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

2. Stability of the Health Care System in the USA

3. Alaska WWAMI then (1974) Alaska WWAMI then (1974) University of Alaska Fairbanks Anchorage Psych

4. Alaska WWAMI now

5. How has WWAMI impacted Alaska? ► Alaska WWAMI program has produced over 450 physicians, with high return rate ► 2011: Class 1 MEDEX Northwest Anchorage graduates 15 physician assistants; 14 remain in Alaska ► In addition > 100 MEDEX graduates practicing in Alaska from earlier classes ► Alaska Family Medicine Residency part of UW Family Medicine Residency Network

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

9. Growing GME in Alaska ► Pediatrics track  Summer 2012  Recruiting for 4 residents  8 months per year in Seattle, 4 months per year in Alaska ► Psychiatry track  Summer 2012  2 residents year 1, 3 residents year 2  First cohort: 3 years Seattle, 1 year in Alaska  Second cohort: 2 years in Seattle, 2 years in Alaska

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) Year 200520062007200820092010 Apply 738594 79 8067 Admits 29 42313429

12. Predicted number of medical students based on total population needed to generate one medical student (16541 pop) StatePopulationpredictedactual+- Alaska7102314329-14 Idaho 1,567,5829455-39 California -37,253,95622522154 -98 New York19,378,10211711335+164

13. Clinical offerings for Alaska WWAMI students ► 132 3 rd -year required clinical rotations ► 32 4 th -year rotations ► 20 preceptorships (one a week for entire year for first year students) ► 15 -17 rural shadowing programs between 1 st and 2 nd year ► Mainly ambulatory non-hospital rotations ► In 2011, 153 rotations utilized ► 7 students this year in Alaska Track ► 3 WRITE sites (Juneau, Palmer/Wasilla, Kodiak)

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 expand Challenges ► 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 40 th 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.