Alaska Physician Workforce

1. Alaska Physician Workforce Alaska State Hospital and Nursing Home Association Thomas S Nighswander MD MPH Assistant Clinical Dean Alaska WWAMI Program School of Medicine, University of Washington Ketchikan September 9, 2011

3. in 1971 Alaska started with 10 students, only 5 were from Alaska 1st year site moved to Anchorage in 1989 1st clerkship was started by Dr. Hansen in OB/GYN in 197_, second in 1977 FM by Dr. Tom Nighswander FM Residency started in 1997 in 1971 Alaska started with 10 students, only 5 were from Alaska 1st year site moved to Anchorage in 1989 1st clerkship was started by Dr. Hansen in OB/GYN in 197_, second in 1977 FM by Dr. Tom Nighswander FM Residency started in 1997

6. What does it take to grow our own? Pipeline Faculty and facility capacity Clinical training capacity Post graduate training (Residency-Apprentice)

7. Pipeline- our challenge What is the graduation rate at your high school and how well prepared are your graduates? Especially in math, science and English. Universities preparing for remedial boot camps. Anchorage School District graduation rate is 70 percent

8. Predicted demand/current production Predicted demand 52 MD/Year Current production 20 students/ 12 Residents each year Students - 78% return rate for students Residents – 80% stay in Alaska 50 % in rural practice 1/3 in tribal sites National Comparisons – State medical schools have a 40+% return rate to their state

10. AAMC data Alaskans in med school Number who applied If we were at national average, how many should have applied

11. Alaska applicants and admissions to all US medical schools (AAMC)

12. Predicted number of medical students based on total population needed to generate one medical student (16541 pop)

14. Payments for student rotations Direct costs for clinical student rotations Physician reimbursement $317,140 Student Housing $110,000 Student Travel $29000 Indirect Costs for Infrastructure support Student services Academic Faculty Support Quality assurance Faculty Development Site development

15. Clinical Training sites are becoming stressed It is an investment in the future, but it takes time (resources) All professional health care workers need it: nurses, nurse Practitioners, Physician Assistants, DO students and MD students Currently Students needing training (except nurses) annually: 20 PA students 15 nurse practitioner students 40 Alaska WWAMI students (combined third and fourth years) ?? WWAMI students from other WWAMI states (who return in significant numbers to work here DO students

16. How much could we expandChallenges Classroom could take 40 students. We do not have enough students in the pipeline for that many high quality applicants. Productivity pressures on physicians in practice, both public and private limit clinical training capacity Resources ($) Will need to develop clinical training sites and pay for them. We need to do more Residency training in Alaska - It will take $ for this to happen

17. What about our own medical school? Four years of medical education in Alaska is in the not so distant future. We now have three years (barely) but we are adding more clinical sites every year (we need bench strength) Having a medical school does not solve any of the challenges that I have mentioned This Saturday we are celebrating the 40th year of the Alaska WWAMI program which has produced over 450 physicians . The five state WWAMI program has an international reputation for a unique model of distributed medical education . Our relationship with the School of Medicine has worked well. It is a continuously evolving relationship

18. What you can do. Short term: Look in your own backyard Quality and out put from your K-12 programs especially in Math, Science and English How can you help expose these students to health careers by mentoring and volunteer experiences . Professional training opportunities for all health career students. Long Term: Clinical training sites will need to be developed and supported (early recruitment)

19. New conceptual model for clinical training…now possible in Alaska We need clinical providers who do not work in a vacuum. Providing health care is a team effort The practice model does exist in Alaska and works with improves outcomes and efficiency. Team members might include: Case Managers, Nurse Practitioners, Physician Assistants, Certified Medical Assistants, Behavioral Health workers, Nutritionists, Physicians. They do not fall out of the sky. They need to know how to work together and should have training together. And be prepared to work together at the end of their training.