doing is exploring a well-known problem in our state, which is access to care,” he said, noting that she took the research further than addressing local literature and needs assessments. 

“She talked to rural health providers and leaders, hospital leaders in the state to get the local perspective,” he said. “She was a very self-directed learner and very self-motivated.”

Even though Maine counties don't meet the federal definition of a maternal health care desert — which is a county without a birthing unit or obstetric providers— Bigelow’s research highlighted the rare challenges the state faces due to its county structure and vast rural areas. 

While every county in Maine still has at least one birthing unit, the large size and irregular shape of some counties means many women face long travel times to access care, she explained. It presents challenges in identifying maternal health care deserts. 

"I think it becomes an issue when we can't get red-flagged by (the federal government) because we don't meet this definition of maternal health care desert because of how our counties are designed," Bigelow said.

While current federal criteria may not accurately reflect the state's rural health care landscape, there are steps Maine health care systems can take to bridge this gap, she added. 

Mainly, Bigelow said more longitudinal rural training experiences in specialties like family medicine and obstetrics will help bridge the health care gap.

In addition to developing Maine-specific metrics that could help identify at-risk areas more accurately and target resources more effectively, one key recommendation from the MERGE project is to expand and diversify graduate medical education programs in the state, especially for obstetrics, as research suggests residents often practice within 100 miles of where they train.

Cross-training existing health care professionals offers another potential solution, Bigelow said. With Maine producing significantly more family medicine doctors, providing additional obstetrics training to family physicians could help fill gaps in maternal care. 

The MERGE internship program not only benefits the students but also contributes to the collaborative's broader goals. McLellan noted, “We hope to establish a pipeline of learning that encourages future physicians to work in Maine's rural communities.”

As the MERGE Collaborative continues its work, Bigelow's research will be made publicly available online and shared with local legislators. 

The internship program will be offered again next summer, with applications available on the MERGE Collaborative website in early 2025.