Alaska Family Medicine Program
Providence Alaska Medical Center & The University of WashingtonProvidence Hospital/Alaska Family Medicine Program
A Luminous Vision
Alaska Family Medicine Residency’s purpose is to help residents become…
Physicians fulfilled through their investment in their patients and communities, proud to provide the best care to all their patients, and committed to a lifelong career of service and learning.
We answer our residents’ call to…
Guide me. Challenge me. Trust me to serve.
We welcome…
All students who have an interest in rural, full-scope practice with culturally diverse and underserved patients, and are drawn to working in a limited resource environment.
Our program takes advantage of…
The challenging and diverse cultural and physical environment of Alaska to teach residents necessary knowledge and skills for full scope family medicine. Rural Alaska is the venue for personal and professional fulfillment through a lifelong career of compassionate service to individuals and community.
Our Faculty…
Honor the commitment of our residents to full scope practice, professionalism, and service with compassion. Brought together through a desire to teach and a vision of family medicine as the pre-eminent medical specialty, faculty work continuously to learn and grow. AKFMR faculty hold themselves to the same high standards that are set for the residents, within a supportive, creative, and fun learning atmosphere.
Graduates…
Are trained to be competent to work in isolated low-resource environments using a solid foundation of medical knowledge, diverse skills, and thorough understanding of the healthcare system and community needs.
History
Alaska was the last state in the United States to have a residency program. There is only one residency program in Alaska for all years of training – the Alaska Family Medicine Residency (AKFMR). It was developed in the 1990s by a consortium of state leaders with the intent to train family physicians for the unique aspects of practice in the most remote parts of the state; AKFMR has been affiliated with the University of Washington since its inception. AKFMR provides rigorous training to help prepare our residents to practice in any challenging setting, but particularly rural settings. Residents receive extra training in rural settings, emergency medicine, orthopedics, obstetrics, pediatrics, neonatal intensive care, and trans-cultural medicine to prepare them for the unique challenges of bush practice.
Rural
Alaska is an amazing place to live and to practice family medicine. It is an enormous state — over 660,000 square miles (more than twice the size of Texas). There are only about 600-700 miles of roads in the state. 75% of its land and 30% of its population are off-the-road-system – accessible only by boat or plane. Limited accessibility, coupled with extremes in weather, makes health care delivery challenging.
To meet those challenges, Alaska has developed a unique medical system including community health aides, small regional hospitals staffed by family physicians, radio medicine (now evolving into telecommunication/telemedicine), and an efficient system for air transportation. Family Physicians in rural and bush Alaska practice the full scope of family medicine and are responsible not only for medicine in their own communities, but also in outlying villages.
There is no substitute for direct rural experience. The residency encourages as much rural experience as is allowed by the Graduate Medical Education guidelines. A six-week block in the R2 year is spent in either Bethel at the Yukon-Kuskokwim Delta Regional Hospital or in Sitka as part of the Southeast Alaska Regional Health Consortium.
The experience includes heavy patient volumes, pathology rarely seen elsewhere, frequent patient transport (often in adverse weather conditions), obstetrics, village site visits, and the challenging task of evaluating patients by phone through discussions with community health aides. R3’s spend eight weeks in rural rotations elsewhere in Alaska, often being one of only a few physicians, hours from the nearest major medical facility. These rotations help residents to understand the uniqueness of delivering health care in Bush and rural Alaska.
Curriculum Overview
Our curriculum was designed to meet the needs of family physicians that practice in remote and isolated Alaskan communities. Alaskan bush communities differ greatly from many rural communities of the lower 48 states and our areas of emphasis reflect this. We encourage our residents to think freely so they will feel comfortable managing patients without rapid specialist access other than by telephone. Our faculty, who all have longstanding experience with the Alaskan rural and urban needs, continually revise and improve the curriculum based on the needs and input of the residents. The close faculty resident relationship has helped to maximize resident learning while minimizing those parts of the curriculum that are ineffective in meeting their goals.
See below for a breakdown of the curriculum by year or go to Core Rotations for detailed descriptions of our rotations.
