Alaska Physician Alaska Physician WorkforceWorkforce

Alaska State Hospital and Nursing Home AssociationAlaska State Hospital and Nursing Home AssociationThomas S Nighswander MD MPHThomas S Nighswander MD MPH

Assistant Clinical Assistant Clinical Dean Alaska WWAMI ProgramDean Alaska WWAMI Program

School of Medicine, University of WashingtonSchool of Medicine, University of WashingtonKetchikan September 9, 2011Ketchikan September 9, 2011

Stability of the Health Care System in the USA

Alaska WWAMI then Alaska WWAMI then (1974)(1974)

University of AlaskaFairbanks

AnchoragePsych

Alaska WWAMI nowAlaska WWAMI now

REV_09/2011

LEGENDFirst-year Site

Rural/Unserved Opportunities Program (R/UOP)

Required Clerkship Site

Residency Rotation

Area Health Education Center (AHEC)

WWAMI Rural IntegratedTraining Experience (WRITE)

WWAMI Clinical Medical Education Office

WWAMI Track Offices

RequiredClerkship Sites

CC - Chronic CareEmd - Emerg MedFam - Fam MedIntMd - Internal MedNeur - NeurologyPeds - PediatricsPsych - PsychiatrySurg - SurgeryOb/G - ObG

ResidencyPrograms

Fam - FamilyMedicineIntMd - InternalMedicineOb/G - Ob/GynPeds - PediatricsPsych - Psychiatry

Petersburg

ValdezCordova

Homer

Haines

Prince of Wales Island

Unalaska

Ketchikan

*Alaska not to scale.

Nome

Kotezbue

Soldotna

FamOb/G

FamInt MedNeurOb/GPedsPsychCC

Int Med

EmdSurgOb/GCC

Fam

Fam

FamPeds

Peds

2010-2011WWAMI ProgramSite Map -Alaska

How has WWAMI impacted How has WWAMI impacted Alaska?Alaska?

►Alaska WWAMI program has produced Alaska WWAMI program has produced over 450 physicians, with high return over 450 physicians, with high return raterate

►2011: Class 1 MEDEX Northwest 2011: Class 1 MEDEX Northwest Anchorage graduates 15 physician Anchorage graduates 15 physician assistants; 14 remain in Alaska assistants; 14 remain in Alaska

► In addition > 100 MEDEX graduates In addition > 100 MEDEX graduates practicing in Alaska from earlier practicing in Alaska from earlier classesclasses

►Alaska Family Medicine Residency part Alaska Family Medicine Residency part of UW Family Medicine Residency of UW Family Medicine Residency NetworkNetwork

What does it take to grow our What does it take to grow our own?own?

►PipelinePipeline►Faculty and facility capacityFaculty and facility capacity►Clinical training capacityClinical training capacity►Post graduate training (Residency-Post graduate training (Residency-

Apprentice)Apprentice)

Pipeline- our challengePipeline- our challenge

►What is the graduation rate at your What is the graduation rate at your high school and how well prepared are high school and how well prepared are your graduates? Especially in math, your graduates? Especially in math, science and English.science and English.

►Universities preparing for remedial Universities preparing for remedial boot camps.boot camps.

►Anchorage School District graduation Anchorage School District graduation rate is 70 percentrate is 70 percent

Predicted demand/current Predicted demand/current productionproduction

► Predicted demand 52 MD/YearPredicted demand 52 MD/Year► Current productionCurrent production

20 students/ 12 Residents each year20 students/ 12 Residents each year Students - 78% return rate for studentsStudents - 78% return rate for students Residents – 80% stay in AlaskaResidents – 80% stay in Alaska

► 50 % in rural practice50 % in rural practice► 1/3 in tribal sites1/3 in tribal sites

► National Comparisons – State medical National Comparisons – State medical schools have a 40+% return rate to their schools have a 40+% return rate to their statestate

Growing GME in AlaskaGrowing GME in Alaska►Pediatrics trackPediatrics track

Summer 2012Summer 2012 Recruiting for 4 residentsRecruiting for 4 residents 8 months per year in Seattle, 4 months 8 months per year in Seattle, 4 months

per year in Alaskaper year in Alaska►Psychiatry trackPsychiatry track

Summer 2012Summer 2012 2 residents year 1, 3 residents year 22 residents year 1, 3 residents year 2 First cohort: 3 years Seattle, 1 year in First cohort: 3 years Seattle, 1 year in

AlaskaAlaska Second cohort: 2 years in Seattle, 2 Second cohort: 2 years in Seattle, 2

years in Alaskayears in Alaska

AAMC dataAAMC data

►Alaskans in med schoolAlaskans in med school►Number who appliedNumber who applied► If we were at national average, how If we were at national average, how

many should have appliedmany should have applied

Alaska applicants and Alaska applicants and admissions to all US medical admissions to all US medical

schools (AAMC)schools (AAMC)Year

2005 2006 2007 2008 2009 2010

Apply

73 85 94 79 80 67

Admits

2929 42 31 34 29

Predicted number of medical students Predicted number of medical students based on total population needed to based on total population needed to

generate one medical student (16541 generate one medical student (16541 pop)pop)

State Population predicted actual

+-

Alaska 710231 43 29 -14

Idaho 1,567,582 94 55 -39

California -

37,253,956 2252 2154 -98

New York 19,378,102 1171 1335 +164

Clinical offerings for Clinical offerings for Alaska WWAMI studentsAlaska WWAMI students

