Addiction Medicine Fellowship - This proposal seeks funding to expand the MaineHealth Maine Medical Center-Portland (MHMMC-Portland) Addiction Medicine fellowship training program by adding two fellows trained specifically in rural addiction medicine. Maine, a predominantly rural state, faces high rates of substance use disorders (SUD) and overdose deaths, especially in Western Public Health District counties like Franklin and Oxford. These counties have above-average SUD rates, significant overdose deaths, and a shortage of healthcare providers, including addiction specialists. The goal is to train addiction medicine specialists familiar with rural healthcare barriers, increasing workforce capacity and improving access to care. Maine's rural populations face challenges such as geographic isolation, poverty, and limited healthcare access, exacerbated by an aging population and chronic health issues. Rural areas like Franklin and Oxford counties suffer from healthcare shortages, especially addiction medicine specialists, despite high SUD prevalence. Expanding the fellowship to train physicians with expertise in rural addiction medicine can help address these shortages and improve healthcare access, with evidence showing that physicians trained in rural settings are more likely to remain in these areas. Maine is the most rural state in the U.S., with a population that is older and economically disadvantaged. Over 40% of towns in Franklin and Oxford counties are designated as Medically Underserved Areas, and many are Health Professional Shortage Areas. These counties face large distances between residents and healthcare providers, further hindered by transportation issues and lack of affordable healthcare. Additionally, substance use, particularly related to opioids and psychostimulants like methamphetamine, has worsened in these regions, with increasing overdose deaths and substance-exposed infants. MaineHealth’s Addiction Medicine Fellowship program, established in 2019, has trained nine physicians, eight of whom now practice in Maine. This program has a 100% board pass rate and offers a one-year curriculum, including rotations in inpatient and outpatient addiction medicine and specialty electives. The expansion funded by this HRSA grant will add two fellowship positions focused on rural Maine, specifically in Oxford and Franklin counties. The fellowship will involve clinical training in addiction medicine, including the management of opioid use disorder, alcohol withdrawal, perinatal addiction care, and harm reduction services. The new fellowship rotations will be based in Norway (Oxford County) and Farmington (Franklin County). In Norway, fellows will work at MaineHealth Comprehensive Addiction Medicine (CAM) in collaboration with local clinics and recovery programs, while in Farmington, fellows will train at a new addiction medicine program integrated into a primary care practice, working with local behavioral health teams and at the Franklin County Correctional Facility. Fellows will also continue participating in existing Portland-based rotations, providing a comprehensive training experience. Fellows will engage in didactic teaching and scholarly activities, including case presentations, journal clubs, and lectures on addiction medicine. They will also participate in research, quality improvement projects, and other educational initiatives during their fellowship. The program incorporates stigma-focused training, teaching fellows to provide trauma-informed, non-judgmental care and address healthcare-related stigma. Additionally, fellows will receive interprofessional training in addressing social determinants of health. The expansion of the fellowship program into rural areas will address the critical shortage of addiction medicine providers in underserved communities, improve access to care, and help reduce health disparities in rural Maine. By training fellows with a focus on rural addiction medicine, the program aims to strengthen addiction treatment
