Alaska, Washington doctors discuss collaborative efforts needed to care for patients with complex needs

Alaska health care providers are increasingly collaborating with their counterparts from the lower 48 states, particularly in Washington, on patient care. Doctors from both states discussed that process during the 2022 Alaska State of Reform Health Policy Conference.

 

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Dr. Jack Sedwick, Otolaryngology Specialist at Alyeska Center for Facial Plastic Surgery & ENT, said he routinely refers patients to the University of Washington for surgical procedures that are beyond his purview.

“Typically, I refer patients in limited capacities,” Sedwick said. “One [capacity] is patients in the emergency room that have problems that are too complex to be dealt with here. An example was, two months ago, I was on call and a woman in a commercial fishing boat cut her scalp. In that situation, with exposed bone, the only reasonable structural reconstruction is free-flap. It’s really a surgical complexity thing.”

In a situation like that, Alaska doctors can perform life-saving services, then send the patient to the lower 48 for follow-up care.

“Even if we can’t do the microvascular reconstruction, there’s a lot of life-saving things we get patients from the state here first,” Sedwick said. “And then we’re triaging, and sending them on their way.”

Dr. John Scott, Chief Digital Health Officer at University of Washington Medicine, said the patient transfer can be challenging, particularly if their needs are complicated. But the COVID-19 pandemic had a silver lining because it sparked a temporary waiver on interstate licensure.

“From 2020 to 2021, almost every state, including Alaska, said, ‘If you’re going to be seeing patients here by telemedicine, you don’t need to have a license,’” Scott said. “So the University of Washington took advantage of that to the tune of about 2,500 patient visits, and saw the demand was way more than the whole WWAMI region, more than our neighboring states. So we are in the process of getting more of our physicians licensed in Alaska. And we’ve learned some of the pros and cons of going through that process.”

Dr. Lance Dunlop, Assistant Dean for Pacific Northwest University of Health Sciences, said the school started working with Alaskan and other WWAMI students about 50 years ago. Out-of-state students often perform residencies in the Alaska, which can supplement it’s workforce.

“They started the collaboration of bringing medical students to Alaska,” Dunlop said. “And what the research found in this has been replicated again and again. If we can get students to rotate here, they tend to stay here. So those that choose to come to Alaska disproportionately stay. We have a large number of physicians, actually a little over 40 at this point, who have stayed here because of their experience. And many of those weren’t from Alaska, many of those are from the lower 48.”

Dr. James Bales, Neurosurgery Specialist at Anchorage Neurosurgical Associates, said he cared for many Alaskan patients when he was training at the University of Washington.

“Six years into my residency program, I was taking care of a lot of Alaskan patients,” Bales said. “There were a lot of patients coming out of Alaska and being transferred down for specialty care in a setting where it may be a week in the hospital.”

While health care can be less expensive in Washington, other expenses occur when Alaskan families need to seek care in the state, particularly if follow-up care takes a significant amount of time.

“Family members have to find a place to stay,” Bales said. “I saw kids who would come down with head injuries. Those patients got excellent care. The problem was that, from a family perspective, now you have a child who’s at Seattle Children’s or Harborview Medical Center, who may be there for weeks of recovery. And that is hard trying to get those family members back to Alaska when they’re life-flighted down. You’re looking a parent in the eye and saying, ‘We got you down here, but you’re going to need to find a way to get back.’”

Bales said he would like to see additional collaboration between the 2 states.

“There are still a lot of patients that get sent down to the University of Washington that we miss out on here in Alaska,” Bales said. “And in some circumstances they need to go there and they need that specialty level of care. And I have reached out to the University of Washington and we’re trying to build something where we can have a combined clinic, essentially up here, or they can come up here and work with patients who may be post-op patients of theirs.”