Co-Chairs:

Representative Sharon Cissna

Senator Donny Olson

Filling the Need:

Mid Level Health ProvidersWednesday, February 21st 2007

Noon to 1:00 PM

Butrovich Room, State Capitol

A light lunch will be served

Check out our new website at: www.akhealthcaucus.org

Cathy Giessel, MS, ANP, FAANPCathy Giessel, MS, ANP, FAANP

Lifelong AlaskanLifelong Alaskan BSN - University. of BSN - University. of

MichiganMichigan MS - UA Anchorage MS - UA Anchorage Fellow, American Fellow, American

Academy of Nurse Academy of Nurse Practitioners Practitioners

Alaska Board of Nursing, Alaska Board of Nursing, chairchair

RN - 32+ yearsRN - 32+ years ANP - 7 yearsANP - 7 years

Lifelong AlaskanLifelong Alaskan BSN - University. of BSN - University. of

MichiganMichigan MS - UA Anchorage MS - UA Anchorage Fellow, American Fellow, American

Academy of Nurse Academy of Nurse Practitioners Practitioners

Alaska Board of Nursing, Alaska Board of Nursing, chairchair

RN - 32+ yearsRN - 32+ years ANP - 7 yearsANP - 7 years

Nurse PractitionersYour Choice for Healthcare

Nurse PractitionersYour Choice for Healthcare

AccessibleAccessibleCost-effectiveCost-effective

Quality Primary CareQuality Primary Care

AccessibleAccessibleCost-effectiveCost-effective

Quality Primary CareQuality Primary Care

““Advanced nurse practitioner” Advanced nurse practitioner” Registered Nurse Registered Nurse Specialized education and experienceSpecialized education and experience Certified to perform acts of medical diagnosis Certified to perform acts of medical diagnosis Prescription and dispensing of medical, Prescription and dispensing of medical,

therapeutic, or corrective measures therapeutic, or corrective measures Regulated by the Board of Nursing.Regulated by the Board of Nursing. Independent practice of healthcareIndependent practice of healthcare

““Advanced nurse practitioner” Advanced nurse practitioner” Registered Nurse Registered Nurse Specialized education and experienceSpecialized education and experience Certified to perform acts of medical diagnosis Certified to perform acts of medical diagnosis Prescription and dispensing of medical, Prescription and dispensing of medical,

therapeutic, or corrective measures therapeutic, or corrective measures Regulated by the Board of Nursing.Regulated by the Board of Nursing. Independent practice of healthcareIndependent practice of healthcare

Anchorage Municipal Health Dept hired the Anchorage Municipal Health Dept hired the first NP in Alaska in 1970first NP in Alaska in 1970

Independent practice since 1984 with full Independent practice since 1984 with full prescriptive authority for all medications.prescriptive authority for all medications.

NPs make treatment decisions based on NPs make treatment decisions based on clinical judgment and evidence-based clinical judgment and evidence-based research, not standardized protocols.research, not standardized protocols.

Anchorage Municipal Health Dept hired the Anchorage Municipal Health Dept hired the first NP in Alaska in 1970first NP in Alaska in 1970

Independent practice since 1984 with full Independent practice since 1984 with full prescriptive authority for all medications.prescriptive authority for all medications.

NPs make treatment decisions based on NPs make treatment decisions based on clinical judgment and evidence-based clinical judgment and evidence-based research, not standardized protocols.research, not standardized protocols.

High quality, acute, chronic and specialty healthcareHigh quality, acute, chronic and specialty healthcare

Order and interpret diagnostic testsOrder and interpret diagnostic testsDiagnose acute and chronic illnessDiagnose acute and chronic illnessPrescribe medication or other treatmentsPrescribe medication or other treatmentsManage patient’s careManage patient’s careRefer to specialists as appropriateRefer to specialists as appropriate

Order and interpret diagnostic testsOrder and interpret diagnostic testsDiagnose acute and chronic illnessDiagnose acute and chronic illnessPrescribe medication or other treatmentsPrescribe medication or other treatmentsManage patient’s careManage patient’s careRefer to specialists as appropriateRefer to specialists as appropriate

Maintain and improve healthMaintain and improve health

Individualized comprehensive health Individualized comprehensive health education and counselingeducation and counseling

