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Alaska AFP Provides 'Gathering Place' for Far-flung Physicians
Weather, Geography Define Family Medicine in State
By Sheri Porter
During his transcultural medicine/wilderness medicine rotation in Willow, Alaska, Justin Carricaburu, D.O., learns about winter survival, including how to dig a snow cave.
Katy Sheridan, M.D., holds a newborn, one of many she has delivered as part of her solo family medicine practice in Soldotna, Alaska.
The snow outside the Valdez home of John Cullen, M.D., reaches the bottom ledge of the kitchen window. What's remarkable, however, is that the kitchen is located on the second story of the house.
The largest state, Alaska is two-and-a-half times as big as Texas, covering more then 570,000 square miles. Juneau, the state capital, can be accessed only by air or sea.
"I'm looking out my kitchen window, and the snow comes up to the base of the window," says John Cullen, M.D., president of the Alaska AFP, describing the scene outside his window in a phone interview with AAFP News Now. "But given that my kitchen is on the second story, you can just imagine how much snow is out there," says the Phoenix native, who came to Alaska for the third year of his family medicine residency training and never left.
Still, Cullen can drive to his clinic, which is located just a mile away and which sits only 50 yards from the local hospital. He and his partners provide "full-spectrum family medicine" to the locals. In addition to the urgent, preventive and chronic disease care always handled by FPs, Cullen delivers about 50 babies a year -- some by cesarean section -- and performs surgery when necessary.
"Because of the isolation, we have to be prepared to handle everything," says Cullen.
Family Physicians Rely on Chapter
- Alaska is known for its harsh winters and rugged environment, which makes practicing family medicine in the state difficult at best.
- The Alaska AFP helps keep the chapter's 367 members connected and professionally engaged.
- The Alaska Family Medicine Residency works closely with and supports chapter efforts, and 80 percent of graduating residents stay in Alaska.
It's easy to see why the 367 members of the Alaska AFP -- who dot this vast geography like tiny push pins on a wall map -- rely heavily on their chapter for support.
Doty, a member of the AAFP's Board of Directors, puts it this way: "We use the chapter as a gathering place, because we have such disparate practices and we're so far-flung. Chapter meetings are a way to share ideas and anchor our professional relationships."
"The chapter was -- and still is -- my professional lifesaver," says Katy Sheridan, of Soldotna, a native of Alaska who graduated from a residency program in Maine in the 1990s and then returned to her home state to practice family medicine.
Once settled, Sheridan had the social support of family and friends -- and ample invitations for holiday dinners. "But I really felt professionally isolated in a lot of ways," she says.
"I started going to the state chapter meetings and, subsequently, met family doctors from around the state who became my lifeline and career support," says Sheridan, who served as chapter president for two consecutive years beginning in 2004.
Residency Supports Chapter Work
Residency Director Harold Johnston, M.D., told AAFP News Now that ties between the program and the chapter are strong. For example, faculty members help teach the ALSO course, and a resident serves on the chapter's board of directors. A good number of residency faculty members also are active in chapter leadership.
Residents are encouraged to get involved in both the chapter and the national AAFP, to the extent that the residency program pays full membership dues for all 36 residents.
Residency training in Alaska is rigorous. "We have to focus on areas of training that prepare residents for that low-tech practice that they are likely to find in the 'bush'" said Johnston. The bush areas of Alaska are towns and villages -- some with as few as 50 people -- that are accessible only by boat, plane or snowmobile.
Because of the unique demands placed on family physicians in Alaska, the residency program focuses heavily on obstetrics, orthopedics, pediatrics and emergency medicine. It also features three and half months of required rural rotations, a two-part transcultural rotation that teaches residents about Alaska history and culture, and a workshop on winter survival skills.
The payoff is that 80 percent of residents stay in Alaska after they graduate; it's the highest in-state retention rate in the nation. And 50 percent of those graduates practice in rural communities -- also higher than the national average.
"After spending three years in Alaska, if you were at all interested in the first place, it's very likely that you're going to want to stay," says Johnston.
Indeed, coming to Alaska for training -- and then settling in for good -- seems to be a common story.
FACTS ABOUT THE ALASKA AFP
Number of chapter members: 367
Date chapter was chartered (as a territory before statehood): Sept. 16, 1953
Location of chapter headquarters: Soldotna
2012 annual meeting/scientific conference date/location: June 14-17/ Kenai High School/Kenai
Keeping Members Connected
Granholm understands the difficulties of keeping members connected and says the chapter has long relied on the Internet, e-mail and conference calls. Chapter meetings often include members calling in from Bethel, Nome, and sometimes Sitka and Juneau.
More recently, Facebook has been a welcome addition to the chapter's outreach to members. "Part of my goal (as president) is to increase communications to our tiny little practices spread out over this large geographic area," says Granholm. She wants Alaska FPs to be more tuned in to issues such as practice transformation and accountable care organizations -- topics that are hot in the "Lower 48" states.
Chapter leaders give much credit for the chapter's success to Marilyn Dodd, the chapter's executive director since 1996. In the past 15 years, the chapter has added nearly 70 new members, an impressive feat for a chapter so small.
In the winter, Dodd manages chapter business out of her home in Clam Gulch, a tiny town on the Kenai Peninsula. When the weather's more amenable -- and when the need arises -- she makes the trip into Soldotna some 19 miles away.
Summing Up the Stories
Another recalls a harrowing three-and-a-half-hour ambulance ride through a snowy mountain pass to deliver two teenage boys with critical head injuries to the next town, where they were airlifted to Anchorage for treatment.
Alaska FPs don't hesitate to call in the Coast Guard for assistance when needed. And they sometimes have to consider where might be the safest place for a woman in preterm labor to deliver and then base their final decision on flight conditions and the availability of airport landing lights.
Family physicians in Alaska speak of the natural beauty of their state and how they wouldn't live anywhere else.
"People love practicing up here," says Doty. "We may work a little harder and we may put in a few more hours, but there's a lot of joy."
AAFP Chapter Spotlight series
YouTube video: "Too Much Snow in Valdez"
Alaska FPs Rely on Each Other