Category:Overview of YKHC Medical Practices

From Guide to YKHC Medical Practices


General Overview

The Yukon-Kuskokwim Health Corporation (YKHC) is a Native owned and operated health care system. It is located in Bethel, off the road system, which makes it “Bush.” It is 400 miles west of Anchorage. Bethel is the regional medical hub for the Yukon-Kuskokwim Delta. YKHC provides health care for over 27,000 Yup’ik Eskimo and Athabascan Natives living in over 50 villages scattered over an area the size of Oregon. Subsistence is a way of life for most village families. The culture is largely intact; many village preschool children and elders speak Yup’ik only. The population of the region has recently re-achieved the numbers that existed before the measles, influenza and TB epidemics of the 1950s. The result is that over half the population is less than 18 years of age.

YKHC Medical Practices Overview

A medical staff of over 80 physicians, midlevels, dentists and optometrists provide comprehensive inpatient, outpatient, obstetrical, and emergency services in Bethel. In the villages, Community Health Aides are integral in the delivery of care. Five villages also serve as subregional clinics in conjunction with village health aides and midlevel practitioners. YKHC is an exciting place to work. It is remote but not isolated. Medicine stays vibrant and on the cutting edge of quality with clinical rounds, telemeradiology, clinical research, telemedicine, use of local and statewide evidence-based guidelines, and the opportunity to train and mentor students and residents.

Practicing medicine in this region presents unique and interesting challenges (and frustrations). Working in a remote region spread out over a large area, Bush medicine has inherent travel and outreach issues. Working in our health care system is similar to practicing medicine in a third world country with a high quality infrastructure of well trained and experienced clinical staff; a comprehensive electronic medical record system; CT scanner, full laboratory services, level four trauma center, medevac systems, OR back up and tertiary services available a plane ride away.

Medicine at YKHC is unique and interesting. It runs the gamut from primary care to subspecialty co-management of patients to critical care with NICU/PICU/ICU patient stabilization and transport. Our physicians, midlevels, nurses, clinical pharmacists, physical therapists, respiratory therapists, dentists, optometrists and support staff all work closely as a team to provide excellent patient care. We all depend on each other and support each other to provide the best care possible. We try to orient our new medical providers as well as we can before and after they start working here, but there are so many unique and uncommon challenges that it takes at least a year to get comfortable with how handle the many of the medical challenges that come up. This is why we expect all new staff to ask lots of questions and consult more experienced providers with any care, follow up, referral issues that come up. More experienced providers are also expected to help new providers and give them advice and feedback in a timely and constructive fashion.


In our environment of limited resources and staffing, a culture of good teamwork is critical to providing good patient care especially at a busy facility such as ours. The nurses, RTs and pharmacists caring for our patients are very good clinically and they know our patient population well. If a team member communicates that they are concerned about a particular patient you should take their concern seriously. They will often be your eyes and ears as you will rarely have time to spend a lot of time with your patients. Treat the staff with respect and consider them a valuable member of your healthcare team. Praise them for a job well done.

Pediatrician Specific Practice: Description of How Pediatrics is Practiced Differently at YKHC

YKHC is an unusual and wonderful place to practice medicine and especially pediatrics. Pediatricians at YKHC act as subspecialist extenders for all pediatric specialties that are not available in Bethel and often not in Alaska. There are many unique and interesting challenges (and frustrations) with practicing medicine in a remote region with travel and communication issues that are unique to our area. It is a lot like practicing third world medicine with much better support and infrastructure. The medicine is interesting and spans from primary care to pediatric subspecialty management to critical care with NICU/PICU patient stabilization and transport. Pediatricians at YKHC are primarily responsible for Chronic Peds Patients or complex and chronically ill kids, but we also do a variety of other patient care activities as well.

Pediatricians manage approximately 1,200 chronically ill patients of mainly Yup’ik Alaskan descent with significant respiratory, genetic, metabolic, cardiac, endocrine, neuro and infectious disease issues. They act as pediatric subspecialty extenders and consultants for family medicine, emergency medicine and village health aide providers. Pediatricians manage ADHD, fetal alcohol syndrome, cerebral palsy, seizure disorders, congenital heart disease, congenital adrenal hyperplasia, asthma, aspiration syndrome, chronic lung disease, and issues related to prematurity. In clinic, we see complex-care pediatric patients, urgent, acute and well child care patients as well as ER follow up patients. The hospitalist pediatricians need to be able to stabilize, manage, and transport critical care and neonatal emergency patients. Occasionally the hospitalist pediatrician will fly on medevacs to villages for potential preterm or high-risk term infant deliveries. The pediatricians assist and collaborate with pediatric sub-specialists when they visit YKHC and via email, text and phone. Occasionally pediatricians make visits to village clinics or subregional centers.

At YKHC, our pediatric patients get more invasive disease than children in the lower 48. We have therefore modified standard lower 48 guidelines and created some of our own for more conservative evaluation and treatment of our patients. In most places you would not do as many labs and xrays as we do here, but many times pneumonia, bacteremia and serious infections are missed if we do not check. Kids can be running around the ER with a little cough and no significant lung exam findings and have a significant pleural effusion on CXR. Or a well-looking 2-month-old with a low grade temp will have 230 WBCs in their CSF. We also have invasive Hflu A infections with either indolent or aggressive presentations. It pays to be very, conservative, vigilant and to watch kids closely before sending them back to a village where they may get worse and not be able to return due to weather.

A Glimpse of YKHC Bush Practice

Presentation with pictures of YKHC facilities, staff, and people of the region. pdf 2 mb

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