Alaska’s physician shortage called ‘grim’

Federal panel meeting in Anchorage is told relief is still in school
By ROSEMARY SHINOHARA
Anchorage Daily News
http://www.adn.com

A shortage of primary care physicians in Alaska will get worse before it gets better because the best solutions — training more Alaskans to be doctors and teaching them within the state — will take years, a panel of doctors warned during a federal hearing Tuesday.

Doctors, Medicare clients and patient advocates spoke at a Senate Health, Education, Labor and Pensions Committee hearing held by committee member U.S. Sen. Lisa Murkowski, R-Alaska, in the Anchorage Assembly chambers at Loussac Library.

The picture is grim, said Dr. Ross Tanner, president-elect of the Alaska State Medical Association. He cited a state and University of Alaska report in August that concluded the state needs nearly 400 more doctors to provide the same level of care as elsewhere in the country.

The medical association is backing state legislation to subsidize training of 20 Alaska medical students per year in the WWAMI program — Wyoming, Washington, Alaska, Montana and Idaho — operated through the University of Washington. Ten Alaskans are in each UW medical class now. They study their first year at University of Alaska Anchorage.

The bill to double their numbers is progressing through the Legislature. But it will take each student seven or more years to get trained, through four years of med school and at least three years of on-the-job training in residency programs.

Besides participating in WWAMI, Alaska offers one three-year residency program, to turn out 12 new family practice doctors per year.

That’s far too few, Tanner said. “By contrast, Texas has 6,400 resident slots. California has 9,000 slots. We are very much underserved.”

Even considering Alaska’s comparatively tiny population, the discrepancies are huge.

The two programs combined, WWAMI and the Alaska Family Medicine Residency, produce about 14 doctors per year who stay in Alaska, according to the state study.

When Murkowski discovered WWAMI students from UAA sitting in the audience Tuesday, a row of casually dressed young people among the suited established doctors, she asked them, “What’s it going to take to keep you here?”

“I’m facing $100,000 in debt. That’s kind of scary,” Melissa Howell of Eagle River stood up to say. “I want to come back.”

“I’m not too concerned about debt,” said Ross Baldwin of Kenai. “I’m interested in surgery,” a high-paying specialty. But if he goes into surgery, he will have to spend seven years or so in some town Outside, where he could set down roots, because there’s no surgery residency program in Alaska.

“Alaska residency programs are a huge concern to me,” Baldwin said.

Dr. Harold Johnston, director of the Family Medicine residency, said Alaska could add more residency programs in different specialties, such as internal medicine, or could have branches of Outside programs that doctors would rotate to for parts of their studies.

Alaska has both the lowest per capita number of medical school slots in the country and the lowest number of residency spots, he said.

The huge problems faced by patients on Medicare, the federal insurance program for those 65 and over, kept resurfacing during Tuesday’s discussion like a persistent wart.

People on Medicare say if their primary care doctors retire, or for any reason they don’t have one, they just can’t find a general practitioner who will take them on.

Murkowski started off the hearing by talking about mail she’s gotten over the past year from constituents who say they’d made 80 to 100 calls trying unsuccessfully to secure a doctor.

The lack of adequate access for Medicare patients is partly due to the shortage of primary care physicians here and partly due to Medicare reimbursement rates that are less than half of their normal charges, say Anchorage doctors.

Frank Appel, chair of the Alaska Commission on Aging, said his doctor sent out a letter last summer saying he would no longer provide Medicare service, and he still hasn’t found another doctor. “The quality of care for seniors in the state is declining,” he said.

Carl Berger, a retired state employee who lives in Bethel and recently turned 65, joked that he counts himself lucky for having a heart condition. That gets him in to see a specialist. He’s been without a primary care doctor since Dr. Jay Caldwell retired. Berger said he’s willing to pay to come to Anchorage to see a doctor, if only one will take him.

Murkowski and U.S. Sen. Ted Stevens recently introduced a bill to provide tax incentives for doctors to practice in rural locations.

Murkowski will soon propose another bill backing expansion of doctor training programs, supporting medical careers for disadvantaged youth, and expanding community health centers, among other proposals.

She will also press for higher reimbursement rates for Alaska Medicare patients, Murkowski said.

Tanner said federal legislation needs to permanently fix the Medicare payment system, making it more realistic.

He said the government could also make residency programs like the Family Practice Residency eligible for federal support, and encourage regional residency partnerships between different states.

And it could find ways to help medical students deal with their debt, he said.

This article originally appeared on the Alaskan Dispatch News website. They have removed it but we will keep it posted for archive purposes. Please feel free to read a follow-up the Alaskan Dispatch News did on this physician shortage story.