CoChairs:

1
Co-Chairs Representative Sharon Cissna Senator
Donny Olson
2
Filling the Need Doctors, Dentists
Psychiatrists
Check out our new website at www.akhealthcaucus.
org
Wednesday, January 24, 2007 Noon to 100
PM Butrovich Room, State Capitol A light lunch
will be served
3
Agenda

• Filling the Need Doctors, Dentists
  Psychiatrists
• January 24, 2007
• Introductions/Opening Remarks
  Rep. Sharon Cissna
  and Senator Donny Olson
• Medical Education in Alaska - Dennis
  Valenzeno, Ph.D., Director, Alaska WWAMI
  Biomedical Program,
• Professor and Associate Dean, UAA
• Physicians needs in Alaska - Aron S. Wolf,
  M.D., M.M.M., of Wolf Healthcare, P.C.
• Alaska Dental Workforce - Brad
  Whistler, D.M.D., State Dental Officer, DHSS
• Alaska Area Tribal Dental Services Ron
  Nagel, D.D.S., M.P.H. Dental Consultant for the
  Alaska Native Tribal Health Consortium
• Securing an Adequate Number of Physicians for
  Alaskas Needs - Harold Johnston, M.D.,
  F.A.A.F.P , Program Director, Providence Alaska
  Family Practice Medical Center
• Discussion.

4
Medical Educationin Alaska

• Dennis Valenzeno, Ph.D.
• Director, Alaska WWAMI Biomedical Program,
• Professor and Associate Dean, UAA

Alaska Legislative Health Caucus, January 24, 2007
5
Educating a Physician

• Undergraduate degree
• can be in a variety of disciplines
• 4-year medical school program
• confers M.D. degree
• 3 to 7 years residency training
• qualifies for independent practice
• specific for specialty

6
Medical Education in Alaska
WWAMI is Alaskas Medical School

• Admit 10 Alaskans per year
• Year 1 in Anchorage at UAA
• Year 2 in Seattle
• Years 3-4 in any WWAMI state
• Alaska Track nearly all in Alaska
• ? Three of four years can be completed in Alaska

7
How Are We Doing?
1. Quality of WWAMI Medical Education

• 1 ranked Primary Care medical education 13
  consecutive years
• 1 ranked Rural Health medical education 15
  consecutive years
• 1 ranked Family Medicine medical educaiton 15
  consecutive years

US News World Report, Americas Best Graduate
Schools, 2007 edition
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How Are We Doing?
2. Graduates Practicing in Alaska

• Each year 7 to 8 WWAMI graduates begin practice
  in Alaska
• Return on investment 7.5 new physicians for 10
  funded positions 75
• National average lt40

Alaska WWAMI Database
American Association of Medical Colleges, Key
Phys Data by State, Jan 2006
9
How Are We Doing?
3. Alaska WWAMI applicants

• Alaska WWAMI
• 7 to 8 applicants per position
• most competitive WWAMI site last year
• excellent qualifications
• top group of 10 2nd group 3rd group for
• MCAT (Medical Coll. Aptitude Test)
• undergrad GPA (grade point average)

Alaska WWAMI Database
10
How Are We Doing?
4. Alaskan Applicant Success - nationwide

• All US Med Schools
• 38 of Alaskan applicants accepted
• 2nd lowest of all US states
• AK applicant quality at or above natl avg
• MCAT
• undergrad GPA

American Association of Medical Colleges database
2004
11
How Are We Doing?
5. Public Support for Medical Education

Currently
Proposed (20)
American Association of Medical Colleges database
2004
12

13
Physician needs in Alaska

• Aron S. Wolf M.D. MMM.CPE

14
A Growing Changing Need

• In the 1950s, 60s and 70s most physicians came
  to Alaska for their rotations in the Military or
  The Public Health Service
• This changed with the end of the Berry Plan (or
  physician draft)
• It also changed with the change to Native
• Self Determination and fewer Service Corps
  Physicians in Alaska
• WWAMI was begun in the 1970 to BEGIN to address
  the homegrown needs

15
Mental Health Needs

• Pre-1962 (API) severe patients sent to Oregon for
  hospitalization or housed in jail
• API 1962but based on 1940s models
• 1970scommunity mental health centersstatewide2
  2 catchment areas
• Originally designed to serve needs of all in the
  area
• With more limited funding their focus has
  narrowed to the most chronic patients
• Psychiatrists traveled as consultants to most of
  these areas on an intermittent basis
• 200s The use of telemedicine to bring the
  psychiatrist to the patient

16
Studies of need

• 1999 and 2001 studies coordinated by mefor
  Providence used the following procedure
• Identification of National Needs Guidelines for
  each medical specialty and sub-specialty
• A survey of all practicing Anchorage
  Physicians---noting their ages and years in
  practice---issues fulltime or notwhen they
  might retire or pull backplans to recruit--

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Study protocols cont

• Development of a formula for determining the
  total number of patients using the private sector
  of the medical communityie military/Native
  health Care/VA etc.There was a wider statewide
  number for specialists
• Development of the Actual Anchorage data for
  each specialty
• Comparison of this Data with the National Needs
  Data