| Rotations Offered | Weeks on Service Intern Year | Weeks on Service 2nd Year | Weeks on Service 3rd Year |
| Ambulatory: Dedicated outpatient clinical rotation at the FMP site | 4 | 2 | 4 |
| Community and Ambulatory Medicine (CAM): This rotation serves as an introduction to the FMP site and the patient centered medical home and is composed of outpatient clinic sessions and didactic sessions. Interns will have a relaxed schedule with dedicated preceptors and peer level support during the first block of their residency. Didactic presentations review the EHR, billing and coding, the interdisciplinary care team, and other primary care topics. | 4 | ||
| Cardiology: Composed of time with the inpatient cardiology team as well as the outpatient cardiology clinic seeing general new referrals. Includes continuity clinic at the FMP site. | 2 | ||
| Critical Care (ICU): Teams of 4 residents. Work under dedicated intensivists at the hospital. Procedural opportunities available. | 4 | ||
| Dermatology: Composed of time with community dermatology clinics and sometimes includes online modules. Includes continuity clinic at the FMP site. | 2 | ||
| Elective: 6+ months over 3 years. Involves time in continuity clinic at the FMP site; rural electives exclude time at FMP site | 4 | 16 | |
| Adult Emergency Medicine: These are staffed by ER physicians. R1 Year includes time at a community ER site (Soldotna, Fairbanks are the common rural options, ANMC ER for a local option). This rotation does not include clinic at the FMP site. Third Year includes Two 2-week blocks at the PAMC ER, the Level 2 Trauma Center for the state. Includes clinic at the FMP site and often includes cross-coverage call on the inpatient medicine service on the weekend. | 2 | 4 | |
| Pediatric Emergency Medicine: Staffed by ER physicians, some of which have specialty Peds EM training. This rotation includes clinic at the FMP site and often includes cross-coverage call on the inpatient pediatrics service on the weekend. | 4 | ||
| Geriatrics: Includes time at a local ALF doing home visits on site, time with local hospice teams, and time in the PAMC wound care clinic. There is dedicated time for scholarly activity during this rotation and many residents participate in a GEM article review. This rotation includes clinic at the FMP site and often includes cross-coverage call on the medicine service on the weekend. | 4 | ||
| Gynecology: Includes time in our internal OBGYN consult clinic at the FMP site working with the OB faculty and a local OBGYN to address concerns within our own clinic panel. Additionally, includes time with community OBGYN and/or GYN/ONC clinic. This rotation includes time at the FMP site and often includes cross-coverage call on the OB service on the weekend. | Linked to Ambulatory Clinic rotations. | 4 | |
| Inpatient Pediatrics: Staff the inpatient pediatrics service at PAMC which is run by dedicated pediatric hospitalists. There are often medical students on this rotation. This rotation includes clinic time at the FMP site. (2 weeks days/2 weeks nights) | 4 | 4 | |
| Medicine (Inpatient): Staffed by primarily full scope FM physicians, majority of which are core faculty at the residency. The service keeps a dynamic cap to grow the census through the year as the teams mature. Max census is usually 15-18 patients for 2 interns and 1 senior, but this can go higher depending on the milieu and the team. There are usually medical students on this rotation. This rotation includes clinic time at the FMP site and includes night and weekend coverage. Interns serve as the primary clinician for their panel of patients with management of the team being the primary responsibility of the senior resident. | 16 | Some cross coverage. | 10 |
| Musculoskeletal (Ortho): 2-week block in R1 year. Includes clinic time at the FMP site. | 2 | ||
| Obstetrics: These rotations are dedicated time on L&D, OB Triage, postpartum, and antepartum units. Staffed by core FM OB faculty and combination of community OBGYN and CNM faculty. R2 serves as the senior on the rotation. | 8 (6 weeks on days, 2 weeks on nights) | 8 (6 weeks on days, 2 weeks on nights) | |
| Outpatient Pediatrics: R1 year includes time at community outpatient peds clinics, Alaska Cares (forensic pediatric clinic), and pediatric therapies (PT/OT/SLP). Second year includes time at a single primary care site, typically at Southcentral Foundation for time with AK Native beneficiaries and the IHS system. | 4 | 4 | |
| Health Systems and Practice Management: Focuses on functioning within larger health systems. Includes didactic experiences meant to enhance the resident’s understanding of functioning within larger health systems. Includes dedicated time for work on QI project. Rotation is led by the Medical Director of the FMP site. This rotation includes clinic time at the FMP site. | 2 | ||
| Psychology: Focuses on management of substance use disorders and integrated behavioral health. | 4 | ||
| Rural and Austere Medicine (RAM): Covers winter survival skills, field triage, and other rural medicine topics. 2-week rotation in R1 year paired with TCM. There is the option of participating in components of this rotation as a facilitator/peer teacher in R3 year, but this is not required. Additional, optional opportunities include the Marine Wilderness Medicine experience in the Spring/early summer. | 2 | 2 | |
| Surgery: Includes time with general surgery/trauma surgery service as well as ATLS experience and floor management of surgical and postoperative patients. This rotation includes clinic time at the FMP site. | 2 | ||
| Transcultural and Community Medicine (TCM): Uses a combination of didactic and experiential learning opportunities to deepen resident’s understanding of the diversity of our Anchorage community as well as that of our Alaskan community more broadly. This rotation is led by the behavioral health faculty of the residency. | 2 |
Our Clinic
Providence Family Medicine Center
Location: Anchorage, Alaska
Providence Family Medicine Center (PFMC) is the continuity clinic for our residents. We are proud to be a level 3 NCQA certified patient-centered medical home. We serve our community as part of the health care safety net for a richly diverse patient population. At PFMC we utilize intensive patient and population data to prospectively manage chronic diseases, analyze and improve our practice, and ensure patient safety. Our advanced access scheduling, electronic patient portal, RN case management, transitions coordination, and patient data collection allow us to constantly improve our patients’ experience.
