Health care has a unique niche in any community. Seen from varied angles, it is a calling, a technology or a public service. But it also is a big business, one with major growth forecast.
Nationwide, health care is an enormous sector. But on the Kenai Peninsula, its role is growing in ways that reflect development specific to the area.
"We consider health care and fostering health care as an important factor," said Tom Boedeker, who serves as Soldotna's city manager and also on the operating board of the borough-owned Central Peninsula General Hospital in Soldotna.
"It is a vital economic sector, and it spurs development in other areas."
Boedeker cited factors that make the health care industry particularly attractive to a community. It provides stable, high-paying jobs. It enhances the quality of life for people nearby. And it has great potential for future growth.
For the Kenai Peninsula, much of that growth traditionally has followed the booming population. But the health sector economy here can do more. For one thing, technology and services are expanding. But the competitive advantages long held by Anchorage are shifting as well.
In the past, many health care dollars left the peninsula as people pursued care elsewhere. But as more services become available close to home, those patients are more likely to shop for care here.
"The willingness to drive to Anchorage is less and less," Boedeker said.
On the peninsula, an average of 1,408 people worked in health care related jobs during the year from July 2000 through June 2001. The total payroll was $41.2 million, according to Brigitta Windisch-Cole, a labor economist with the state Department of Labor and Workforce Development.
The actual number would be somewhat higher, because the official figures do not include the staff at Seward's hospital, which is administered via Anchorage.
Expanding services are evident at Central Peninsula General Hospital. Recently the Soldotna facility added a sleep laboratory and began offering cardiac rehabilitation. In 1999, it got its first magnetic resonance imaging (MRI) machine.
Outside the purview of the hospital but also on the central peninsula, the new Kenai Public Health Center opened last summer, the federal Veterans Administration opened a clinic in the fall and Bridges Community Resources Network helped launch the nonprofit Central Peninsula Health Centers with the first opening its doors in Soldotna in January.
In the year 2000, 12 of Alaska's 100 biggest private employers and two of the top 10 were health care providers. That excludes the fact that many health care workers are government employees.
"Health care should lead the way in services growth because it is both the single largest slice of the industry and its most dynamic," state labor economist Neal Fried wrote in the May issue of "Alaska Economic Trends."
"The aging of Alaska's huge baby boom population and technological change are important factors in the expansion. Alaska is also one of the few places in the country left without managed care."
The lack of managed care and the fact that the population has grown large enough to support more specialists are beginning to attract more health professionals to the state.
A 1998 study of Alaska's work force (reported by the Western Interstate Commission for Higher Education) found that of the state's 15 fastest growing occupations, 10 were in health services. It projected a need for about 150 new nurses each year. Other jobs predicted to be difficult to fill include physicians, physicians' assistants, dentists, optometrists, occupational therapists, physical therapists, pharmacists and veterinarians.
The aging of the baby boomer generation will increase patient demand at the same time that current workers are retiring. On the Kenai Peninsula, where senior citizens are increasing in numbers and young adults are not, these trends may have a big effect.
Debi Honer, the director of human resources at CPGH, said the hospital has held its own so far in hiring professional staff, but staffing is challenging.
"We've all heard that there is a nursing shortage that has been seriously felt in the Lower 48. Here at CPGH, we have been fairly successful in recruiting," she said.
"... Of all the positions in the facility, the pharmacist is probably the one that takes the longest to recruit. But I am glad to say we are fully staffed in that area (now)."
The hospital hires about 100 people a year, and clinical positions are much more difficult to fill than support vacancies. Certain specialties, such as emergency room nurses, intensive care unit nurses and physical therapy assistants, also have taken time to fill, she said.
Honer tries to recruit in state, using the charms of the Kenai Peninsula as a draw. But often Alaska hospitals have to look out of state for qualified people.
She said she was upbeat about the potential of new education programs to provide more skills to residents interested in health careers. Specifically, the University of Alaska is working to enhance nursing training, and the Kenai Peninsula College now is partnering with Weber State University, which has a distance education nursing program available to Alaskans. The first class of licensed practical nurses will graduate this spring from the Soldotna campus.
"I am sure the university is listening, and they are going to provide more educational options locally," she said.
The public and private sectors here work closely together in other ways when it comes to health care. The spectrum of medical providers ranges from profitable private clinics to public health services entirely underwritten by government funding, such as vaccinations for infants.
The city of Soldotna is providing support however it can, Boedeker said. For example, the city recently purchased land by Fireweed and Marydale for a project with Heritage Place to help develop an assisted living facility.
The city has an indirect role, too, in providing reliable infrastructure such as power, water and even clear sidewalks. Medical providers are particularly sensitive to service disruptions, he said.
Certain portions of Soldotna are evolving toward a medical district. He pointed to Redoubt Avenue between Binkley and Birch, Corral Avenue between Fireweed and the Spur Highway as examples. The businesses may not be there now, but he predicted those sections will become less residential and more medical in years to come.
Boedeker has heard of several physicians looking to expand or start clinics in the area.
"We see continued activity that shows continued growth or stability. We see them as positive signs."
Balancing growth is one challenge for medical businesses, he said.
The community's need for services must be analyzed against the costs involved in trying to offer services locally. The peninsula population has grown large enough for some specialties but remains too small for others.
CPGH is weighing such options as it works on its long-range plans.
"What you don't have the critical mass for, you don't try to do," Boedeker warned. "We're not going to try to have a brain surgeon.
"We have to ask, does this make sense for us to provide here, cost effectively? Or is it not available elsewhere?"
One possibility CPGH is considering for the next growth phase is satellite clinics.
Although the peninsula's larger towns are well-provided for with medical facilities, the outlying residents often face considerable travel to get treatment. Soldotna, Seward and Homer have hospitals; Kenai, North Kenai and Ninilchik have clinics. Even tiny Seldovia has a resident physician. But no medical providers have set up shop yet in Cooper Landing, and Anchor Point lost its physician. Peninsula villages rely on health aides or visits from the itinerant public health nurse.
Boedeker recommended that future medical services should be discussed on a borough level and analyzed carefully. In the long term, the hospital may establish satellite clinics to offer basic care over a wider geographic area, he said.
Back in Soldotna, the hospital itself is poised for more growth. Despite recent service additions, the service area population has outgrown the existing facility. CPGH is focusing on preparing for future community needs and making sure existing needs are served well, he said.
"Even if you don't add anything," he said, " ... it has got to involve some expansion. So how do you go about it?
"There is going to be a lot of discussion in the community, because hospital facilities are not cheap."
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