Provide information necessary to make Provide information necessary to make healthy choices and educated healthcare healthy choices and educated healthcare decisionsdecisions

On average, NPs spend 31% more time with On average, NPs spend 31% more time with patients than physicians (2002, BMJ)patients than physicians (2002, BMJ)

Individualized comprehensive health Individualized comprehensive health education and counselingeducation and counseling

Provide information necessary to make Provide information necessary to make healthy choices and educated healthcare healthy choices and educated healthcare decisionsdecisions

On average, NPs spend 31% more time with On average, NPs spend 31% more time with patients than physicians (2002, BMJ)patients than physicians (2002, BMJ)

Reduce future healthcare costs Reduce future healthcare costs

Focus on promoting health and preventing Focus on promoting health and preventing illness, which reduces healthcare costs for illness, which reduces healthcare costs for the patient.the patient.

NP patients have fewer emergency room NP patients have fewer emergency room visits and lower average hospital length-of-visits and lower average hospital length-of-stay. stay. (2003, Hospitals and Health Networks; 2000 JAMA; 1995 (2003, Hospitals and Health Networks; 2000 JAMA; 1995 JAANP)JAANP)

Focus on promoting health and preventing Focus on promoting health and preventing illness, which reduces healthcare costs for illness, which reduces healthcare costs for the patient.the patient.

NP patients have fewer emergency room NP patients have fewer emergency room visits and lower average hospital length-of-visits and lower average hospital length-of-stay. stay. (2003, Hospitals and Health Networks; 2000 JAMA; 1995 (2003, Hospitals and Health Networks; 2000 JAMA; 1995 JAANP)JAANP)

EducationEducation

Registered Nurse (4 year baccalaureate)Registered Nurse (4 year baccalaureate)Experience as Registered Nurse Experience as Registered Nurse Master’s (2-3 years) and/or doctorate (2-3 Master’s (2-3 years) and/or doctorate (2-3

years) in a specialtyyears) in a specialtyNational board certification exam required National board certification exam required

by Alaska by Alaska

Registered Nurse (4 year baccalaureate)Registered Nurse (4 year baccalaureate)Experience as Registered Nurse Experience as Registered Nurse Master’s (2-3 years) and/or doctorate (2-3 Master’s (2-3 years) and/or doctorate (2-3

years) in a specialtyyears) in a specialtyNational board certification exam required National board certification exam required

by Alaska by Alaska

Types of NPsTypes of NPs

Family, adult, pediatrics, geriatrics, Family, adult, pediatrics, geriatrics, women’s health, mental health, certified women’s health, mental health, certified nurse midwife, emergency, neonatal, adult nurse midwife, emergency, neonatal, adult and family psychiatric/mental healthand family psychiatric/mental health

Some subspecialty practice settings in Some subspecialty practice settings in allergy/asthma, cardiology, oncology, allergy/asthma, cardiology, oncology, neurology, pain managementneurology, pain management

Family, adult, pediatrics, geriatrics, Family, adult, pediatrics, geriatrics, women’s health, mental health, certified women’s health, mental health, certified nurse midwife, emergency, neonatal, adult nurse midwife, emergency, neonatal, adult and family psychiatric/mental healthand family psychiatric/mental health

Some subspecialty practice settings in Some subspecialty practice settings in allergy/asthma, cardiology, oncology, allergy/asthma, cardiology, oncology, neurology, pain managementneurology, pain management

ReimbursementReimbursement

Designated as primary care providers in Designated as primary care providers in AlaskaAlaska

NPs practice in hospitals, private and public NPs practice in hospitals, private and public clinics clinics

Reimbursed by insurance companiesReimbursed by insurance companiesReimbursed by Medicaid and Medicare at Reimbursed by Medicaid and Medicare at

85% of physician reimbursement85% of physician reimbursement

Designated as primary care providers in Designated as primary care providers in AlaskaAlaska

NPs practice in hospitals, private and public NPs practice in hospitals, private and public clinics clinics

Reimbursed by insurance companiesReimbursed by insurance companiesReimbursed by Medicaid and Medicare at Reimbursed by Medicaid and Medicare at

85% of physician reimbursement85% of physician reimbursement

Alaska NP EducationAlaska NP Education

University of Alaska Anchorage University of Alaska Anchorage Program began in 1981, first graduates in 1983. Program began in 1981, first graduates in 1983.

