When John Cullen moved to Alaska, he didn’t expect to stay. “I had planned on going someplace I could do obstetrics,” he says. Cullen, MD, FAAFP, grew up in Phoenix and rotated into Valdez (population: 4,000) for his third year of residency in 1994.
But Cullen and his wife fell in love with Valdez, a remote coastal town surrounded by water, forests, mountains, and glaciers. “There’s not many places where you can ski and sail on the same day,” he says. “It’s spectacularly beautiful.”
Today, 24 years later, Cullen is president of the American Academy of Family Physicians, and he still practices family medicine in Valdez. As one of four doctors in town, he covers some emergency department shifts at Providence Valdez Medical Center. There, he’s treated patients after avalanches, chain saw accidents, fishing mishaps, and falls into crevasses. He’s also treated severe hypothermia: “I’ve brought two people back from a core body temperature of 70 degrees.” Sometimes, he’ll put emergency patients on 45-minute plane flights to Anchorage. But if a storm prevents flying—Valdez gets 300 inches of snow a year—he’ll have to keep them stable until the sky clears.
Cullen’s private family practice covers everything from strep throat to back pain to pre-op physicals. He delivers babies, some by cesarean section, and performs some other surgeries. “In our community, you have to have a very broad scope of practice,” Cullen says.
All across Alaska, the nation’s largest yet third-least populous state, physicians enjoy careers much like Cullen’s—filled with the challenges of remoteness and extreme weather, the joys of small-town community, and more independence than their peers in the Lower 48. Practicing medicine in Alaska can be more difficult at times, but it offers rewards that come with using a wide range of physicians’ skills.
“The people here are very tough,” Cullen says. “Sometimes, just making sure they get enough care is difficult. They want to soldier through.” Once, a patient with a severe pelvic fracture flew himself into Valdez’s airport. People have hiked out of the wilderness on broken legs. “Ninety-three-year-old grandmothers are still splitting wood in their cabins,” he says. It’s difficult to talk them into coming into town to see a doctor and even more challenging to get them to rest while they’re recovering, Cullen says.
For some Alaska doctors, traveling to the state’s tiny villages is part of the job. Every three months, Katie Tsigonis, MD, leaves Fairbanks in a Chevy Suburban to see patients in two tiny villages in central Alaska: Minto (population: 210) and Manley Hot Springs (population: 89). She’s a doctor for Chief Andrew Isaac Medical Center in Fairbanks, which serves Alaska Native communities across the state’s vast interior. Her 300-mile round trip by land on Alaska Route 2 is unusual compared to most of her fellow clinicians’ travels. They fly to the Native communities they serve because no roads go there. “The struggle is always: How do we give the same care out in rural Alaska, a fly-in only small village, that we give at a more central location like Fairbanks?” Tsigonis says.
In Minto and Manley Hot Springs, Tsigonis does electrocardiograms (EKGs), delivers babies, implants intrauterine devices, conducts sports physicals, immunizes kids, and educates families on end-of-life care. “The patients are so amazingly lovely,” Tsigonis says. In Manley Hot Springs, she stays at a cabin owned by a woman whose husband was a prominent dog musher. In December, she attended the Christmas program at the 59-student Minto School.
Tsigonis’ employer serves 30 villages in Alaska’s interior: from Tok, near the border with Canada’s Yukon Territory, to Anaktuvuk Pass, north of the Arctic Circle. For reference, the U.S. Postal Service once named Anaktuvuk Pass as home to the nation’s most remote post office.
Tsigonis used to fly into Stevens Village (population: 78). “In the winter, you wear your snow gear on the plane, because you never know what’s going to happen,” she says. “Someone has hopefully plowed [the landing strip], and usually someone picks you up on a snow machine, or a sled behind a snow machine, and takes you to the clinic.”
The clinic has no running water because the ground is too hard. Doctors bring their own food and bottled water, since there’s none to buy in the smallest villages—and they pack a few extra days’ worth, in case they’re “weathered in,” or stranded by a storm.
Back at the main clinic in Fairbanks, Tsigonis and fellow clinicians also take phone calls from trained health aides in each village, local residents who have a deep rapport with their neighbors. The aides can insert IVs, perform EKGs, and take pictures to share with the doctors via the clinics’ cloud-based electronic health records system. The village clinics all have emergency lifesaving medicine, including epinephrine for anaphylaxis, injectable morphine, and diazepam to stop seizures. Most village clinics have Pyxis MedStation systems, which doctors can signal remotely from Fairbanks to release medication.