We provide our residents with a safe, supportive, and innovative learning environment in which to develop the skills to practice full scope Family Medicine. Residents learn how to work as the leaders of a multidisciplinary teams to provide high quality, low cost care to our patients in the context of our rapidly changing health care system. PFMC provides comprehensive family oriented care and offers a sliding fee scale in accordance with the mission of Providence.
Our Hospital
Providence Alaska Medical Center
Location: Anchorage, Alaska
www.providence.org/alaska
The majority of inpatient rotations are at Providence Alaska Medical Center (PAMC), the largest hospital and primary medical referral center in Alaska. JCAHO-accredited, the 341-bed modern hospital offers the full range of tertiary medical services with physicians representing every medical specialty except some pediatric subspecialties and transplant surgery. It is extensively involved in the community and remains the only hospital safety net for the uninsured of Anchorage. The hospital is part of the sisters of Providence Health System, which owns and operates a comprehensive array of health related services in California, Oregon, Washington and Alaska. The Sisters of Providence have been in Alaska since 1902 when they brought health care to Nome, Alaska. They also operate smaller hospitals in Kodiak and Seward, Alaska.
Partner Facilities
PAMC Specialty Centers
Location: Anchorage, Alaska
Providence Alaska Medical Center provides quality health care through a number of specialty centers, including:
- 24-hour Emergency Department and trauma center with LifeGuard Air Ambulance
- Heart Center
- Children’s Hospital at Providence encompassing Family Maternity Center with perinatal and neonatal services for high-risk births
- Level 3 Newborn Intensive Care Unit, Pediatrics Intensive Care Unit and a pediatric specialty clinic
- Cancer Therapy Center
- Mental Health Services offering chemical dependency recovery services, adult and adolescent mental health units
- Rehabilitation services
- Sleep Disorders Center
- Diagnostic and intervention radiology department
Alaska Native Medical Center
Location: Anchorage, Alaska
Inpatient and outpatient rotations also occur at the Alaska Native Medical Center (ANMC) in Anchorage, a 150-bed inpatient and outpatient facility. ANMC has become the national “flagship” of the 44 Indian Health Service hospitals under the U.S. Dept. of Health and Human Services. It has Alaska’s only Level 2 trauma center and is a referral center for all native hospitals and clinics in the state. Facilities include an OR, ER, Labor and Delivery, Inpatient Medicine and Pediatrics facilities including their corresponding intensive care units. The adjacent new Primary Care Center was constructed to provide primary care services to the growing native population in the Anchorage area. Approximately 50% of all Native Alaskans are now living in the Anchorage catchment area. Pediatrics, Family Medicine, and Ob/GYN are all found in the Primary Care Center. Alaska’s Center for Disease Control and the Alaska Native Health Board are also located on the campus.
Yukon-Kuskokwim Delta Regional Hospital
Location: Bethel, Alaska
Web Site: www.ykhc.org
Many residents spend six weeks in the second-year in Bethel, a town of just over 6,000 at the center of a growing population of over 22,000 scattered across 75,000 square miles of the Yukon National Wildlife Refuge. It is accessible only by airplane or boat and is surrounded by wetland and tundra. The population of the entire delta is 89 percent Alaska Native, primarily Yup’ik, Chup’ik, and Inupiaq Eskimo as well as Athabascan. The Yukon-Kuskokwim Health Corporation (YKHC) manages the Yukon-Kuskokwim Health Delta Regional Hospital, a JCAHO-accredited facility. It is fully equipped for primary acute care medical services and has air transportation links to Anchorage hospitals. Inpatient facilities include a 20-bed combined medical-surgical-pediatric unit and a 7-bed obstetric unit. In addition to a busy outpatient clinic and a full-service emergency room run by family medicine, the outpatient services include dental, eye, and specialty clinics. It has approximately 20 primary care physicians most of whom are family physicians.
Central Peninsula General Hospital
Location: Soldotna, Alaska
Web Site: www.cpgh.org
Several first year residents will have an opportunity to rotate through the ER in Soldotna as part of the Emergency Medicine rotation. Central Peninsula General Hospital is a JCAHO accredited, Borough-owned, non-profit facility. The Hospital is administered by CPGH, Inc. and operates through an Agreement with the Kenai Peninsula Borough. The hospital serves the communities on the Kenai Peninsula from Cooper Landing to Ninilchick, and beyond. The Hospital features a busy, small town ER with a great team of ER physicians, Family Physicians, and highly skilled nurses. Soldotna is located near the Kenai and Russian Rivers, and is a major salmon fishing center in Alaska. A wide variety of medical, surgical, and trauma emergencies present to the residents in Soldotna. Lifeguard emergency flight service has a helicopter in Soldotna, and residents may have the opportunity to be involved with medivacs. In the summertime, the ER has record high numbers for fish hook removals.