OPINION: Training is retaining: How to keep physicians in Alaska

Alaska is facing a physician shortage. In December 2023, the Health Resources and Services Administration ranked Alaska 48th in meeting primary medical needs (21.85%), 22nd for dental needs being met (34.98%), and 48th for mental health needs being met (11.90%).

For over 50 years, Alaska WWAMI Medical Education — a medical school partnership between the University of Alaska Anchorage and the University of Washington School of Medicine — has played a key role in educating and training future physicians in-state. And while Alaska WWAMI’s class size has recently increased to 30 students admitted per year, that alone won’t solve Alaska’s physician shortage issue.

The case for GME expansion

In order to increase physicians practicing in Alaska, we need to increase graduate medical education (GME) opportunities.

After graduating from medical school, GME is the necessary next step in a physician’s professional education, required by all states prior to being eligible for an unrestricted medical license.

In Alaska, we require at least two years of GME, which refers to residencies, internships and fellowships. But Alaska has the fewest number of GME programs, the fewest number of GME trainees, and the lowest medical resident-to-state-population ratio in the nation. In our opinion, this shortage is the critical barrier to addressing the state’s health care needs.

The connection between GME and community physicians

Nationally, about one in seven physicians is in a GME program. These trainees provide 20% of the care for hospitalized patients and 40% of the care for patients without insurance, contributing $8.4 billion in patient care annually.

Consider also that the retention rate for medical residents typically remains high in the communities where they train. For example, approximately 70% of Alaska Family Medicine Residency trainees stay in Alaska after completing their training. This program alone has trained over 27% of the state’s family medicine physicians.

Where do we go from here?

Federal funding for GME is crucial, but Alaska is one of just seven states that does not use Medicaid to fund GME. We also do not see federal employers, such as the Department of Veterans Affairs, the Health Resources and Services Administration, and the Department of Defense, providing GME positions in Alaska.

GME expansion in Alaska therefore requires partnerships across systems of care and their respective funding streams. To that end, the University of Washington held a WWAMI GME Summit in Anchorage earlier this year to explore options and yielded three clear recommendations for the state: First, Alaska should create a GME council to clarify a future vision and process for expanding GME in Alaska; second, Alaska Medicaid should support GME to signal to stakeholders and policy leaders that expanding GME in Alaska is important; third, Alaska should create a multidisciplinary GME teaching health center.

We are enthusiastic and optimistic that Anchorage was the setting for this regional GME Summit, because it signaled that GME should be — and is — a policy priority. We ardently believe that increasing GME in Alaska will increase the number of physicians that practice here and will improve access, quality, and outcomes of medical care — goals we all share.

Dr. Alexander von Hafften is a psychiatrist who first trained and worked in Alaska in 1990 as a WWAMI resident from the University of Washington School of Medicine Department of Psychiatry and Behavioral Sciences. He returned to Alaska in 1993 and since then, has been actively involved in undergraduate and graduate medical education.

Lindsay Lodis is a publicist for Alaska WWAMI School of Medical Education and has placed student, faculty and preceptor stories across the state to help illustrate the impact of medical education on a local, state and regional level since January 2023.

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