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Findings

• An aging of the physician population
• A severe lack of primary care physicians-especiall
  y internists-as well as family physicians
• A severe lack of psychiatrists
• Relative needs in all other areas
• The problems were MORE severe on the 2nd study in
  2001

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statewide

• Needs and costs for recruitment and retention of
  physicians across the state
• Significant lack of primary care physicians
  throughout the state
• SORRAS study by the Sate and UA showed that 16
  million dollars are spent annually to recruit
  physicians and other health care professionals
• The cost per hire was 28,000
• With the need for temporary or locums physicians
  this drove the cost to 38,000 per hire

20
Issues

• High cost of medical educationhuge debt for each
  physician
• Poor payment by public programsmedicare and
  medicaid especially for primary care
• Competition for physicians across the country

21
Some ideas for relief

• Increase WWAMI positions (Dr. Johnston)
• A combined recruiting and retention initiative
  (ASHPIN) or others
• Use of technology/telemedicine
• Cooperation between segments of the health care
  systemprivate/clinics/hospitals/Native health
  system/VA and military

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Alaska Dental WorkforceHealth Caucus January
24 2007

• Brad Whistler, DMD
• DHSS Division of Public Health
• Section of Womens, Childrens and Family Health

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Alaska Dental Workforce Current, Active Licenses
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Alaska Dentists FY2005 Perspectives

• 563 Current, Active Licenses
• 457 Current Active Licenses that list an Alaska
  address
• U.S. Dentist to population ratio (ADA, 1999)
  11,873 (GP/Ped at 12,200)
• Alaska Dentist to population ratio (SFY2005)
  11,452
• Dental-Health Professional Shortage Areas
  (Dental-HPSAs) 15,000 or 14,000 with high
  needs

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DistributionHeath Professional Shortage Areas
(HPSA)
26
Dental Workforce - Demographics
27
Dental Participation in Medicaid, FY2005
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U.S. Dental Workforce
29
Dental Workforce
30
Dental Workforce An Economic ViewAdequacy of
Current and Future Workforce, A. Jackson Brown
(ADA Publication), 2005

• Reviews dental workforce from an economic view
  based on disease, consumer demand, household
  income, population, education levels, changes in
  productivity and insurance coverage v. a needs
  based approach.
• Acknowledges graying of the workforce through
  2025 and projects increased part-time dentists
  from 14 in 2002 to 17 in 2025, however the
  report concludes that there is an adequate dental
  workforce through this period.
• The report notes that overall access to dental
  care in the U.S. is excellent and strategies
  should deal with short-term adjustments than
  longer term approaches to increase the number of
  dentists.

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Alaska Area Tribal Dental Programs

• Ron Nagel, DDS, MPH
• Director, AK Dental Clinical and Preventive
  Support Center
• Consultant, Alaska Native Tribal Health
  Consortium
• www.ANTHC.org

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DDS Demographics

• 4000 dentists graduate and 6000 retire each year
  (this trend will likely continue and may broaden
  as baby-boomers leave practice)
• Historically only 2-3 of dentists go into public
  service, so simply producing more dentists has
  proven to be inefficient in filling positions in
  underserved areas.
• 25 of AK dentists are 55 or over

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DDS Demographics Continued

• 25 -29 annual vacancy rate, and a 30 turnover
  rate, in AK tribal programs, and climbing.
• 140 DDS vacancies in Tribal programs nationally,
  A 300 increase since 1995
• The vast majority of new dentists are offered
  loan repayment

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Conclusions/Recommendations

• A dwindling number of dentists in Native and
  rural communities is a great concern
• A Personal sense of well being and the experience
  of living and working in a Native community are
  strongly associated with retention, over
  financial factors 2006 Kelly study.
• Current loan repayment/scholarship monies need to
  be tied to a career in public service rather than
  short term tours
• The oral health workforce needs to be expanded
  beyond dentists and hygienists

35
Securing an Adequate Number of Physicians for
Alaskas Needs

• Alaska Physician Supply Task Force
• Alaska Health Summit
• December, 2006

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Task Force Members

• Co-Chairs
• Richard Mandsager, MD, Previously Director, State
  of Alaska Director of Public Health. Currently
  Director of Childrens Hospital at Providence
• Harold Johnston, MD, Director, Alaska Family
  Medicine Residency
• Members
• Rod Betit, President, Alaska State Hospital and
  Nursing Home Association
• David Head, MD, Medical Director, Norton Sound
  Health Corporation, and Chair, Alaska State
  Medical Board, representing Alaska Native Tribal
  Health Consortium
• Jan Gehler, Ph. D., Interim Provost, University
  of Alaska Anchorage
• Jim Jordan, Executive Director, Alaska State
  Medical Association
• Karen Perdue, Associate Vice President for Health
  Affairs, University of Alaska
• Dennis Valenzeno, Ph. D., Director, Alaska WWAMI
  Biomedical Program

