think there’s been a change in culture, and I think Alaska has been a little bit more progressive in promoting women,” says Ella Goss, CEO of Providence Alaska Medical Center (PAMC). Goss started working at Anchorage’s largest hospital in 1997 as an ER nurse and rose through the ranks of management. Providence has intentionally promoted female leaders from within, she says, developing their potential because the talent pool in Alaska is so small due to the state’s population.

The population was even smaller when four Roman Catholic nuns followed the 1902 gold rush to Nome and started a hospital there. In 1910, they built a hospital in Fairbanks, and in 1939 they built a fifty-two-bed hospital in Anchorage. PAMC has grown to 401 beds and is one of the largest employers in the state.

Prior to statehood, barely a dozen MDs worked in Alaska, and female doctors were even rarer. When Helen Whaley and Elizabeth Elsner arrived in the territory in the ‘50s, they were the first of their kind. Such firsts still occur in the 21st century. This summer, Dr. Maryna Orin came to Anchorage as the first woman in Alaska practicing in her specialty, bariatric surgery.

If she had not left her home country of Belarus, Orin might not be helping obese and severely overweight patients today. “A career in medicine in Belarus was not a highly sought career path for many political reasons, and I just kind of brushed it off,” she says. Maybe she would’ve become an engineer, except that she came to the United States as an exchange student in Indiana.

“That’s when I allowed myself to explore what is it that I really want, not what society thinks I should do but what is it I want,” Orin recalls. Her path began with volunteering at hospitals, then going to a community college, transferring to a four-year school, then to medical school, and then a fellowship at Duke. “Just because something seemed impossible at the time, don’t give up on your dreams.”

Spencer became a supervisor, then manager. She earned a master’s degree in healthcare management, and now she oversees clinical services for Bristol Bay Area Health Corporation in Dillingham, responsible for audiology, optometry, pharmacy, physical therapy, radiology, and the laboratory.

While some are drawn into healthcare, Dr. Jennifer Kolanko strove to enter the field from a young age. “As early as third grade,” she says, “a good friend of mine and I would rent books from the library with a medical focus.” Kolanko, the manager of PeaceHealth Ketchikan Medical Center’s Rehabilitation Therapies department, credits her interest to growing up with hearing-impaired parents and a hearing-impaired sibling. She figures that pointed her toward helping those in need.

Ella Goss was only a bit older when she set her sights on medicine. “When I left high school, I knew that nursing was in my future,” she says. “I started with a hospital-based RN diploma program [it was a three-year program] and absolutely loved nursing.” Goss, originally from Canada, became a travel nurse, and during an assignment in Alaska she loved the place so much that she stayed.

As she acquired experience, Goss rose to leadership positions. “I was invited to apply for a director job when I was a chief flight nurse,” she recalls. However, “I didn’t meet the qualifications, which was master’s preferred, bachelor’s required. And so I went to my boss and said I’m not qualified, and they changed the requirements… I was flattered that the requirements were changed for me, but I didn’t think it was appropriate.” So she sought the necessary degrees anyway.

Physical therapy became Kolanko’s specialty because of her interests in overall wellness and prevention of disease. Likewise, Jodi Pfeiffer became a physical therapist assistant (PTA) simply to help people. “Physical therapy is a way to help people achieve their highest level of function and perform the activities that they need and want to do,” she says, and now Pfeiffer is the PTA program director at UAA.

To succeed in healthcare, professionals must overcome various hurdles. The training and education can be a challenge—at least, finding the time for it, according to Goss. “I think the biggest obstacle for many of my colleagues is work-life balance. Many of my female colleagues need to work full time… [so] furthering of their education becomes a luxury versus a priority.” When she mentors female leaders, Goss encourages them to make school a priority, though she acknowledges that she’s fortunate to have been able to do so.

A language barrier kept Erly Areniego from becoming a nurse, as she once dreamed, but she still makes an impact as Environmental Services Manager at PeaceHealth Ketchikan. Speaking Tagalog as her first language, Areniego has studied business English and worked her way up from laundry attendant in 2009 to section lead in charge of a crew of twenty-seven. Responsible for ordering, scheduling, and communicating with other departments, the position also came with a raise that helped support her son’s education. Now he’s a surgical nurse at Ketchikan Medical Center.

For Spencer, sexism and racism stood in her way, when she was getting started. “I remember at that time, part of the interview process required a picture of the applicant, as well as disclosing personal information that is not allowed today: marital status, age, gender. I remember very clearly feeling that I may not get a job because of ethnicity” as an African-American. “I have always made sure that I dressed well, not expensively, but in my mind there should never be a physical reason not to be hired for a job.”

Pfeiffer encountered prejudices, as well, when she was new in the field. “[M]any people did not take me seriously,” she says. “They were sure that I did not have enough knowledge and life experience to perform the job well. In addition, many did not think that I was physically strong enough to perform the activities necessary.”

Kolanko learned that sometimes patients themselves are an obstacle to providing care. “You can try as hard as ever to push your recommendations and advice on some patients—but ultimately, they have to buy in and do the work.” When that fails, Kolanko says it’s hard not to take it personally. “I’ve overcome that by being confident and accepting that if I’ve followed the research, used good clinical reasoning, considered the patient’s participation in my plan of care, and ruled out red flags—I’ve done all I can for that patient, and it’s time to refer out. But I’ll never stop being compassionate about wanting my patients to succeed.”

