Dr. Jonathan Casurella took a salary hit in October to practice medicine at the Anchorage Neighborhood Health Center, while lugging along nearly $160,000 in school debt.
The 37-year-old described the job that allows him to provide a variety of services to the city's poor, underserved and refugee populations as a "good fit" for him.
But, he said, he's not sure how much longer he can afford to continue doing it after the Alaska House of Representatives passed an operating budget Thursday with many deep cuts, including one to the program subsidizing salaries of medical professionals who work with under-served or rural populations.
The $1.2 million cut means the program will only have about $800,000 for 2015, and doctors like Casurella won't be able to tap into the money to repay their education loans.
The Alaska Legislature only created the program, known as SHARP-II, three years ago. Lawmakers and supporters hoped the financial incentives would help fill the void of experienced doctors in remote parts of Alaska. So far, 62 doctors have signed three-year service contracts under the program, agreeing to work in hard-to-fill positions for help with their loans or other payments. It mimics a federal program some state legislators say doesn't go far enough.
"Our needs are much larger than what the feds could do," said Rep. Bob Herron, D-Bethel, who introduced the original House bill in 2011.
The cuts approved Thursday dismayed those who describe the program as a lifeline for hiring primary care doctors. Many affected health officials vowed to keep fighting to get at least some of the money restored in the Senate.
"What we're hoping is that the Senate holds firm on this line item if we can get public opinion that this is not something to cut," said Kimberly Cohen, the executive director of the health clinic where Casurella works. "This is actually what (Gov. Sean) Parnell promised us, which is if we don't have Medicaid expansion, we're going to have community health centers."
Parnell included full funding, about $2 million, for the program in the budget he sent to the Legislature. The House cut that down to $836,300, enough money for about 37 practitioners instead of the intended 90.
Rep. Mark Neuman, R-Big Lake, chairman of the House Finance subcommittee where the reduction originated, said the money-strapped state had to make choices and cut programs. He said he put a priority on other health and social services, such as senior centers and facilities for foster children.
"The SHARP Program again goes back into basically paying people their cost for education, their student loans," he said. "And you know, it's a nice thing to try to do it, but how long can we try and do it with a reduced budget?"
If the cut sticks in the Senate, Casurella and 38 other health care providers tentatively accepted into the program, including physical therapists, nurses and clinical social workers, won't get funding. Casurella, a father of two, had anticipated a three-year contract with a $35,000 annual payment toward his student loans starting this year.
The 62 others who already have agreements may lose all or part of their payments, said Randi Sweet, chair of the SHARP Advisory Council. The program is funded by state general funds and requires an employer match.
Cohen said she was blindsided by the reduction and doesn't know what it would mean for the health center's dental director and physician's assistant who both have established contracts with the program. She said they could get up to 50 percent more pay elsewhere. Casurella, also trained to deliver babies, could double his pay if he left the clinic, she said. She already had a doctor quit after he was turned down from benefits under SHARP-II.
"It's just devastating. I'm totally in shock," Cohen said. "It's the way I keep my physicians and (the cut) is going to kill us."
Casurella said he has had friends thinking about moving to Alaska who have contacted him about SHARP-II.
"I know it's a big draw," he said. "We've got a huge problem in this state retaining primary care providers."
A study conducted by students at the University of Alaska Anchorage in 2012 and 2013 found 21 percent of positions for family physicians and 16 percent of positions for pediatricians remained vacant in rural communities, compared to 5 percent and 4 percent in urban Alaska.
The same appears to be true for pharmacists. On Prince of Wales Island east of Ketchikan, pharmacy owner Bill Atland just recruited a recently-graduated pharmacist from Florida. She had testified from her home state in favor of the SHARP-II bill three years ago. Now, she's in limbo, recommended for the program but awaiting the final state budget to learn if her student loan will be subsidized, Atland said.
"She hasn't received anything yet," Atland said. Whatever happens, he said he hopes she stays.
Atland, a pharmacist himself, opened Whale Tail Pharmacy with his wife Sarah in 2000. Ketchikan, about 55 miles across the Clarence Strait, is the next closest town with a pharmacy.
"For rural Alaska, it's difficult," he said about hiring a health-care workforce.
Atland said there are five health-care providers on Prince of Wales Island accepted into SHARP-II. "We need to keep them here," he said.
Reach reporter Tegan Hanlon at firstname.lastname@example.org or 257-4589.
By TEGAN HANLON