The programs are an effort to combat an increasing shortage of health care providers at all levels, said Sheila Fleutsch, a recruiter at the Alaska Native Tribal Health Consortium.

"It is a problem. I can't think of any health profession that is not in a situation where demand exceeds supply, somewhere," she said.

According to the Alaska Community Health and Emergency Management Service, about 30 communities in Alaska are designated as federal health professional shortage areas. To achieve that designation, the communities must be recognized as having an uneven proportion of patients to physicians specializing in either primary care, dental care or mental health.

Patricia Carr, a unit coordinator focusing on the physician shortage with the state Division of Public Health, said that while the state has a relatively low number of physicians per capita, there is a high number of physician assistants. The state's goal, Carr said, is to encourage new doctors to infiltrate areas where there is a shortage of care, largely in the Bush. She added that, by working with other organizations, such as the Alaska Health Summit, and providing incentives to young physicians, progress is slowly being made.

The division's efforts entail providing financial incentives for recently graduated doctors; and serving as a primary contact for the National Health Service Corps.' Student Experiences And Rotations in Community Health (SEARCH) program, Carr said. SEARCH takes physicians who are just finishing school, or who are still studying and are interested in increasing their experience, and places them in a working clinic where they can perform hands-on medicine.

Other organizations are also taking steps to recruit and retain physicians for remote Alaska villages.

The Alaska Primary Care Association Inc. teamed with the National Health Scholar program to offer loan repayment of up to $25,000 per year to recent graduates with a signed committment to practice in rural Alaska. So said Pat Sedrick, the professional recruiter for the association. Other initiatives Sedrick sited include the J-1 Visa program, which sponsors, licenses, and arranges practice for immigrant students; and a program in which trained nurse practitioners, medical doctors and physician's assistants work part-time in a village clinic.

Sedrick said it is difficult to attract providers to the remote areas because those areas often are reliant on a sole practicioner to take care of all health problems. Fleutsch noted that the unique geography and isolation of rural Alaska requires a "special kind" of person for a health care provider.

"When a doctor is faced with so many opportunities in so many places, one has to wonder why that doctor would chose a remote Alaska village instead of a rural community in the Lower 48 that still has roadways," she said.

The Native Tribal Health Consortium, Fleutsch said, is working on an initiative to train and groom Alaskans to become physicians; and the Alaska Native Health System provides loan pay-backs and payment of malpractice insurance for physicians within the system.

It's all part of an effort, spearheaded by the University of Alaska Anchorage, to increase the number of providers coming from the state, Fleutsch said.

'A grass roots effort'

The UAA School of Nursing hopes to double the number of trained nurses graduating its program annually by 2006. Currently, the school comprises 317 students in one of four programs, ranging from a one-year nursing certificate to a Master's degree in Nursing Science, said Dr. Tina DeLapp, the director of the school.

Students have the option of attending the one-year certification program, a two-year Associates' program or a four-year Baccalaureate program. They may also add an advanced degree after the completion of a bachelor's degree in nursing science.

The programs are part of an effort to combat Alaska's nursing shortage, which DeLapp called a "crisis." Longer life expectancy and growing interest in home health care have upped the ante on registered nurses, she said.

"The nursing shortage is a function of both an increased demand for providers and the expansion of the places where nursing care is delivered," she said.

The program is divided into theory classes and clinical-care sessions, during which students get hands-on training in the practice of medicine. As part of what Fleutsch called "a grass roots effort," one and two-year students, as well as R.N.s who are interested in completing an advanced degree, may do the clinical care from remote locations under the guidance of a licensed nurse.

The effort seems to be working, DeLapp said.

"A huge majority of our students stayed in the community they did the program in," she said. "Training nurses in their home community means we're training nurses in the community to which they are already committed."

A more focused program within the school, Recruitment and Retention of Alaska Natives into Nursing -- or RRANN -- provides outreach and assistance for Alaska Natives who are interested in nursing.

That support includes a designated hall in student housing, living stipends and scholarships for participants, academic advising, tutoring and mentoring, and social and cultural support, said Laureen Young, a RRANN student success facilitator.

Marlene Smith, a student nurse from Kotzebue and a member of the RRANN program, moved to Anchorage after 12 years of nursing in her home community. While her adjustment to life in an urban center was difficult both financially and emotionally, Smith credits the program with her success. After completing her Associates degree and taking the license exam in spring of 2004, she plans on returning to Kotzebue as an R.N.