With more regional clinics, specialty services, hospital expansions and the growth of telemedicine around the state, medical travel within the state and to the Lower 48 is becoming a bit less of an expense.

Alaska still trails the national average for physicians per 1,000 by a significant margin, and while the increase in doctors from 2007 to 2009 slightly outpaced population growth statewide, an aging population presents significant challenges.

From 2007 to 2009, the population grew by 1 percent, to 679,720, while doctors increased by 2 percent, to 1,583 from 1,545.

During the same period, the Medicare-eligible population who are older than 65 increased by 9 percent. The national average for doctors per 1,000 is 3.2; Alaska averages 2.3. Alaska has long had difficulty recruiting and retaining doctors to treat Medicare patients because of low reimbursement rates.

The aging population is reflected in the growth of long-term care facilities and expanded access to cancer, heart disease and dialysis treatment.

Alaska's health care sector is its fastest growing industry, with its workforce increasing by 40 percent to 29,000 from 2000 to 2007. Several large-scale projects are under way, including a $154 million, 143,000-square foot replacement to Norton Sound Regional Hospital in Nome and a $150.3 million campus expansion for Providence Alaska Medical Center in Anchorage.

From 2007 to 2009, the Anchorage and Matanuska-Susitna boroughs were the only areas of Alaska to see growth across all 12 professions licensed by the state, including physicians, pharmacists and dentists.

Statewide, the number of psychologists declined by 4 percent from 2007 to 2009, the only of 12 professions to see an overall loss.

What follows is a brief region-by-region breakdown of recent expansions in Alaska health care services. Unless otherwise noted, growth numbers are from February 2007 to August 2009.

Interior

The number of physicians and physicians assistants in the Interior region grew by just 2 and 3, respectively, from 2007 to 2009, and the number of pharmacists declined by one. There was a large boost in nurse practitioners by 53 percent in that span, from 34 to 52.

Registered nurses grew by 9 percent, to 731; certified nurse assistants increased by 26 percent to 459. Dentists increased by 11 percent, to 70, and dental hygienists by 14 percent to 50.

Hub city Fairbanks saw the opening of the $14 million, 12,747-square-foot Harry and Sally Porter Heart Center at Fairbanks Memorial Hospital in February. An estimated 400 residents per year previously traveled to Anchorage or the Lower 48 for heart services.

The new facility has three cardiologists, video conferencing capability and the most state-of-the-art technology.

The Fairbanks Cancer Treatment Center is the first accredited cancer care program in Alaska. It provides all aspects of cancer care and offers integrated programs in cancer diagnosis, treatment, clinical trials, education programs and prevention.

Fairbanks Memorial has also expanded its cancer care services with the Fairbanks Imaging Center, a 57,000-square-foot facility with an array of diagnostic services that aid in cancer detection, diagnosis and treatment.

Aiding children ages 6 to 18 with psychiatric treatment needs has also gotten a boost in Fairbanks with the 2008 opening of the 77,000-square-foot Boys and Girls Home of Alaska.

During the 2008 fiscal year, nearly 800 children were placed in residential treatment facilities outside the state at a cost of about $40 million.

The Boys and Girls Club Home has four cottages, each housing up to 30 children, a cafeteria and eight classrooms.

The facility helped boost the number of professional counselors in the Interior from 51 to 64 between 2007 and 2009.

Southcentral

From 2007 to 2009, the Anchorage/Mat-Su region saw a 3 percent increase in doctors, 1,043, and a 32 percent increase in physician assistants, from 136 to 179.

The Anchorage/Mat-Su region is the closest in Alaska to hitting the national average of physicians per 1,000 at 2.8, about 12.5 percent below the U.S. average of 3.2.

The state's Gulf Coast region, which includes the Kenai Peninsula and Kodiak, had a 9 percent increase in doctors to 127, and nurse practitioners in the region went from 41 to 48.

Pharmacists and pharmacy techs were the greatest source of growth across the state health care sector, with overall increases of 12 percent and 30 percent, respectively.

In the Anchorage/Mat-Su region, pharmacists grew by 20 percent to 294 and techs by 31 percent to 778.