Estimated >160 Family NPs, > 45 Psych Mental Health Estimated >160 Family NPs, > 45 Psych Mental Health NPsNPs

Family Family 15-20 applicants for the12 openings/year15-20 applicants for the12 openings/year

PsychiatricPsychiatric 8 students admitted every other year8 students admitted every other year

90% of graduates practice in Alaska after graduation90% of graduates practice in Alaska after graduation HRSA traineeship grants available for full-time HRSA traineeship grants available for full-time

studentsstudents

University of Alaska Anchorage University of Alaska Anchorage Program began in 1981, first graduates in 1983. Program began in 1981, first graduates in 1983.

Estimated >160 Family NPs, > 45 Psych Mental Health Estimated >160 Family NPs, > 45 Psych Mental Health NPsNPs

Family Family 15-20 applicants for the12 openings/year15-20 applicants for the12 openings/year

PsychiatricPsychiatric 8 students admitted every other year8 students admitted every other year

90% of graduates practice in Alaska after graduation90% of graduates practice in Alaska after graduation HRSA traineeship grants available for full-time HRSA traineeship grants available for full-time

studentsstudents

NPs meet Alaska’s Primary Care needs NPs meet Alaska’s Primary Care needs

More than 540 NPs in Alaska in both urban and More than 540 NPs in Alaska in both urban and rural Alaskarural Alaska

Alaska has one of the highest ratio of nurse Alaska has one of the highest ratio of nurse practitioners per capita in the nation- practitioners per capita in the nation- 66.9 per 66.9 per 100,000100,000. (2000 HRSA data) . (2000 HRSA data)

Many NPs practice in rural Alaska, often as the Many NPs practice in rural Alaska, often as the only HCP in a communityonly HCP in a community

Most NPs accept Medicare and Medicaid patients. Most NPs accept Medicare and Medicaid patients. (Only 10% of physicians accept Medicare.)(Only 10% of physicians accept Medicare.)

More than 540 NPs in Alaska in both urban and More than 540 NPs in Alaska in both urban and rural Alaskarural Alaska

Alaska has one of the highest ratio of nurse Alaska has one of the highest ratio of nurse practitioners per capita in the nation- practitioners per capita in the nation- 66.9 per 66.9 per 100,000100,000. (2000 HRSA data) . (2000 HRSA data)

Many NPs practice in rural Alaska, often as the Many NPs practice in rural Alaska, often as the only HCP in a communityonly HCP in a community

Most NPs accept Medicare and Medicaid patients. Most NPs accept Medicare and Medicaid patients. (Only 10% of physicians accept Medicare.)(Only 10% of physicians accept Medicare.)

Safe, quality careSafe, quality care

Only 1.4% of NPs in US have been named Only 1.4% of NPs in US have been named as primary defendant in malpractice caseas primary defendant in malpractice case

Numerous studies finding NP care Numerous studies finding NP care comparable to MD care comparable to MD care (1991 Annuals of Internal (1991 Annuals of Internal Medicine; 1979 CBO; 2002 BMJ; 2006 Cochrane Medicine; 1979 CBO; 2002 BMJ; 2006 Cochrane Database of Systematic Reviews; 2004 Medical Care Database of Systematic Reviews; 2004 Medical Care Research and Review; 2000 JAMA; 2004 Medical Care; Research and Review; 2000 JAMA; 2004 Medical Care; 1974 NEJM)1974 NEJM)

Only 1.4% of NPs in US have been named Only 1.4% of NPs in US have been named as primary defendant in malpractice caseas primary defendant in malpractice case

Numerous studies finding NP care Numerous studies finding NP care comparable to MD care comparable to MD care (1991 Annuals of Internal (1991 Annuals of Internal Medicine; 1979 CBO; 2002 BMJ; 2006 Cochrane Medicine; 1979 CBO; 2002 BMJ; 2006 Cochrane Database of Systematic Reviews; 2004 Medical Care Database of Systematic Reviews; 2004 Medical Care Research and Review; 2000 JAMA; 2004 Medical Care; Research and Review; 2000 JAMA; 2004 Medical Care; 1974 NEJM)1974 NEJM)

