Chairing a field hearing of the Senate Health, Education, Labor and Pensions Committee on Feb. 20, the state's junior senator heard from people who have trouble finding doctors and from doctors who tried to explain why that is.

She also heard ideas on how the federal government could help ease the situation.

Health care is a major concern nationwide. In Alaska, the cost of health care is roughly 70 percent higher when compared to the Lower 48, adding to the financial burden.

Last year, Americans spent $1.9 trillion on health care, Murkowski said. That's more than was spent on food or housing, and four times the amount spent on national defense. By 2015, that figure is estimated to balloon to nearly $4 trillion. Alaskans spend more than $5 billion a year on health care, a figure that is also expected to increase in coming years.

Those rising figures are largely attributed to an aging population — assuming that the older one gets, the more often he needs to see a doctor, and the more medications he'll need to take. In 20 years, some 20 percent of the U.S. population will be 65 years old or older, Murkowski said.

In Alaska, the number of those older than 65 is expected to increase from 43,000 to 124,000 between 2005 and 2025.

At the same time, experts predict a national shortage of 200,000 physicians, with a shortage of nearly 400 in Alaska. About a third of the nation's doctors are nearing retirement age, while for the past quarter-century, medical schools have kept enrollments virtually flat.

Murkowski read off several messages from constituents detailing their troubles in finding a doctor to accept a new Medicare patient, either themselves or a family member. Some said they had made more than 100 calls to doctors in the Anchorage area and were turned down.

One was speaker Carl Berger, of the Lower Kuskokwim Economic Development Council in Bethel. Berger just turned 65 and entered into the Medicare system. His doctor of 20 years retired, and Berger can't find a general practitioner to take him as a patient.

“Lucky for me I have a heart condition,” he said. “I'm able to see another doctor. But what doctor would want to see me if he get reimbursed only 40 percent of his costs?”

Speaker Frank Appel, of the Alaska Commission on Aging, recently got a letter from his doctor of 15 years saying that once Appel reaches 65, he'll have to find a new doctor.

“I believe the challenge faced by seniors and others who can't find a doctor is intolerable,” Murkowski said at a Commonwealth North health care discussion held later that afternoon. “This is not a new problem, but I think people believe that it's not going to happen to me. I think people should realize that turning 65 is one of those things that happens after 64. We must help current physicians stay in the practice of medicine and increase our health care work force.”

Rita Hatch, a volunteer with the Older Persons Action Group, a senior advocacy organization, said she does an ongoing survey of Anchorage doctors who accept new Medicare patients. There are currently about 20 doctors on her list.

The Anchorage Neighborhood Center is the only facility taking new patients, and it is being overwhelmed.

Doctors said they are reimbursed only 40 percent of their actual costs for services provided to Medicare patients. That doesn't cover their overhead costs.

“It seems like we are the bad guys,” said Dr. Ross Tanner, president-elect for the Alaska State Medical Association. “But for me to remain financially soluble, I have to be paid for what I do.”

He added that a plumber or engineer would not be asked to take a reduction in their fees, but that's exactly what the federal government demands when doctors treat Medicare patients.

“It's not a greed thing,” he said. “I don't have a bunch of money that I go home and roll around in every day. I am the cheapest thing that Medicare could spend their money on. I am cheaper than the emergency room or any specialist.”

Everyone agreed that efforts in recruitment and education need to be stepped up, but those are costly programs.

The annual cost of recruiting doctors to Alaska is more than $24 million, said Karleen Jackson, commissioner of the state Department of Health and Social Services. The average cost to hire a physician surpassed $74,000.

Medical school can cost from $125,000 in a public school to $200,000 in a private college. That's a huge debt load for a young person, Tanner said.

Alaskans have the lowest acceptance rate of applicants entering into medical school. And those entering into school now won't be ready to open their own practices for at least seven years.

Alaska needs 59 new doctors each year to approach national levels of doctor to population ratios. But Alaska has no medical school, is limited on the number residency students it can train and is limited on the number of students it can enroll into a Washington state medical school program.

That means that a number of Alaskans who want to become a doctor will have to train Outside. Statistics show that doctors practice within 100 miles of where they trained.

So how to make it better?

Doctors offered several suggestions:

• Enact federal legislation to fix the Medicare payment system to reflect the higher Alaska costs.
• Enact legislation to provide tax credits for young doctors to practice in “frontier” states, like Alaska.
• Enact legislation to revamp the funding for residencies.
• Develop programs to help medical students with the debt garnered to attend medical school.

On the federal level, Murkowski and Sen. Ted Stevens continue to work for higher Medicare and Medicaid reimbursements for Alaska providers. Earlier this year, Alaska's senators introduced the Rural Physician Relief Act, a bill that provides tax incentives for doctors to practice in rural areas.

Soon, Murkowski will introduce the Physician Shortage Elimination Act, which will double the funding for the National Health Service Corp., a program dedicated to meeting the needs of the underserved. Some 80 percent of the applicants to the program are turned away each year.

The bill will allow rural and underserved residency programs to expand by removing barriers that prevent programs from developing rural training rotations, and will create programs that target disadvantaged youth in rural areas by creating a pipeline into health care careers. The bill also offers grants to community health centers to expand residency programs.