Dental care is one sector where the state as a whole outpaced the Anchorage/Mat-Su region. The region added just one dentist from 2007 to 2009 compared to 18 in the rest of the state. The Gulf Coast region had the largest increase of any region with 15 percent growth from 46 dentists to 53 dentists.

A new skilled nursing facility opened in Seward last fall and is the first in Alaska to use a less institutional "greenhouse" approach for long-term elderly care.

The Providence Wesley Care Center facility has a 40-bed capacity with four cottages of 10 rooms each and offers both nursing and rehabilitative care, as well as social services, activities, nutrition and spiritual care.

Patients on the Kenai Peninsula needing dialysis services no longer need to drive to Anchorage. Fresenius Medical Care has opened a kidney dialysis facility in Soldotna.

In Anchorage, Providence's $150 million major campus expansion will serve more specialized prenatal and natal care in addition to cardiac services.

The campus expansion will increase the number of neonatal intensive care unit beds from 47 to 66, as well as modernize and expand the prenatal, mother-baby, obstetric triage and labor/delivery areas of the maternity center.

A second dedicated cardiac surgery operating room will also be added.

Southeast

The Southeast region saw its population decline by 1 percent from 2006 to 2008, but a greater dip from 2007 to 2009 in physicians (down 5 percent), physician assistants (down 21 percent), occupational therapists (down 3 percent) and psychologists (down 20 percent).

Registered nurses increased by just 2 percent, to 660, and certified nurse assistants by 13 percent, to 508.

Expanded local services include greater access to surgical and orthopedic care, and the new Bartlett Regional Hospital Infusion Therapy Center in Juneau that opened in May 2009.

The Infusion Therapy Center has four patient chairs and one bed for administration of blood transfusions, antibiotic therapy, PICC line insertions (similar to intravenous therapy), chemotherapy and therapeutic phlebotomies.

Bartlett Regional is also expanding its orthopedic services, its medical/surgical unit and its same-day care unit with an $8 million project set to be completed in January 2011.

Southeast residents have had greater access to ambulatory (same-day) services since early 2009, when orthopedist Dr. John Bursell opened a $669,260 facility to handle pain management procedures that typically involve injections to relieve chronic pain.

Native health

As of 2006, the Alaska Native population that used Indian Health Service or tribal facilities was 130,682. There are 36 tribal-operated health centers across the state and seven tribal-operated hospitals in Barrow, Kotzebue, Nome, Bethel, Dillingham, Anchorage and Sitka.

In Nome, the Norton Sound Regional Hospital is currently being replaced at a cost of $154 million.

The Alaska Native Medical Center in Anchorage is the only hospital in Alaska — and the only tribal hospital in the nation — with Magnet designation recognizing nursing excellence. It also has the only Level II Trauma Center in the state, serving as the trauma referral center for all state hospitals.

Alaska Natives have a 25 percent higher mortality rate from cancer than American whites, and the Centers for Disease Control recently awarded an $800,000 grant in enhance colorectal cancer screening efforts.

Diabetes is a tremendous problem around the nation, and is hitting Natives even harder. Only the Interior and Anchorage regions of the state have rates below the U.S. average for Native populations. The Alaska Native Tribal Health Consortium has a diabetes team with a computerized registry to help with prevention education and treatment of diabetes.

Toward that end, Alaska Tribal Health Systems, or ATHC, continues to expand its telemedicine program to 250 sites across the state. To date, it's been used for more than 70,000 clinical cases among 30 autonomous organizations.

Annual consultations number 14,000 to 17,000 per year, providing care to 12,000 Alaskans annually.

Most specialty consultations using this system are completed within 24 hours, reducing patient wait times and the backlog of patients scheduled for in-person specialty clinic, opening up in-person appointment slots. Patients who need additional testing or in-person evaluation and care are seen in an expedited manner.

More than 70 percent of consultations prevent patient travel, which the ATHC estimates saves around $3 million to $4 million in travel costs.

In place since 2001, the telemedicine carts and software created in Alaska are also now being used across the country as well as a few countries outside the U.S.

Andrew Jensen can be reached at andrew.jensen.@alaskajournal.com.