Certified Registered Nurse Anesthetists (CRNA)Certified Registered Nurse Anesthetists (CRNA)

Another type of advanced practice RNAnother type of advanced practice RNDeliver anesthesia in hospitals or outpatient Deliver anesthesia in hospitals or outpatient

surgery centers surgery centers Independent practiceIndependent practiceMore than 100 in AlaskaMore than 100 in AlaskaUrban and rural practicesUrban and rural practicesNo in-state education programs in Alaska No in-state education programs in Alaska

Another type of advanced practice RNAnother type of advanced practice RNDeliver anesthesia in hospitals or outpatient Deliver anesthesia in hospitals or outpatient

surgery centers surgery centers Independent practiceIndependent practiceMore than 100 in AlaskaMore than 100 in AlaskaUrban and rural practicesUrban and rural practicesNo in-state education programs in Alaska No in-state education programs in Alaska

NPs in Alaska NPs in Alaska

NPs are nurses with advanced training and NPs are nurses with advanced training and skills who combine the philosophy of skills who combine the philosophy of nursing, with the tools of both nursing and nursing, with the tools of both nursing and medicine, to address healthcare needs of medicine, to address healthcare needs of Alaskans. They provide accessible, cost-Alaskans. They provide accessible, cost-effective, quality primary healthcare.effective, quality primary healthcare.

NPs are nurses with advanced training and NPs are nurses with advanced training and skills who combine the philosophy of skills who combine the philosophy of nursing, with the tools of both nursing and nursing, with the tools of both nursing and medicine, to address healthcare needs of medicine, to address healthcare needs of Alaskans. They provide accessible, cost-Alaskans. They provide accessible, cost-effective, quality primary healthcare.effective, quality primary healthcare.

WORKFORCE DEVELOPMENT

Alaska Mental Health Trust Authority Beneficiaries

ISSUES AND CONCERNS

• High staff turnover

• Low social status

• Insufficient training

• Limited educational and career opportunities

• Poor wages and benefits

OVERVIEW

• One of five focus areas for the Alaska Mental Health Trust Authority

• Involves a wide variety of stakeholders• Looking across the workforce from

executive staff to mid-level managers to direct service staff

• Trust funds used as seed money and springboard for long-term programming

GOAL 1: RECRUITMENT

• Develop Credentialing and Quality Standards Steering Committee

• Develop comprehensive “grow your own” recruitment strategy for youth

• Develop comprehensive in-state and out-of-state marketing strategies

• Develop partnership with the Department of Labor & Workforce Development

GOAL 2: RETENTION

• Provide loan forgiveness, scholarships and other incentives

• Provide technical assistance to help providers develop agency-specific recruitment and retention plans

• Develop strategies to increase wages and benefits

GOAL 3: TRAINING/EDUCATION

• Establish three regional training cooperatives

• Provide support for the Geriatric Education and Training Program

• Support and enhance existing education and training programs

Dental Health HygienistsDental Health Hygienists

Vickie Hauff, Vickie Hauff, HygienistHygienist

Hygienists could increase Hygienists could increase cost effectiveness for oral cost effectiveness for oral

healthcarehealthcare

Preventing Chronic Health Preventing Chronic Health Problems for AlaskansProblems for Alaskans

Caries risk in Alaska is 2.5 times greater than the Caries risk in Alaska is 2.5 times greater than the national ratenational rate

Systemic illnesses related to oral healthSystemic illnesses related to oral health Heart DiseaseHeart Disease Diabetes (2.6 times greater than the national rate)Diabetes (2.6 times greater than the national rate) Pre-term birthPre-term birth

Millions of dollars are spent trying to fix oral health Millions of dollars are spent trying to fix oral health problems when early intervention is being ignored and problems when early intervention is being ignored and

could prevent these chronic diseases. could prevent these chronic diseases.

