As chronic diseases take their toll on aging baby boomers, experts expect to see an increasing demand for doctors. And Alaska will need doctors interested in living in rural Alaska.
“The boomers are about to get sick,” Dr. Bruce Clark told members of the Gerontological Society of America at its annual meeting in November. He’s the producer of a 2012 PBS series on “Caring for an Aging Society.” He said the Kaiser Foundation has found that 70% of health care is related to chronic conditions such as diabetes, asthma, heart disease, and depression.
“You know, it’s kind of a free ride up through your twenties, thirties, forties, and maybe into your fifties,” said Clark. “By the time you cross that sixth-decade threshold, the chronic conditions begin to stack up.”
Reid Blackwelder is President of the American Academy of Family Physicians, and a professor of family medicine at the Quillen College of Medicine in Tennessee. He says the nation is facing a shortage of the doctors who provide basic treatment and decide if a patient needs to see a specialist.
“Every other country has recognized the value of primary care and have that as the foundation of their system,” says Blackwelder. “They have at least, most other countries, have at least 50% of their physician work force as being primary care and this country is right around 30%.”
Blackwelder says part of the problem is the U.S. medical system discourages medical students from specializing in internal medicine, primary care, and general pediatrics.
“Traditionally all the payment models have emphasized, it’s called fee for service,” Blackwelder explained. “So they pay for procedures, for things that are done at a very much higher rate than paying for value and what can be done at the level of primary care. So there’s a huge pay disparity; there’s a salary gap that’s significant.”
He says Alaska has more primary care physicians relative to its population than the norm in the lower 48, but needs more.
“The problem is where people are located,” says Blackwelder. “Because Alaska has such a rural population, and relatively few physicians, those patients who are outside the urban, or the more highly populated areas, definitely have difficulty finding a physician in Alaska.”
Blackwelder says if people can’t find a primary care provider, they may turn to specialists, a situation that can contribute to higher medical costs. Or, he says, they wait too long to seek care.
“The absence of having access to primary care early on is that chronic diseases become worse and acute diseases need emergent care.”
The solution, says Blackwelder, is for Alaska to “grow its own” doctors.
Dr. Ian van Tets is working to do just that. He’s co-program director of the Della Keats program in the Alaska WWAMI School of Medical Education. WAMMI stands for the five states in the program: Washington, Wyoming, Alaska, Montana, and Idaho. Van Tets says WWAMI funds medical education at the University of Washington Medical School, and helps place students in residencies in the five states. He says WAMMI accepts 20 Alaskans per year.
“It enables Alaskan students to become doctors, makes it easier for them,” says van Tets. And the flip side of that is it makes it more likely for us to have doctors here in Alaska, because instead of recruiting people from outside, we’re training people who already live here and want to work here.”
Van Tets says where students spend their residencies often affects their entire career.
“People tend to stay where they do their residency. They finish medical school, they finish their residency. They get married, they start having kids, they’re starting a career.”
Van Tets says medical schools are disproportionately filled with people from well-educated families who know how to work the system to get scholarships and grants. He says WWAMI works to increase the diversity of medical school students, and especially to bring in people who are more likely to work in areas with a chronic shortage of doctors:
“And particularly because where that shortage is most pronounced is in the bush. So we really want students, we place an extra value on recruiting students who come from, for example, an Alaska Native background because we don’t have very many Alaska Native doctors,” says van Tets. “And students who come from rural backgrounds, because it’s very hard to recruit doctors. I mean if you can earn a very good salary living in Anchorage, or a very good salary living in Seattle, you have to be a fairly special person to go and live in Bethel, or to go live in Barrow. But if your family all live in Bethel, then that’s a different matter altogether.”
Van Tets says WWAMI is one of the most highly rated programs of its kind in the country, according to Newsweek, and some 95 percent of the Alaskan students stay and practice medicine in Alaska for at least a year.
This is part three in a six-part series by Joaqlin Estus on "Aging in Alaska" for Koahnic Broadcast’s KNBA Public Radio (broadcasting Alaskan Native voices), made possible through a MetLife Foundation Journalists in Aging Fellowship, a project of New Media and the Gerontological Society of America.