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With patients turned away, Anchorage Neighborhood Health Center tackles staff shortage

  • Author: Tegan Hanlon
  • Updated: May 31, 2016
  • Published July 3, 2015

At the Anchorage Neighborhood Health Center, a lack of health care providers has temporarily constricted access to medical care at the facility that serves some of the city's neediest residents.

Over the past few months, the neighborhood health center in Midtown has been reeling from rapid staff turnover. It has welcomed a new executive director and medical director, but lost health care providers. Some have retired, left the state or switched to private practice. Others just "want a change," said Jon Zasada, the Anchorage Neighborhood Health Center's director of development and marketing.

"We keep using the words 'perfect storm,' and it is so cliche," Zasada said. "It's tough when you're between leadership."

For some new patients, an understaffed Anchorage Neighborhood Health Center means a medical appointment will have to wait -- at least until the end of this summer. Currently, providers continue to see patients who have visited the center within the last three years, said Tammy Green, the center's new executive director who started June 1.

But the center is only taking new patients who meet at least one of four criteria, she said. They must be homeless, pregnant, HIV-positive or in need of a primary care provider as a requirement for their release from the hospital, she said.

Dr. Jenny Love, the neighborhood health center's new medical director, said the restricted access is far from ideal.

"I'm not happy about it," Love said. "It's not something I would want to publicize, but it's reality. It's what we've had to do in order to make sure that we're not overwhelming the staff."

Green said she expects the neighborhood health center to remain in this state of transition, with limited access, until at least the end of the summer. The limited access does not apply to the health center's dental service, she said.

"It's a hard thing when you know you really want to serve the community and you may not be able to meet that need right away," she said. "But I just want to assure our community that we're doing everything we can to bring the promise back, to make sure that we can serve all of our patients or all the folks who need us."

In 2014, the neighborhood health center had 13,919 patients, 66 percent of whom had an income at or below the federal poverty level, $14,580 for a single person that year. Forty-two percent did not have health insurance, according to the health center's annual report.

The neighborhood health center charges for its services on a sliding fee discount, a federal program. So someone without health insurance whose household income is at or below poverty level would pay $20 for a medical visit that normally costs $253 at the health center.

While the neighborhood health center has limited access for medical appointments, it is redirecting new patients to other clinics, said Green, who previously worked as the system director of well-being for the Providence Health and Services system.

But other federally funded community health centers aren't necessarily nearby. There are clinics about 50 miles north in Wasilla and 40 miles south in Girdwood. The Providence Family Medicine Center in Anchorage, tied to a residency program, accepts patients regardless of their ability to pay. Mikal Canfield, a spokesperson for Providence Health and Services in Alaska, said that because of changes in patient demand and to ensure resident physicians have a broad spectrum of training experience, the patients the center treats are determined on a daily or weekly basis. Patients that it cannot treat are referred to other Providence facilities, he said.

Meanwhile, the Anchorage Neighborhood Health Center recently hired five new health care providers -- three physicians, one nurse practitioner and one physician assistant -- who will start over the next several months, Green said. She expects that as the health center trains the new providers, it will start to accept new patients -- likely by the end of summer and into the beginning of fall.

"The really great thing that I think is important is that all of our (new) providers we have hired on are from Alaska," Green said. "I think that's a real bonus. These people who know our community. These people who want to stay in our community."

In June, Zasada said, the community health center's employees worked a range of hours. Together, they added up to about ten full-time health care providers. At full capacity, the health center would employ 15, Zasada said.

Love, who previously worked at the Alaska Psychiatric Institute, said the Anchorage Neighborhood Health Center has worked to push its mission to prospective employees, which Green described as "to really meet and care for the folks in our community who oftentimes are not only underserved, but not served at all."

Both Green and Love said the neighborhood health center is working to build a pipeline of potential health care providers. So instead of recruiting reactively when someone leaves the clinic, it will already have a list of names to call when a space opens up.

Recruiting a health care provider can take about 18 months, Love said. A graduate of the University of North Carolina School of Medicine, Love compared the neighborhood health center's shortage of providers in June to basketball.

"We have the gymnasium. We have the fans. We have the basketball. We have the first string. We're developing our coaches and we're trying to get benches," Love said.

Love said she has recruited health care providers for more than seven years. This year, she spent a lot of time on the phone, getting the word out about the Anchorage Neighborhood Health Center. She said she typically started her mornings making calls to the East Coast and as the day went on, the people she called lived farther west.

"It's really about getting your brand out there so people know who you are," Green said.

But, there's competition. And as a community health center, the Anchorage Neighborhood Health Center can't necessarily offer the salaries of a private practice "just by the nature of the game," she said.

Green and Love both said they've seen a shift in the medical industry toward primary care. Demand for primary care providers is up, but not necessarily the supply.

"So there's a very small recruitment pool and the competition is tough," Love said.

Love said some people might recognize a "community health center" as a "free health clinic," but underscored that the Anchorage Neighborhood Community Center is more than that.

"We truly are a community perspective," she said. "Not only do we have services all under one roof, but we have a very diverse patient population. We have a very diverse workforce within our center as well."

The Anchorage Neighborhood Health Center has also shifted its recruiting practices. Instead of focusing its efforts on experienced health care providers, who have already worked in emergency rooms or at community health centers, Love said she has started talking to people who recently graduated and might have less experience.

"It's sort of a dual role -- for each provider who lacks experience, I make sure I have a mentor," she said.

Two of the new physicians and the nurse practitioner have prior experience, while the third physician and physician assistant recently graduated, Green said.

Zasada said developing an employee pipeline -- pulling from graduates who recently completed their residencies and experienced health care providers -- takes constant attention, which it wasn't necessarily given before.

On Thursday, Love, who started in March, was signing on another new health care provider who previously worked as a physician in Ukraine and recently finished schooling to become a physician assistant in the United States, Green said.

In June, Green told the Alaska Dispatch News, "I have no doubt that if you come back in the next three to six months, we'll have a very different story to tell."

And on Thursday, she said, "We expect to be in service to community again, and new patients, by the end of summer."

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