The ProblemThe Problem

Many Alaskans cannot afford oral healthcareMany Alaskans cannot afford oral healthcare

Preventable oral diseases can cause life Preventable oral diseases can cause life threatening emergenciesthreatening emergencies

Many factors exacerbate oral health disparities:Many factors exacerbate oral health disparities: The current structure of the oral healthcare delivery The current structure of the oral healthcare delivery

systemsystem Maldistribution of providersMaldistribution of providers Geographic, educational & cultural barriersGeographic, educational & cultural barriers Cost of careCost of care

Hygienists Can Help:Hygienists Can Help:We have the education to We have the education to

provide the needed oral health provide the needed oral health carecare

The registered dental hygienist is a The registered dental hygienist is a licensed oral health educator and clinical licensed oral health educator and clinical operator who, as part of the dental team, operator who, as part of the dental team, uses preventive, educational, and uses preventive, educational, and therapeutic methods which aid individuals therapeutic methods which aid individuals and groups to attain and maintain optimum and groups to attain and maintain optimum oral health. oral health.

Our LimitationsOur Limitations Cannot go independently to places that Cannot go independently to places that

need the care. need the care. For Example: villages, schools, homebound For Example: villages, schools, homebound

facilities, etc. facilities, etc. Unable to see a patient prior to a dentist examUnable to see a patient prior to a dentist exam Additional current licensing limitations: Additional current licensing limitations:

Cannot do anesthesia without a dentist Cannot do anesthesia without a dentist presentpresent

Cannot do restorative proceduresCannot do restorative procedures

Current system does not enable us to provide Current system does not enable us to provide access for preventative servicesaccess for preventative services

Hygienists as Mid-Level Hygienists as Mid-Level ProvidersProviders

California, Minnesota, Oregon, Idaho, Ohio, California, Minnesota, Oregon, Idaho, Ohio, Kentucky & Washington, etc. all have additional Kentucky & Washington, etc. all have additional expanded functions beyond the procedures expanded functions beyond the procedures allowed by Alaska statutesallowed by Alaska statutes

American Dental Hygiene AssociationAmerican Dental Hygiene Association Proposed ADHP (Advanced Dental Hygiene Proposed ADHP (Advanced Dental Hygiene

Practitioner): a cost-effective response to the oral Practitioner): a cost-effective response to the oral health crisishealth crisis

Services providedServices provided DiagnosticDiagnostic PreventativePreventative TherapeuticTherapeutic Minimally invasive restorativeMinimally invasive restorative

A possible future for Hygienists A possible future for Hygienists as the mid-level provider for as the mid-level provider for

AlaskansAlaskans The possibilities:The possibilities:

Key to cost effectiveness is early interventionKey to cost effectiveness is early intervention

Education is preventionEducation is prevention

Collaborative Agreements to expand servicesCollaborative Agreements to expand services

Where we need helpWhere we need help

Expand our scope of practice and Expand our scope of practice and geographic rangegeographic range

We need to improve Alaskan’s access to a We need to improve Alaskan’s access to a full range of dental servicesfull range of dental services

““Win – Win” solution for allWin – Win” solution for all

Nurse Retention: Even More Important than Recruitment

A Conversation Prepared by the Alaska Nurses Association

2000, and Revised 2007

• In January of 2000, seven months after the Nurses’ Strike of 1999 at Providence Alaska Medical Center, the administration there – noticing a out flux of nursing staff -- requested that the Alaska Nurses Association offer suggestions for the retention of nurses.

• What I am offering today is an updated version of the ten suggestions offered at that time with the idea that they can apply to any 24-hour health care facility in Alaska.

• This is not a “scientific” document, but is meant to open a conversation on the topic.

Retention Idea #1

• Address staffing/working condition issues immediately. Do not let them molder. Involve Registered Nurses in finding solutions to identified problems. Take their suggestions once in a while.

Retention Idea #2

• Recognize that a culture that recruits RNs, also retains RNs.

• Treat RNs as responsible, valuable adults, worthy of respect and occasional accommodation.

Retention idea #3

• Provide qualified staffing to cover meals and rest periods on a regular basis, i.e. an uninterrupted meal break of 30 minutes at a reasonable time; and a 15 minute rest period after each four hours worked.

Retention idea #4

• Address working conditions that lead to workplace injuries;

• Eliminate risk factors such as mandatory overtime.

Retention idea#5

• Provide “recruitment bonuses” for currently employed RNs to encourage them to talk their RN colleagues into applying for and accepting employment at their health care facility.

Retention idea #6

• Provide on-campus (or near campus) childcare and “sick child” care at reasonable rates for ALL shifts.

