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VA official: Recruitment a challenge in Alaska; partners, tele-health help in providing care

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JUNEAU, Alaska — The chief of staff for the Alaska Veterans Affairs Health Care System said Thursday that recruitment of doctors and nurses is one of the biggest challenges the system faces.

Cynthia Joe said this challenge isn't exclusive to the VA in Alaska. But Alaska has no medical school, and while there are nursing programs, hospitals and clinics are often trying to pull from the same pool of candidates.

Joe said the VA has been working to fill two vacant health-care provider positions at the VA's Wasilla clinic and been relying on contract physicians and the Southcentral Foundation to help with patients. The VA is also recruiting for two primary care physicians at the clinic in Fairbanks, with the second provider about to leave, she said. At full strength, that facility would have three primary care physicians.

The VA has added recruitment incentives, including offering to pay for moves and help with student loan costs, Joe said.

Joe made her remarks while visiting the VA clinic in Juneau. The brightly lit facility, located in the federal building downtown, is the newest and smallest of the VA clinics in Alaska, clinic manager Elizabeth Bochynski said. It opened in 2010.

The clinic has one doctor and traditional examination rooms. But it also has space for tele-health consultations, in which doctors at remote sites — sometimes out of state — can provide mental health care or, with the assistance of an on-site nurse, medical care and exams.

Nearly 90 percent of VA patients live within an hour of a VA facility, Joe said. The VA also has partnered with community health providers around the state as part of an effort that has helped rural veterans remain in their local communities for care and, during the last year, has contributed to substantially lower appointment wait times for new patients, Joe said.

U.S. Sen. Mark Begich, D-Alaska, has pointed to the partnerships as a model for other VA systems and said he is proud of the service the VA in Alaska provides. But he said there is room for improvement.

At a meeting with veterans Thursday, Begich heard complaints about attitude problems within the VA, difficulty getting requested appointments, and hassles with disability claims.

He said a concern he had with the location of the Juneau clinic was that people had to go through security to reach it. He liked one veteran's suggestion that there be a rating system for doctors outside the VA system who work with veterans, Begich said.

There has been renewed national focus on the VA system amid allegations of problems, including delayed medical care, at VA facilities across the country.

Begich, who sits on a conference committee on veterans' issues, said in an interview that the discussion at Thursday's meeting would have been much different if Alaska had the problems with waiting lists that have been seen elsewhere. But he acknowledged recruitment concerns, saying there are wage caps for primary care doctors in the VA system and those doctors often can make more money elsewhere.

There can't be a one-size-fits-all approach in addressing the problems nationally, Begich said.

Murkowski, who also has met with veterans, has expressed concern with staffing at the VA clinic in Wasilla and asked the VA's inspector general to look into the quality of care provided there. She was unavailable for comment Thursday, but her spokesman, Matthew Felling, said by email that the challenges with recruiting and holding onto health care providers tracks with concerns Murkowski's office has heard.

"But the reason we have asked for the VA investigation is to take the most thorough look at Alaska's challenges to see if there are other contributing factors beneath the surface, even intangibles, that are difficult to determine through the snapshot audit we saw recently," he said.

A federal audit released last month found the vast majority of medical appointments for veterans were scheduled within 14 days at the Alaska Veterans Health Care System in Anchorage. The Anchorage facility was the only Alaska VA facility looked at, and the audit provided a snapshot-in-time look.

Joe said there is good, ongoing staff training when it comes to scheduling.

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