► 132 3132 3rdrd-year required clinical rotations-year required clinical rotations► 32 432 4thth-year rotations-year rotations► 20 preceptorships (one a week for 20 preceptorships (one a week for

entire year for first year students)entire year for first year students)► 15 -17 rural shadowing programs 15 -17 rural shadowing programs

between 1between 1stst

and 2and 2ndnd year year► Mainly ambulatory non-hospital Mainly ambulatory non-hospital

rotations rotations ► In 2011, 153 rotations utilized In 2011, 153 rotations utilized ► 7 students this year in Alaska Track7 students this year in Alaska Track► 3 WRITE sites (Juneau, Palmer/Wasilla, 3 WRITE sites (Juneau, Palmer/Wasilla,

Kodiak)Kodiak)

Payments for student Payments for student rotationsrotations

► Direct costs for clinical student rotationsDirect costs for clinical student rotations Physician reimbursement $317,140Physician reimbursement $317,140 Student Housing $110,000Student Housing $110,000 Student Travel $29000Student Travel $29000

► Indirect Costs for Infrastructure supportIndirect Costs for Infrastructure support Student servicesStudent services Academic Faculty SupportAcademic Faculty Support

► Quality assuranceQuality assurance► Faculty DevelopmentFaculty Development► Site developmentSite development

Clinical Training sites are Clinical Training sites are becoming stressed becoming stressed

► It is an investment in the future, but it takes time It is an investment in the future, but it takes time (resources)(resources)

► All professional health care workers need it: All professional health care workers need it: nurses, nurse Practitioners, Physician Assistants, nurses, nurse Practitioners, Physician Assistants, DO students and MD studentsDO students and MD students Currently Students needing training (except nurses) Currently Students needing training (except nurses)

annually:annually:► 20 PA students20 PA students► 15 nurse practitioner students15 nurse practitioner students► 40 Alaska WWAMI students (combined third and fourth years)40 Alaska WWAMI students (combined third and fourth years)► ?? WWAMI students from other WWAMI states (who return in ?? WWAMI students from other WWAMI states (who return in

significant numbers to work heresignificant numbers to work here► DO studentsDO students

How much could we expandHow much could we expandChallengesChallenges

► Classroom could take 40 students. We do Classroom could take 40 students. We do not have enough students in the pipeline for not have enough students in the pipeline for that many high quality applicants.that many high quality applicants.

► Productivity pressures on physicians in Productivity pressures on physicians in practice, both public and private limit practice, both public and private limit clinical training capacityclinical training capacity

► Resources ($) Will need to develop clinical Resources ($) Will need to develop clinical training sites and pay for them.training sites and pay for them.

► We need to do more Residency training in We need to do more Residency training in Alaska - It will take $ for this to happenAlaska - It will take $ for this to happen

What about our own medical What about our own medical school?school?

► Four years of medical education in Alaska is in the Four years of medical education in Alaska is in the not so distant future. We now have three years not so distant future. We now have three years (barely) but we are adding more clinical sites every (barely) but we are adding more clinical sites every year (we need bench strength)year (we need bench strength)

► Having a medical school does not solve any of the Having a medical school does not solve any of the challenges that I have mentionedchallenges that I have mentioned

► This Saturday we are celebrating the 40This Saturday we are celebrating the 40thth year of year of the Alaska WWAMI program which has produced the Alaska WWAMI program which has produced over 450 physicians . The five state WWAMI over 450 physicians . The five state WWAMI program has an international reputation for a program has an international reputation for a unique model of distributed medical education . unique model of distributed medical education . Our relationship with the School of Medicine has Our relationship with the School of Medicine has worked well.worked well.

► It is a continuously evolving relationshipIt is a continuously evolving relationship

What you can do.What you can do.

► Short term: Look in your own backyardShort term: Look in your own backyard Quality and out put from your K-12 programs Quality and out put from your K-12 programs

especially in Math, Science and Englishespecially in Math, Science and English How can you help expose these students to How can you help expose these students to

health careers by mentoring and volunteer health careers by mentoring and volunteer experiences .experiences .

Professional training opportunities for all health Professional training opportunities for all health career students.career students.

► Long Term: Clinical training sites will need Long Term: Clinical training sites will need to be developed and supported (early to be developed and supported (early recruitment)recruitment)

New conceptual model for New conceptual model for clinical training…now possible in clinical training…now possible in

AlaskaAlaska► We need clinical providers who do not work in a We need clinical providers who do not work in a

vacuum. Providing health care is a team effortvacuum. Providing health care is a team effort► The practice model does exist in Alaska and The practice model does exist in Alaska and

works with improves outcomes and efficiency.works with improves outcomes and efficiency.► Team members might include: Case Managers, Team members might include: Case Managers,

Nurse Practitioners, Physician Assistants, Nurse Practitioners, Physician Assistants, Certified Medical Assistants, Behavioral Health Certified Medical Assistants, Behavioral Health workers, Nutritionists, Physicians.workers, Nutritionists, Physicians.

► They do not fall out of the sky. They need to They do not fall out of the sky. They need to know how to work together and should have know how to work together and should have training together. And be prepared to work training together. And be prepared to work together at the end of their training.together at the end of their training.