Providers aim to grow pediatricians for Alaska
Dr. Matt Hirschfield of Alaska Native Medical Center, left, and Dr. Michael Acarregui of the Children’s Hospital at Providence are working together to improve pediatric care in Alaska. The state’s first pediatric residency program begins this summer with a goal of training pediatricians to work in rural Alaska.
Photo/Michael Dinneen/For the Journal
The “Alaska Grown” label may have to expand to pediatricians in a few years.
This July, the first residency program to groom pediatricians for possible work in rural Alaska will begin. In conjunction with Seattle Children’s Hospital, the pediatric residency program is the latest product of the All-Alaska Pediatric Partnership that includes the Children’s Hospital at Providence Alaska Medial Center and the Alaska Native Medical Center.
Students will spend eight months per year in Seattle and four in Alaska. The four months in Alaska will be divided equally between Anchorage and sites in either Fairbanks or Bethel, giving the residents a full year in the state during the three-year program.
Dr. Matt Hirschfield, director of maternal child health at AMNC, said the goal is to match the retention rate for the family medicine residency program among the states of Washington, Wyoming, Alaska, Montana and Idaho known as WWAMI. Of the 20 Alaska students admitted to the program each year, Hirschfield said about 80 percent decide to practice in the state.
“It’s been great interviewing,” Hirschfield said of the candidates for the inaugural program. “They’re young, they’re very idealistic. To them, Anchorage is just OK. The draw of the program is going to Fairbanks and Bethel. They’re really excited about doing rural medicine in Alaska with this great population we have up here.”
Dr. Michael Acarregui, executive director of the Children’s Hospital at Providence, was equally effusive in his praise of the pediatric residency candidate pool.
“The quality of applicants has been extremely high,” Acarregui said. “They’ve been very impressive. The people I’ve interviewed have just been top-notch. They’ve been to other parts of the world; they’ve trained at top institutions. It’s an impressive group of future physicians. It’s very exciting. It’s an opportunity to train pediatricians in Alaska. We know that will increase the likelihood that people want to come up here and practice.”
Acarregui joined Providence last June from the University of Iowa Children’s Hospital, and one of his first observations was the heavy reliance on traveling physicians and nurses to meet Alaska’s healthcare needs.
“We really do need to try and grow our own,” Acarregui said.
The All-Alaska Pediatric Partnership, or AAPP, has been in place since 1995 and a consultant’s 2010 recommendations for Providence and ANMC to combine their resources to provide pediatric subspecialist care are steadily being implemented.
“When I interviewed a year ago, I met with physicians of all stripes,” Acarregui said. “I asked them what my focus should be. Every one said it was to improve and strengthen relationship with the Native medical community, and ANMC in particular. Our joint vision is to meet the needs of all Alaska children, Native or otherwise, through combining our systems.”
Alaska’s needs are tremendous, but a widely dispersed and small population makes the cost of providing some pediatric subspecialties beyond what any one hospital’s number of patients would support.
“Especially when it comes to children, you can’t afford to divide up that pie, or the slices are too small,” Acarregui said. “You can’t afford to support infrastructure and specialists that are needed with that small number of kids. We recognize that.”
Acarregui and Hirschfield meet regularly to figure out the best ways to combine their resources. A recent example of how those conversations pay off was ANMC helping to relieve the burden on Providence’s recently hired pediatric endocrinologist (hormone diseases).
There are only two pediatric endocrinologists in the state, and while ANMC has enough pediatricians for its endocrinologist Dr. Rachel Lescher (hired last September) to not have to stay on-call, the Providence endocrinologist Dr. Matthew Benson was on-call 24/7. Now Lescher takes calls for Providence one week per month to provide some relief for Benson.
“It’s a small step toward building a relationship between the hospitals around pediatric subspecialties,” Hirschfield said.
Similarly, when Providence hired Dr. Maria Caimol, a pediatric nephrologist (kidney diseases), ANMC contracted for her services. Caimol is the only pediatric kidney specialist in the state, and bringing her to the ANMC campus regularly not only saves disruption for patients, it helps support her salary at Providence.
Over the last year, Providence has hired several new subspecialists, including Caimol, who received her medical degree in the Philippines, and Benson, who received his in Israel.
Others include Dr. Corinna Muller, one of only four maternal-fetal health specialists in the state, and Dr. Claire Wilson, a pediatric gastroenterologist.
ANMC is looking to add to its single pulmonologist (lung diseases), and both hospitals could use a neurodevelopmental pediatric specialist.
“We have a lot of those kids up here, and we only have one person in town that does it,” Hirschfield said. “We have way more business than that one person can handle. We’re jointly recruiting for that position. They’re pretty rare doctors. Even places like Seattle, they’re not very frequent. Getting one up to Alaska is not very easy.”
Recruiting physicians to Alaska does attract a certain personality, and as several recent hires illustrate, often brings worldwide flavor.
“She been real excited about the outdoor activities,” Acarregui said of Caimol. “It helps. People who by nature are more adventurous are more likely to seek opportunity up here.”
Providence and AMNC are also working to find ways to utilize the telehealth system that allows remote access to rural Alaska villages. The telehealth system has been bolstered by the recent activation of the TERRA-Southwest high-speed internet network built by General Communications Inc.
The first video teleconference when the TERRA-Southwest was turned on was between Gov. Sean Parnell and Yukon-Kuskokwim Health Corp. CEO Gene Peltola, and the crystal clear quality of the feed shows the potential for increased consultations and follow-up care.
Additional support staff on the ground in villages such as case managers and IT personnel will be needed, but achieving more regular contact with patients both child and adult could reduce costs of traveling to Anchorage or beyond, and also avoiding medevacs or emergency room visits.
Hirschfield said patients with kidney or hormone ailments may be seen once a month or once per quarter in the Lower 48, but similar patients in Alaska may be seen only once or twice per year.
“We could have all sorts of big benefits down the road,” he said.
One of the main goals of the AAPP is to keep kids and their families in the state rather than sent Outside to Seattle or Oregon for care. From there, Hirschfield said, the goal is to keep them in their villages to avoid the cost and disruption that comes with travel to Anchorage.
According to the state Medicaid office, travel costs alone run some $50 million annually to support patient care and families.
“We’re going to need a little support out in the region, technological and case management support,” Hirschfield said. “If we can get those things cooking, this is potentially an unbelievable savings for state Medicaid.”
Besides cost savings, better pediatric care will also save lives.
“Our joint vision is to meet the needs of all Alaska children, Native or otherwise,” Acarregui said.
Andrew Jensen can be reached at firstname.lastname@example.org.