By Tim Bradner

Thinking of working in health care? Being dentist? A doctor?

Behavioral health therapist? How about a counselor?

These are all worthy goals, and society needs you, particularly in Alaska. Health care is also one Alaska occupational fields that has been growing in recent years and given the state’s aging population, that’s likely to continue.

But get ready to pack home big new education loans, maybe on top of what you’re already carrying. For dentists, it’s $150,000 to $200,000, and debt up to $400,000 isn’t uncommon.

For physicians it can be $200,000 to $300,000. For pharmacists or nurse practitioners, it is often $200,000. Clinical social workers can pack $80,000 to $150,000 in loans once they are through school and certified.

America is choking on student loan debt. Economists see it as a long-term threat to the nation’s economy because, for Millennials, loan payments choke off capital formation to, say, buy a home or save for retirement.

But nowhere is the problem felt more than in health care. It’s a huge problem in Alaska because health care providers in the state also have a tough time recruiting and retaining medical professionals.

But now the state of Alaska is stepping in help. An innovative state-led program to recruit health care professionals in hard-to-fill places in Alaska, and hard-to-fill medical specialties, has resulted in 347 new employment contracts for critically needed health care staff since 2010. This includes new graduates going to work in the state or experienced professionals agreeing to work in underserved areas like rural communities.

The program helps health professionals pay medical education debt and also pays cash incentives to get experienced professionals to serve in underserved places like rural Alaska. The state Dept. of Health and Social Services, or DH&SS, coordinates the program, known as “SHARP.”

Federal and state funds have been used and health care employers pay a share which is 50 percent at minimum and ranging up to 80 percent. A new phase of SHARP being readied is totally financed by employers with no state subsidy involved, although an earlier phase that is federally funded will continue.

So far, the cost has been $15.18 million in federal and state funds to recruit and retain the 347 professionals. When the most recent quarter closes out, another $500,000 will be added.

“Health care providers have real recruiting challenges in both rural and urban locations but it’s particularly acute in rural communities,” said Jeannie Monk, Senior Vice President of the Alaska State Hospital and Nursing Home Association.

“It can be hard to persuade someone to move from the Lower 48 to Bethel, or even Cordova, because of lifestyle and cultural adjustments, but loan repayment is a huge incentive,” she said.

However, Alaska is in stiff competition with other states who have similar problems in their own rural communities, and even more aggressive recruiting programs and incentives. “It’s not just doctors, either. There are shortages in nursing. We’re doing a great job training nurses in Alaska,” Monk said, but there’s still not enough.

Robert Sewell, who coordinates the program within the state Department of Health and Social Services, said Alaska health care providers must import medical practitioners like dentists, psychiatrists, surgeons and specialties like pediatrics because there is no in-state training in these specialties. “In other areas like nursing we train but there are still shortages,” he said.

Employers pay a share of the loan repayments under SHARP, but the private sector has chipped in more in cases where government funds fell short. Elizabeth Ripley, executive director of the Mat-Su Health Foundation, said there were more applications for assistance in the behavioral health field than funds were available in a round of SHARP funding two years ago.

Of eight applications in Mat-Su region SHARP was only able to fund three, she said. The foundation stepped in with $25,000 in private money to fund five more.

“We saw immediate impact, with eight more people going to work with local health providers,” Ripley said. Mat-Su is the state’s fastest growing region and behavioral health is an area of acute need and workforce shortages in the area.

A first phase for SHARP, started in 2010, involved federal funds and targeted certain types of health professionals in rural areas; a second involved state funds and helped professionals serving in larger communities, and also expanded the list of profession occupations eligible for the loan repayments.

The most recent SHARP III, approved by the Legislature and most recently by Gov. Mike Dunleavy, involves private employers making direct payments to recruit professionals with help with education debt.

The federally supported SHARP I, for rural areas and certain critical medical occupations, is meanwhile continuing, Sewell said. SHARP II, which was state-funded, has now ended.

The state coordinates the program because this allows tax-exempt status to the loan repayment under federal law, which is a big factor. If the assistance is taxable it would reduce after-tax payment by 25 percent to 34 percent, according to Sewell.

The federal Affordable Care Act allows education loan assistance in health care to be tax-exempt, but only if the incentives are part of the state-managed program. The state Department of Health and Social Services is now working on regulations to implement the latest phase, to be all private-funded, Sewell said.

Monk said one aspect in rural communities, particularly small ones like Cordova or Petersburg, is that there is an acute need for experienced nurses, not just new graduates. Nurses in a small community hospital have to take care of patients in acute care, in emergency rooms and in many cases long-term care, and they have to have the experience to handle all of these.

“Car crashes or heart attacks may not happen often, but small hospitals have to be ready for them,” Monk said, particularly if weather or other factors delay a medical evacuation to a hospital in a larger community.

“There have to be seasoned people – it’s not just something that can be passed to a new graduate,” she said.

Ripley said an aspect of this that she’s now concerned about is retirements within the health care workforce, and whether there are enough new people “in the pipeline” to replace retirees, who are also the experienced professionals needed to work alongside newly-trained staff.

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