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A podiatric physician/executive helps lead health reform in rural Maine
A 2010 graduate of Dr. William M. Scholl College of Podiatric Medicine, Dr. James Fullwood, AACFAS, is helping to lead healthcare change in the state of Maine, where more than 61 percent of residents live in rural areas. As Chief of Staff at Sebasticook Valley Health, he’s intent on improving care for a patient population of approximately 40,000 in the central part of the state.
“My profession isn’t just the foot and ankle,” he said. “It’s medicine. It’s policy. It’s finances. There are so many pieces to the healthcare puzzle. If the system doesn’t work, it doesn’t matter if you’re a podiatrist or an oncologist, you will have problems. My focus is to help expand access, to help educate on the political side of medicine. Because there’s no such thing as them and us. We’re all in this together.”
Dr. Fullwood always knew he wanted to practice community-based health care in a rural area. After completing a residency in foot and ankle reconstruction and diabetic limb salvage in Minneapolis, he accepted a position in Pittsfield, ME, an old mill town, population 4,200. Sebasticook is a critical access hospital with three primary care locations throughout central Maine, where many barriers threaten the health of its residents.
Those barriers include: 30 to 40 miles and often farther to the nearest pharmacy, doctor or hospital; high unemployment; lack of transportation; lack of internet access; a high rate of hospital closures; too few healthcare professionals; and a heavy burden of chronic disease.
“I see a lot of end-stage renal disease and cardiovascular and peripheral vascular disease,” Dr. Fullwood said. “It’s often a delayed presentation. People don’t have the means to go to doctor and hospital appointments.”
Dr. Fullwood sits on his hospital’s Board of Trustees and he’s an executive member of the Eastern Maine Healthcare Systems’ Central Regional Medical Advisory Group, which oversees the operations of three hospitals.
“With good leadership and the collaboration of many people and communities, we’re trying to figure out what makes sense for all of Maine,” he said. “Even though we are nine hospital systems, we can’t let another hospital fail, even if it’s outside our particular system. If it does, it floods services and we have a limited number of providers and resources. We all have to work together to take care of patients. No one provider or system can do it all.”
One of just 84 practicing podiatric physicians in Maine, Dr. Fullwood points to another serious shortage in his state: One family medicine/general practice physician for every 1,508 people, according to 2014 data reported by the American Association of Medical Colleges. While family physicians make up just 15 percent of the outpatient physician workforce in the United States, they provide 42 percent of care in rural areas, according to the National Rural Health Association.
Rooted in his training at Rosalind Franklin University, Dr. Fullwood supports interprofessional (IP), team-based care, the population health model and the state’s growing cross-system collaboration as a means to improved prevention and treatment. He’s the creator and scientific chair of a biennial IP diabetic foot conference and he’s part of a growing population health effort.
“We’re looking at the services we offer and the resources and people we need to strategically manage disease within our state and organization,” he said. “Because of constraints of health care and what’s going on politically, we realize we’re all fighting for the same thing — our patients and quality care. We still have medical silos, but they’re slowly breaking down.”
Dr. Fullwood has experienced health care in both urban and rural settings. He spent his formative years in New York City before moving at the age of 15 with his family to unincorporated Supply, NC.
“I was a kid from the inner city who became a country boy,” said Dr. Fullwood. “I understand the barriers because I saw them growing up.”
Today, Dr. Fullwood is an advocate for rural practice, promoting it at undergraduate universities, discussing rural health needs with state and federal legislators and mentoring students on rotations in the clinic.
“There are great national and local programs that will help young professionals who commit to rural practice repay their loans,” he said. “But rural communities and health systems across our nation want to keep you. They need your services and they’re willing to invest in you. Rural health is all word-of-mouth advertising. You have to treat your patients right.”
This story first appeared in the Fall 2017 issue of Helix magazine.