Retention idea #7

• Recognize work done “above and beyond” the call of duty:– Premium pay for part time nurses who work on days

off;– Preceptor pay for helping train new nurses;– Certification pay for obtaining additional training;– Provide additional Paid Time Off for long term nurses.

Retention idea #8

• Encourage management and nurses to utilize “overstaff” hours to orient to areas/units where there is a shortage of RNs. Provide “scholarships” for nurses obtaining training in needed areas.

Retention idea #9

• Improve physical environment, comfortable break areas, for nurses with the same care and concern as provided for the general public physical environment.

Retention idea #10

• Provide for health care after retirement for all nurses between retirement age and eligibility for Medicare.

907-274-08273701 East Tudor Road, Suite 208

Anchorage, AK 99507

• The nurses of Alaska stand ready to discuss these and other ideas for improving the nursing profession in Alaska and retaining qualified, dedicated nurses in that profession.

Filling the Need: Distance Masters of Social Work Education in Alaska

Wednesday, February 21, 2007

Elizabeth A. Sirles, DirectorUniversity of Alaska AnchorageCollege of Health & Social WelfareSchool of Social Work

The Demand for Social Workers in Alaska

Alaska's Fastest Grow ing Occupations Requiring a Bachelor's Degree or Higher

Pharm acists

Mental Health and Substance Abuse Social W krs

Physical Therapists

Physician Assist

Medical and Public Health Social W krs

Rehabilitation Counselors

Mental Health C ounselors

Dietitians and Nutritionists

Netw ork System and D ata Com m unications Analysts

Medical and Health Svcs Mgrs

0% 10% 20% 30% 40% 50% 60%

Projected 2002-2012

S ource: Alaska D epa rtm ent of Labor and W orkforce D e velopm ent, R esearch and A nalysis S ection

Locations of MSW Distance Students

•Anchorage (3)

•Barrow (1)

•Eagle River (1)

•Fairbanks (3)

•Homer (4)

•Juneau (4)

•Kenai / Soldotna (2)

•Sitka (1)

•Wasilla (1)

•Fernie, British Columbia (1) Canada

•Ketchikan (2)

•Kodiak (2)

•North Pole (1)

•Petersburg (1)

Multimodal Approachto Distance Education

1/3 Internet & BlackboardSupport

1/3 Four-Day On-site IntensiveCoursework

1/3 Weekly Audio Conference

Our Distance Students

Field Placementsof MSW Distance Students

during 2004-05

• North Slope Borough Counseling Center, Barrow

• Alaska Psychiatric Institute, Anchorage (Block Placement)

• Office of Children’s Services, Anchorage

• Tanana Chief’s Conference Counseling Center, Fairbanks

• Homer Community Health Center, Homer

• Bartlett Regional Hospital, Juneau

• Kenai Peninsula Community Care Center, Kenai

• Community Connections, Ketchikan

• Ketchikan Pioneer’s Home, Ketchikan

• Providence Kodiak Mental Health Center, Kodiak

• Child, Youth, & Family Services Society of Powell River, British Columbia

Field Placements for Distance Students in 2006-07

• Office of Children’s Services, Anchorage• Providence Alaska Medical Center, Anchorage• Hospice of the Tanana Valley, Fairbanks• Tanana Chief’s Conference Counseling Center, Fairbanks

• South Peninsula Haven House, Homer

• South Peninsula Hospital, Homer

• AWARE, Juneau

• Commission on Aging, Juneau

• Kenai Care Center, Kenai

• NAKENU Family Services, Kenai

• Kodiak Area Native Association, Kodiak

• Petersburg Mental Health, Petersburg

• Sitka Counseling and Prevention Services, Sitka

• Behavioral Health Community Mental Health, Wasilla

• Summit Community Services Society, Cranbrook British Columbia

• Hope Cottages, Anchorage along with Waterford University, Ireland

Physician Assistants in Alaska

John Riley PA-C, MSMedex Northwest/UAA

Physician Assistant Program CoordinatorDepartment of Health SciencesUniversity Of Alaska Anchorage

afjor@uaa.alaska.edu

What are Physician Assistants (PAs)?

• Physician assistants are health care professionals licensed to practice medicine with physician supervision.

• PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in virtually all states can write prescriptions.

• Within the physician-PA relationship, physician assistants exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services.

• PA's practice may also include education, research, and administrative services.

Growth of Profession

• The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 50 percent between 2004 and 2014

• The BLS predicts the total number of jobs in the country will grow by 13 percent over this 10-year period

• The PA profession was ranked by CNN and Money magazine in May 2006 as one of the top five jobs in the country

PA Training

• Majority Alaskan PAs trained at Regional PA training center at University of Washington Medex Program

• Second highest percentage Alaska PAs trained at University of Utah PA Program

Medex PA Training

• 6 or more seats at UW Medex reserved for Alaskan applicants

• First year of didactic training in Washington State

• Second year clinical clerkships in training sites across Alaska

PA Program applicants

• The typical applicant already has a bachelor's degree and approximately four years of health care experience.

• Commonly nurses, EMTs, and paramedics apply to PA programs.

Two generations of previous Alaska CHAs trained at Medex

Distribution PAs

• Anchorage 29%

• Outside Anchorage 71%

PAs in Primary Care

• Primary Care 60%

• Specialty Care 40%

What are the future Alaska workforce needs for PAs

and other medical providers?

The following information is quoted from the Alaska Physician Supply Task Force Report

Report of theAlaska Physician

Supply Task Force

There will be a shortage of 1100 physicians over the next 20 years due to physician retirement, aging of the Alaska population and decreased production capacity of new physicians

From Report of theAlaska Physician

Supply Task Force• As of the end of 2005, there were 284

active physician assistants with Alaska addresses and “AA” status; 29 percent were in Anchorage.

• Of 486 advanced nurse practitioners with active licenses and Alaska addresses, 51 percent were in Municipality of Anchorage.

From Report of theAlaska Physician

Supply Task Force

Finding 5. Alaska has and should maintain a higher ratio of mid-level providers (advanced nurse practitioners and physician assistants) to physicians than the national average, in order to make it feasible to provide high quality and timely care to the population. Without these providers the need for physicians would be even higher.

From Report of theAlaska Physician

Supply Task Force • Physician assistants and advanced nurse

practitioners are critical providers of care in Alaska, complementing and extending physician coverage for primary care, for supervision and training of community health aides and practitioners, and in some settings for serving as specialists in surgery, emergency medicine, and other areas.

The “Graying” of Alaska

Population Projection for Alaskans Over Age 65

The “Graying” of Alaska’s healthcare workforce

Age Distribution of Physicians (MDs

and DOs) in AlaskaN=1501

Age Distribution of Physician Assistants in Alaska

N=294

Age Distribution of Advanced Nurse Practitioners in Alaska

N= 424

Strategies

Physician workforce projections are based on “trend” models. Trend models project current conditions into the future. As we increase the number of physicians we must also proportionally increase the numbers of midlevel providers to maintain current ratios

Strategies to increase numbers of PAs educated in Alaska

• Expand UW Medex/ UAA collaboration to provide both years of PA training in Alaska

• Develop bridge program to support professional development of CHAPS to PAs

• Expand support of clinical year training costs

Strategies to increase numbers of PAs educated in Alaska

• Create loan repayment assistance programs and funding for physician assistants practicing in shortage areas Alaska

• Alaska Participate in the HRSA Bureau of Health Professions State Loan Repayment Program

• Expand and support programs that prepare Alaskans for medical careers

Co-Chairs, Sen. Donny Olson and Rep. Sharon Cissna thank you for participating in the Co-Chairs, Sen. Donny Olson and Rep. Sharon Cissna thank you for participating in the Legislative Health Caucus.Legislative Health Caucus.

A copy of this powerpoint, as well as other up-to-date information, can be found on our A copy of this powerpoint, as well as other up-to-date information, can be found on our website: website:

www.akhealthcaucus.orgwww.akhealthcaucus.orgThe audio file of today’s program can be found at:The audio file of today’s program can be found at:

http://www.ktoo.org/gavel/audio.cfmhttp://www.ktoo.org/gavel/audio.cfm(type in the date of this Caucus).(type in the date of this Caucus).

For more information, please call: 1-800-922-3785For more information, please call: 1-800-922-3785