SCH Alaska Track Pediatric Residency Program Welcome Letter

Dear Resident,

Hello from Bethel! Welcome to the University of Washington Pediatric Residency Program Primary Care Alaska Track on behalf of the pediatricians in Bethel. I am the Residency Site Coordinator for the residents who will be rotating at Yukon Kuskokwim Health Corporation (YKHC) in Bethel, Alaska, and look forward to working with you in the next coming years.

During your months here, we will be focusing greatly on your outpatient training since these months will substitute for the University of Washington Pediatric Residency’s Community Pediatrics rotations. Through this focus, I hope that you will find the remote general pediatrician experience to be what you expect, and maybe even more.

We are currently working on developing a schedule that will help to develop your skills as an outpatient pediatrician that coordinates well with the time you will spend at LaTouche Pediatrics. As interns, we plan to have you scheduled mostly in the outpatient clinics.

The following is just some general information about Bethel, the Hospital, and the Pediatric group here in Bethel. If you have any questions, please email me. I will be happy to help with any questions or concerns you may have.

Welcome to Alaska!

Jennifer Hampton, Pediatrician

General Bethel Information

Working and living in Bethel is definitely a unique and rewarding experience. We are located approximately 400 miles due west of Anchorage accessible only by air or river. According to the 2010 census, Bethel has an estimated population of about 6,000. However, the main hospital located in Bethel serves a population of about 27,000 covering an area the size of Portland. There are about 56 villages, give or take a couple depending on whether you are classifying them by having a tribal incorporation or actually being lived in.

Most of our patients are Yup'ik and some are Athabascan. The villages are 95-99% native and Bethel is said to be about sixty percent native population, with the other forty percent being quite diverse.

The subsistence practices in the Delta include berry picking, caribou and moose hunting, salmon fishing, smelt, herring, whale (usually for a village), duck, and others.

Transportation outside Bethel is mostly by plane, and sometimes by boat, four-wheeler, or snowmachine. Without a road system, planes are used much like buses to get from village to village. In the winter, the Kuskokwim river turns into a highway that can take you upriver about 150 miles.

The Hospital

We are a 45 bed hospital with inpatient, OB, outpatient clinic, and ER. Of the inpatient beds, we have 10 pediatric beds. We do not have a PICU or NICU unless the planes stop flying, in which case our ER or OB newborn triage area turns into an ICU for any patient awaiting a medevac to Anchorage.

Pediatrics

The group of pediatricians in Bethel currently includes three full time pediatricians, two 80%-time, and several locums. Most of the pediatricians practice as outpatient clinical physicians or hospitalists, with some of us doing both.

As an outpatient pediatrician, our clinic day usually starts at 9:00 am with patients scheduled until 5:00 pm. Meetings will often be scheduled at 8:00 am with Grand Rounds on Tuesday mornings and Morning Report on Thursday mornings. We have twenty minute appointments, occasionally scheduling more complicated patients for 40 minutes. We will most likely have you start with one hour clinic appointments. As an outpatient pediatrician, our role is to see our scheduled patients as well as be available to the family medicine physicians and all mid-level providers (NPs, PAs) for consults.

You will also spend some time with our inpatient pediatrician. The day starts at 8:00 am when you take sign out from the on call physician and ends around 5:00 pm. As an inpatient pediatrician, our role is to round on the patients on our service; take consults from the inpatient family medicine, emergency medicine, and occasionally outpatient providers; attend high risk deliveries; evaluate RMT (Radio Medical Traffic) for Chronic pediatric patients in the villages; coordinate high risk pediatric medevacs and possibly travel on medevac to village if needed; and update chart information for patients being discharged from ANMC.

Radio Medical traffic is an outdated term for the phone calls and notes we receive from the health aides in the villages. Since there are not physicians or nurses in those villages, the clinics are run by health aides who have high school educations and medical protocol training. They call physicians in Bethel when they hit dangerous vitals or move beyond their standing orders. You and your attending will decide whether the patient they call about can be treated by the small formulary they have in the clinic or if they need to fly in commercially or if they need a medevac to Bethel for treatment.

We all rotate taking overnight call, which is home call. Call starts at 5:00 pm and ends at 8:00 am the following day. The family medicine inpatient providers work shifts with a provider overnight. You will not be expected to take call as an intern, but are welcome to be available for any interesting events overnight or medevacs.

RAVEN electronic medical records

YKHC transitioned from paper documentation to electronic heath records using Cerner on January 28th, 2013.

Look forward to meeting you!