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Weekly UpdatesTo want to become a doctor in Alaska is a little bit different than wanting to become a doctor in the Lower 48. An Alaska doctor needs to be willing to work long hours, sometimes without the modern amenities that a Pennsylvanian or a Californian doctor would have in an emergency. Granted, most doctors who care for patients in remote Alaska villages are hired by local hospitals. Yet they need to receive extra training in certain emergency situations that doctors in the Lower 48 don't have to deal with on a regular basis.
THE PROGRAM
WWAMI--the consortium of Washington, Wyoming, Alaska, Montana, and Idaho-through the University of Washington's Medical School, trains doctors to work in the extreme rural areas of these states.
According to its Web site: www.uw medicine.org/Education/WWAMI, its purpose is to "provide access to publicly supported medical education across the five-state region. The UW School of Medicine maintains a dean's office in each of the five states. For Alaska, Tom Nighswander, M.D., is the assistant dean and WWAMI's Alaska coordinator.
For the past 34 years, WWAMI has been training students through a "decentralized form of medical education. A significant part of any given student's education occurs within the WWAMI region in communities utilizing a combination of both full-time and volunteer teachers," according to the Web site.
LIMITED SPACE
The program reserves a set amount of seats per state in the consortium. Alaska reserves 10 seats for its medical program.
Dr. Dennis Valenzeno, who is the director and professor of WWAMI's Biomedical Program, also serves as dean for Medical and Premedical Programs with the University of Alaska Anchorage. He says that first-year medical students finish their initial year at the University of Maska Anchorage. Then, they return to the University of Washington, along with students from other states in the consortium, for their second year. For their third and fourth years, students have a choice to return to Alaska or any of the other five state regions, to complete "a series of short, usually six-week, clerkship experiences," says Valenzeno. "An Alaska Track allows students to complete nearly all of Year Three and Year Four in Maska."
Fortunately, according to Valenzeno, of the 180 students from the five-state WWAMI program, many choose Alaska as the place to complete their year three- and year-four clerkships. "That exposure draws a few more to practice here-two to three graduates per year. Overall, seven or eight WWAMI grads, from all five states, begin practice in Alaska each year. But (Maska) pays for only the 10 seats occupied by Alaskans."
Valenzeno says that WWAMI is "Alaska's Medical School--that's an often misunderstood concept. WWAMI is the medical school for five states, but it is the only state-supported medical school for Alaskans. It allows Alaskans to complete three to four years in the state."
A GOOD INVESTMENT
Valenzeno says that the Return of Investment from the 10 chosen Alaska medical students benefits the state's health care system. He states, "Our 'rate of return' is well above the national average. That is, of the 10 Alaska WWAMI students accepted each year, on average, five will return to practice in Alaska. That 50 percent return compares to a national average of 40 percent for state medical schools. And, if Alaska's WWAMI were ranked separately from the other WWAMI states, it would rank 11th among the Lower 48 states for rate of return."
After graduation from the WWAMI program, students can embark on their residency programs at the Alaska Family Medicine Residency in Anchorage, which is part of the WWAMI network of family medicine residencies. This school "allows M.D.s to do their residency training in Alaska," Valenzeno says.
DOCTORS IN TRAINING
Dr. Harold Johnston is the director of the Alaska Family Medicine Residency. The AFMR is a division of the Providence Alaska Medical Center, located at 1201 E. 36th Ave. in Anchorage. Johnston says the residency doesn't require doctors to make a commitment after their residency is over, but the program's thrust is to "train physicians to practice family medicine in Alaska."
"A little more than 70 percent of the graduates (from the residency program) practice all over Alaska," Johnston says. "Most of the people have lived in Alaska for a significant time, (and will practice here because of it). A substantial minority of residency students comes from the Lower 48."
Residency students, preparing to work in family medicine in the outback of Alaska, need extra training in obstetrics, orthopedics, emergency medicine, neonatal intensive care, and transcultural medicine. According to Johnston, physicians learn to understand other cultures in transcultural medicine, they specifically learn how to communicate to people from rural villages on how the Alaska health care system works.
