Roger Poitras is CEO of InterMed.

Most of us learn early in life: don’t make medical decisions without consulting a health care professional. When it comes to shaping health care policy, we don’t always follow the same advice, but we should. And in Maine, we’re beginning to.

Our health care system is under real strain. Across the state, hospitals and medical practices are operating with thin margins, struggling to recruit and retain staff and making difficult decisions about which services they can sustainably offer.

Workforce shortages and rising costs are colliding with an aging population and growing demand for care. These pressures create uncertainty both for organizations trying to plan ahead, and for patients who worry about access, continuity and how far they’ll have to travel to receive care.

Against that backdrop, Maine convened a commission to examine how the state reviews major changes in health care. I had the honor of serving on that commission, and the experience was enlightening.

The process was thoughtful and grounded in a genuine commitment to ensuring patients and communities have access to care. Nonetheless, the experience also reinforced an important lesson: effective reform requires more than convening a group and hearing testimony; it requires expertise and the willingness to listen to those who live these realities every day. It also demands a sustained, two-way dialogue and a willingness to wrestle openly with perspectives that challenge initial assumptions.

There were times throughout the course of the commission that the discussion felt oriented toward validating specific solutions rather than fully examining the underlying problems they were meant to address. Given the commission’s scope and timeline, that structure is understandable. But it also points to a broader risk in health care policymaking: when discussions begin with conclusions rather than questions, the range of viable solutions can narrow before the work truly begins.

Health care does not operate in silos. Clinical decisions affect staffing. Staffing affects access. Access affects finances. Regulation touches all of it. When policy is developed without engaging in that full context, it can be well-intentioned but incomplete, or responsive in theory but difficult to implement in practice.

Meaningful reform depends on processes that invite not just agreement, but challenge, nuance and the lived realities of delivering care. This commission showed that Maine is willing to invite frontline voices into the conversation. That matters. But if we want policies that truly strengthen our health care system, the state must continue to invite health care professionals into the conversation earlier and more consistently.

At the same time, those of us who work in health care have a responsibility to join the conversation. This commission was my first experience serving in this type of role, and to be candid, it was not always comfortable. At times, the process felt constrained.

The outcomes are not guaranteed. But participation matters. If we choose not to engage because the process is imperfect, we leave critical decisions to those farther removed from day-to-day care.

The future of health care in Maine will be shaped by who shows up, who stays engaged and who is willing to offer practical, experience-based insight, even when it complicates the conversation.

It’s time to deepen the dialogue, broaden participation and create an ongoing partnership between policymakers and the people who deliver care. That is how we move from conversation to action, and how we ensure Maine’s health care system remains accessible, sustainable and centered on the patients and communities it serves.

In 2021, the Maine Department of Transportation partnered with federal and state wildlife agencies to install a wide culvert designed to help turtles, including the endangered Blanding’s turtle, safely cross a notoriously deadly section of State Route 236 in Eliot. 

In the years since, tens of thousands of people have driven over this wildlife crossing, most of them unaware it is even there. And dozens of species, both shelled and non-shelled, have taken advantage of the underpass. 

During a presentation Tuesday, biologists at the Maine Department of Inland Fisheries and Wildlife reported that the turtle tunnel — the first of its kind in Maine — is working. 

“There’s been a substantial reduction in turtle mortalities,” Greg LeClair, a municipal planning biologist at the state agency, told a small crowd gathered at the Eliot Town Office. “Follow-up surveys have shown much fewer turtles being crushed on that section of road.” 

Last summer, the Maine Department of Transportation deployed special game cameras equipped with a light beam that can detect the movement of small, slow-moving critters. Shortly after 9 a.m. on June 27, the camera trap snapped a photo of a Blanding’s turtle lumbering through the tunnel, safe from buzzing traffic along what one former state biologist called “a highway of death” for shelled reptiles. 

The 8-foot-wide, 6-foot-tall culvert connects wetlands on both sides of the busy state highway, including a nearly 100-acre section of conservation land managed by Great Works Regional Land Trust.

The wildlife underpass and roadside fencing, meant to steer wildlife toward the tunnel, cost approximately $400,000 to install, with Maine DOT contributing a large chunk of the funds to mitigate wetland disturbance from construction of the high-speed toll plaza on the Maine Turnpike in York. 

While the Eliot tunnel was designed with Blanding’s turtles in mind, Maine DOT has documented a slew of other creatures passing through, according to Justin Sweitzer, the agency’s environmental coordinator for southern Maine. Over a period of nearly five months, the cameras snapped more than 270 photos of wildlife in the tunnel, ranging from snapping turtles and salamanders to muskrats and mink.

Not one Blanding’s turtle has been found dead on the road since the crossing was installed, according to the department. A small number of snapping turtles and painted turtles have been killed.

Blanding’s turtles are rare in Maine, found only in York County and the southern part of Cumberland County. The state listed the species as threatened in 1986 and upgraded it to endangered in 1997. Habitat loss and road mortality are among the biggest threats to these reptiles.

Unlike some other turtle species, Blanding’s move around a lot in search of food, often traveling to six wetlands per year, according to Kevin Ryan, a reptile and amphibian biologist at the Maine Department of Inland Fisheries and Wildlife. 

“The closeness of the roads and the houses and the wetlands down in southern Maine means that throughout the course of its life, a turtle is going to come into contact with human infrastructure quite a bit,” Ryan said at Tuesday’s event. 

The life cycle of Blanding’s turtles makes recovery efforts particularly challenging. The yellow-throated reptiles can live to be over 70 years old, with females not reaching sexual maturity until 14 to 20 years of age and often taking decades to produce an offspring that ultimately reaches adulthood. 

“Losing one or two turtles actually matters,” Ryan said. “They’re not like a game species, something like a deer, rabbit, turkey, something like that, where a significant portion of the population can get harvested from year to year and then have it bounce right back.” 

Peter Egelston, chair of the Eliot Conservation Commission, told The Maine Monitor ahead of the event that there is a growing awareness in the community about the importance of preserving wildlife habitat. He noted that Eliot residents adopted an updated comprehensive plan in June that emphasizes natural resource protection and building new trails, among other things. 

“Communities are dealing with what seems like on the surface competing interests,” Egelston said. “There is a huge demand for housing. And yet there is also a huge desire to preserve open space. It’s one of the things that I think has caused a lot of communities to put a different shape to their approach to housing and zoning and so on, because in some ways what we really want to do is have the best of both worlds.”