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Family practice physicians in Alaska can count on treating the usual ear infections, urinary tract infections and rashes. But at any given moment, they also can find themselves the only pair of hands available to perform an emergency laparoscopic surgery for an ectopic pregnancy, talked through the steps via a gynecologist hundreds of miles away communicating into a headset.

Welcome to the true Wild West, an untamed landscape unlike any practice opportunities you’ll find in the Lower 48. There’s no managed care, few hospital-employed positions, and the biggest “fight” the 250 members of the Alaska Academy of Family Physicians faces this year is to encourage four-wheelers to wear helmets.

It was an atmosphere Katy Sheridan, MD, couldn’t leave. Born and raised on a homestead on the Alaska peninsula, she attended medical school at the University of Washington in Seattle, then fulfilled her residency in Bangor, Maine. Eight years ago, she returned as a family practice physician, ready to set up a private practice in Soldotna. Since Anchorage is just 150 miles away, she says her stories of dramatic trauma moments don’t compare to her colleagues.’ On the other hand, how many family doctors deliver 40 babies a year and become president of their group academy for the state only eight years into their career?

If that sounds promising, there’s definitely a practice opportunity ready to welcome you with open arms. As of 2002, our 49th state had the sixth poorest physician-to-patient ratios, with just 1,350 doctors to cover a population of 644,000. And more than half of those physicians are older than 50, so groups like the AAFP foresee an even larger shortage looming.

“A lot of people like the idea of checking out Alaska because it has a mystique about it,” says Sheridan. “A lot of people came here for the summer to work and never left. It doesn’t take people very long to know if they’ll like it or not.”


	Myth Understandings It’s easy to stereotype Alaska, but physician recruiters like Rita McNeal, RN, at Valley Hospital in Palmer quickly erase these misconceptions about the state they love: • Myth #1—The temperatures are frigid. Cold, yes. But an icebox is a bit of an exaggeration. Alaska is one-fifth the land mass of the Lower 48, so just as you can’t assume you’ll swelter in every spot on the continent in the summer, you also can’t presume to freeze in Alaska. In the south central portion, residents expect one to three weeks a year where the temperatures dip below 0 at night (16 is the average for January), and summers in the 60s and 70s. “You can wear shorts from May to August,” McNeal assures. In the Arctic, folks actually welcome winter as the best time to get around. Frozen ground travels more smoothly than boggy soil, so summer can limit some villages to travel via boat only, adds Patricia Clancy, MD, the medical director for the Maniilaq Health Center in Kotzebue. • Myth #2—It costs an arm and leg to live here. It depends on what item you’re buying. Residents consider $4.50 a good deal for a gallon of milk, but they pay between $1.89 and $2.00 for a gallon of gas. A three-bedroom house sitting on an acre of land in the suburbs sells for $170,000. Airline flights within Alaska can be costly according to residents, but you can fly direct to Seattle, Chicago, or Minneapolis for several hundred dollars. • Myth #3 Winters are depressing. Not all of Alaska goes completely dark. Even on the shortest day of the year, the sun appears for roughly seven hours in the Anchorage area, and nearly two hours in the Arctic. “The darkness can bother you a bit,” Clancy admits. “It kind of slows you down, makes you take it easy because it’s a little harder to get out of bed when it’s pitch black. But then I worked years as a night nurse so I went to work in the dark and came home in the dark all the time.” City and suburban areas strive to throw as much light on the situation as possible, with ski resorts flooding their slopes with artificial light. A lot of folks shrug off the situation, turn on the headlights to their snowmobiles and go about their day. “People here are very friendly,” McNeal says. “You can get into a grocery store and start up a conversation in line with anybody. People are very open, and physicians like that—they like it that their patients say thank you at the end of the day.”

Well paid

The financial situation sways its share of interested professionals. Physician recruiter Rita McNeal, RN, who also doubles as the nursing supervisor at Valley Hospital in Palmer, brazenly touts the lack of capitated care here when making her pitches. Thanks to the sparse population and the distances between health-care facilities (although two-thirds of residents live in the south central portion of the state), managed care isn’t even on the radar in the foreseeable future. At best, third-party payers like law enforcement, school systems, and government offices will negotiate discounted fees for service.

Doctors also receive higher Medicare reimbursements than elsewhere since the state’s senators went to bat in Washington for better pay in late 2003. Their argument hinged on the fact that in a state whose motto is “the last frontier,” physicians can, and were, refusing to accept more Medicare patients, leaving nearly 47,000 folks out in the cold.

As for salaries, no matter what measure you use, it falls in the upper range, assures Lee Norman, MD, a former family practice and emergency room physician in Seattle who now uses his master’s in health-care planning and executive MBA to consult with medical organizations in rural Alaska.

McNeal rarely sees a physician’s pay drop below the 75th percentile. “Those that work the full five-day week and are reasonably intelligent about running their offices and keeping expenses down, and don’t spend an hour with each patient will do exceptionally well,” she says. “Others choose to work only three or four days a week and they make a good enough living.”

Not to mention most practices provide you with housing, which can present a problem in the bush. “It seems to be a lynchpin for maintaining one’s spirit,” says Norman.

To top it off, Alaska imposes no state income or state sales tax (some localities do collect a two to three percent sales tax, but they cap it at $200 per purchase). In fact, the Permanent Fund, a unique investment program built on oil profits, actually pays dividends to folks for living in the state. The Fund returned more than eight percent from October through December 2004, increasing its market value by nearly $2.4 billion, reaching almost $30 billion as the quarter closed. It boils down to cash in everyone’s wallet.

Finally, many of the bush positions qualify as loan repayment sites, so young physicians can earn up to $20,000 a year toward educational loan repayments in addition to their salaries if they make a two-year commitment, plus $20,000 annually for each year they stay after that.

“This environment works very well for the entrepreneurial physician who wants to be in private practice,” McNeal says. The average group practice involves two to five physicians, and these private partnerships far outnumber employed positions. “They can see the number of patients they want to see, they don’t have to kill themselves and rush people through like an assembly line. It’s a reasonable schedule and a good lifestyle.”

That lifestyle actually attracts more physicians than the dollar side, in McNeal’s experience. For starters, public schools turn out excellent scholars, thanks to the smaller class sizes and personal attention. “Then, when they start applying to Harvard, they get in,” she says. And it’s hard to top the outdoor experiences when it comes to everything from dog sledding to snowboarding.

Ultimately, the biggest choice comes down to where a physician prefers to work: on road (meaning the big city), off road (affectionately known as the bush), or something in between.