Additionally, doctors receive 100 hours of training in the business of medicine. They learn how to run a family practice; how to write a good contract, how to financially analyze their practice; how to effectively bill their patients; how to supervise a staff; among other issues related to running a family practice within Alaska.
Some graduates open their family practices in cities such as Anchorage and Fairbanks. But, according to Johnston, most grads don't open family practices. Instead, they travel to smaller cities and work out of the local hospitals, as family doctors. By branching out to the smaller cities, doctors are required to travel to remote villages to take care of patients.
Generally, doctors go to Bethel, Dillingham, Dutch Harbor, Wrangell, and other towns with a population of 2,000 to 10,000 to work in the Alaska outback. These doctors enjoy working with Alaskan Natives, where the challenges of frostbite, cultural barriers and wilderness injuries tend to be more prevalent. Johnston states, "More than half of Alaska doctors are female." When it comes to communicating with tribal leadership, which is one of the biggest challenges for these doctors, it helps that women are also part of the tribes' councils. Johnston states, "Female doctors are well accepted in tribal communities. The communication barrier is focused on style (of talking). For example, the Yupik people are more thoughtful in their communication style than Western people. The Yupiks speak slowly and are generally more patient to speak. The doctors are taught to respect that style or they will be turned off."
FACING HEALTH CONCERNS
Johnston says that Alaska doctors face many of the same health care issues that doctors in the Lower 4,8 experience. Diseases, such as diabetes, cancer, ear infections, and other common diseases that plague all humankind. Still, rural Alaska doctors also need to know how to deal with chronic conditions, like boils and injuries. Johnston also adds, "It's hard to reach all the patients, who are scattered across the state, and doctors get burned out on the workload, where there's a lot of responsibility, and they can't see their patients all of the time."
HOPE IN THE FUTURE
There's a crisis that's looming for Alaska residents in the next few years-a shortage of doctors. Yet there's hope on the horizon. Valenzeno says, "Alaska has not historically supported medical education for its citizens. It ranks 45th in terms of state support for medical school positions per capita. Yet, the return on the state's meager investment is excellent."
ALASKAN'S PHYSICIAN CRISIS
"Alaska has a shortage of doctors," says Johnston. "Having enough doctors, who are well-trained, is very important because it affects the economic health of the community and the state. The shortage will be worse unless we get support and build the training programs that we have."
Johnston says that Alaska communities will suffer because people will only live where there is good medical care. Thereby, they will leave their villages and migrate toward cities or out of state, which has quality medical care.
"Alaska doesn't produce enough doctors-our medical schools are very small compared to other states where they produce more doctors," he says.
According to an Oct. 2, 2006, press release from the Alaska State Health and Social Services, (www.hss.state. ak.us/press/2006/pr100206physiciansupply.htm), "Alaska needs nearly twice as many physicians in the next 20 years as it currently has if the state is to meet expected demands." The release sites the Alaska Physician Supply Task Force, which studied Alaska's health care crisis in January of this year, as saying "the increase, about 1,100 more than the state's current 1,350 physicians providing patient care, is needed as the state's elderly population triples and as medical practice patterns change.'"
What's the solution? As Johnston says, Alaska needs to produce more doctors, and to accomplish that goal, it needs more educational opportunities for doctors to be produced here. The task force plans on meeting that goal by "increasing the in-state development of physicians and by increasing the number and viability of medical school and residency opportunities in Alaska for Alaskans; increasing physician recruitment to Alaska by assessing needs and coordinating recruitment efforts, as well as expanding and supporting programs that will prepare Alaskans for medical careers; and increasing physician retention by improving the practice environment in Alaska."
Johnston states in the release that the combination of the "state administration, legislature, the university, and private and tribal health care providers will work with this roadmap, and find ways we can contribute to reach our goals."
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