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Staff to the Task Force

• Health Planning and Systems Development Unit
• in the Commissioners Office, Alaska Department
  of Health and Social Services
• Patricia Carr
• Alice Rarig
• Joyce Hughes
• Stephanie Zidek-Chandler
• Jean Findley

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Alaska Physician Supply Task Force

• Commissioned January 2006 by UA President
  Hamilton and the Commissioner of DHSS Karleen
  Jackson
• Addressed two questions
• What is the current and future need for
  physicians in Alaska?
• What strategies have been used and could be used
  in meeting the need?
• Variety of sources of information, including
  physicians, other experts, and public
  participation
• The consensus of the Task Force is that this
  report represents the best answer possible to
  these questions, within the constraints of time
  and budget, and the inherent uncertainties of
  available data and predictions.

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Assessment of Need

• The ratio of physicians to population in Alaska
  is below the national average (2.05 MDs per 1000
  population in Alaska vs. 2.38 U.S.)
• Alaska should have 10 more physicians per
  population than the national average because of
  Alaskas rural nature, great distances, severe
  weather, and resulting structural inefficiencies
  of the health care system
• Alaska needs a higher ratio of mid-level
  providers (advanced nurse practitioners and
  physician assistants) to physicians than the
  national average
• Shortages most apparent in internal medicine,
  medical subspecialties and psychiatry
• Alaska currently gains about 78 physicians per
  year, loses about 40 per year

40
Strategies that Have Been Used to Enhance
Physician Supply in Alaska

• Residency programs are one of the most effective
  ways to produce physicians for a state or
  community. (Alaska Family Medicine Residency
  places 70 of its graduates in Alaska.)
• In 2005, 29 of 73 Alaskan applicants were
  admitted into medical school. Ten per year attend
  WWAMI (first year in Alaska), others attend
  medical schools without state support from
  Alaska.
• Recruitment for physicians is facilitated by the
  availability of loan repayment programs such as
  the Indian Health Service and National Health
  Service Corps loan repayment programs.
• Alaska has a number of initiatives to increase
  interest in medical careers among Alaskans
  include but these generate too few applicants to
  replenish Alaskas shortage, and diversity is
  inadequate.

41
Figure A. Gain in Alaskan PhysiciansStatic
Doctor to Population Ratio vs. Desired Growth
Scenario
42

43
Recommended Strategies

• The Task Force recommends improved monitoring of
  physician workforce issues and specific
  strategies and action steps to achieve four goals
  related to assuring an adequate supply of
  physicians to meet Alaskas need. These are
  detailed in the report Securing an Adequate
  Number of Physicians for Alaskas Needs.

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Goals

• 1. Increase the in-state production of physicians
  by increasing the number and viability of medical
  school and residency positions in Alaska and for
  Alaskans
• 2. Increase the recruitment of physicians to
  Alaska by assessing needs and coordinating
  recruitment efforts
• 3. Expand and support programs that prepare
  Alaskans for medical careers
• 4. Increase retention of physicians by improving
  the practice environment in Alaska

45
Goals and Strategies for Securing an Adequate
Physician Supply for Alaskas Needs

• Major Goal 1.
• Increase the in-state production of physicians
  by increasing the number and viability of medical
  school and residency positions in Alaska and for
  Alaskans.

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Goal 1. Increase production of physicians
47
Goal 1. Increase production of
physicianscontinued
48
Goal 2. Increase the recruitment of physicians to
Alaska by assessing needs and coordinating
recruitment efforts.
49
Goal 3. Expand and support programs that prepare
Alaskans for medical careers
50
Goal 4. Increase retention of physicians by
improving the practice environment in Alaska
51
Implementation Strategy Next Steps for
Legislature and Other Key Policy Makers

• The shortage of physicians and other health care
  providers creates one of Alaskas most
  challenging public health and higher education
  issues.
• Recommended actions include
• programmatic activities (educational programs,
  research and development of recruitment and
  retention methods and marketing),
• obtaining targeted funding (for support of
  medical school preparatory programs, and medical
  school and residency slots), and
• collaborative planning with key education,
  government and provider partners (including
  University of Washington regarding medical school
  planning).
• Funding the action steps to accomplish the goals
  will be very important. The Task Force recommends
  creation of permanent structures for
• implementation including a Medical Provider
  Workforce Assessment Office.

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Next Steps

• Discussion and consensus needed
• Legislative Initiatives
• Budget Proposals
• Potential Physician Survey
• Programmatic Development
• Department of Health and Social Services
• University (including Area Health Education
  Center)
• Organizations (ASHNHA, ASMA, Others)

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Co-Chairs, Sen. Donny Olson and Rep. Sharon
Cissna thank you for participating in the
Legislative Health Caucus. A copy of this
powerpoint, as well as other up-to-date
information, can be found on our website
www.akhealthcaucus.org The audio file of todays
program can be found at http//www.ktoo.org/gave
l/audio.cfm (type in the date of this
Caucus). For more information, please call
1-800-922-3785