Erly Areniego
PeaceHealth Ketchikan

Jennifer Kolanko works with a patient pre-pandemic. She says, “I’ll never stop being compassionate about wanting my patients to succeed.”

PeaceHealth Ketchikan

From whichever perspective, healthcare professionals can agree about one thing: Alaska has some special challenges. Zink describes it as the centralization of healthcare into urban areas, which Goss is all too aware of. “Even though we are what we would call a mid-size hospital,” she says of PAMC, “in other states we wouldn’t be considered the same because there would be so many other facilities around that state. But in Alaska, Providence is really the catch-all… All things come to us.”

It’s a fact of life Orin noticed within her first months in the state. “A great portion of your patients are going to be from small towns that are very remote.” Although telemedicine helps, Orin says there are other challenges. “For example, when I’m seeing a new patient, we have a standard set of labs… imaging that we need to do… and unfortunately, not every small community has a hospital nearby that has everything.”

Challenges don’t end after patients are discharged, according to Kolanko. “How will they enter their home that has thirty stairs to enter, that they can’t climb? Will we need to have them transported by the medics? The patient lives nearby on a remote island that is only accessible by floatplane. How will we get that patient safely transferred onto the plane?”

Certain resources are limited and often not covered by insurance, Kolanko says. She and Zink both note that Alaska’s vast distance adds to costs. From her vantage point in Dillingham, Spencer says all patients must receive the best care regardless of distance: “The patient that is 300 miles from the only hospital in a region still deserves to get their medication, lab results, and other healthcare in a timely manner.”

Ketchikan likewise has a limited number of specialty services provided locally, but Kolanko says, “[W]e do a fabulous job overcoming that by hosting visiting specialty provider clinics and through creating relationships with vendors that are willing to provide equipment to our patients.”

Alaskans themselves are unique and challenging, Spencer says. “Navigating native customs, political correctness, and social norms all play a part in ensuring great healthcare to the residents of the communities that I serve.” As an example, she says COVID-19 has been a challenge partly because of Alaskans’ cultural memories. “One must understand the historical trauma from the 1918 Spanish Flu pandemic that is still an ever-present remembrance of the devastation that occurred, particularly in rural Alaska.”

“Alaskans have a different lifestyle than people in the Lower 48,” says Pfeiffer. “The lifestyle is more physically demanding than it may be in other areas,” and when their health changes, people may have to change their living arrangements. Pfeiffer adds that people “are so motivated to work hard and achieve their highest level of function.”

Harbor view of PeaceHealth Ketchikan Medical Center.

PeaceHealth Ketchikan

“The ‘job’ doesn’t end at 5:00 pm,” Spencer says. “The ability, want, and desire to help people lives second by second, minute by minute, hour by hour in the interactions that are created at the hospital, grocery store, gas station, and hardware store.”

That holistic approach means “supplying them with hope,” as Goss describes a CEO’s role toward caregivers, patients, and everyone in her hospital. Similarly, Kolanko says her administrative functions are, in their way, a form of treatment. “The support I provide my team directly correlates with their ability to provide optimal patient care,” she says, “and that impacts more patients than I can physically treat on my own.”

Support staff touch all aspects of hospital operations. Areniego observes that her environmental services crew might be called at any moment to complete unexpected tasks, but the staff is always willing to help. It provides for good job security, she adds.

Healthcare professionals need the public to understand their specific fields. For instance, Orin explains that bariatric medicine is not cosmetic surgery, like tummy tucks or liposuction. “We do sleeve gastrectomies, bypasses, some centers do duodenal switches… It’s not the easy way out.”

Pfeiffer and Kolanko both feel their field is underappreciated. Kolanko says physical therapists don’t just treat orthopedic and neurologic injuries: “A PT can help with dizziness, bladder dysfunction and pelvic pain, wound care, chronic pain, and swelling of the limbs after cancer care, and so much more!” She adds that the public overrates massage and ultrasound therapy; they are among the least applied interventions that she considers effective.

Spencer wishes everyone knew that smaller hospitals, like Kanakanak Community Health Clinic in Dillingham, don’t necessarily have smaller problems. On the contrary: “We have to be able to maintain a patient’s life while waiting for a medevac in horrific weather. Medical staff in remote areas are trained in emergency medicine, geriatrics, and pediatrics, and encounter all types of patients at any time of the day and night.”

Not that big hospitals have it easy, according to Goss. “You never truly understand the pressure, within and externally, that is on you as a chief executive to ensure that you’re not only caring for people within your scope of responsibility (all of your caregivers, all of your patients, all of your visitors, all of your physicians) but also how the community views your organization and how one misstep or misspoken word or one small lapse in care can really affect the reputation of your facility and of your caregivers.”

Goss is very concerned about being understood in the proper context, given what she calls “the political climate of the community.” She says, “You end up feeling like you can’t trust people to have conversations because you always put your best foot forward and you try to talk about things appropriately and honestly, and you try to ensure that you’re seeing both sides of the situation, and only what people want to hear is what they take away.”

As COVID-19 improbably became a political issue, Zink had to keep the focus on fighting the virus. The enemy is not other people, she says, even though she’s aware some Alaskans think she tells different audiences different things. She quotes Abraham Lincoln: “No man has a good enough memory to be a successful liar.” Besides, Zink says “chief medical officer” sounds like a grand title, but the truth is “I have very little authority.”

Even a relatively young physician like Orin has seen rapid changes in the healthcare field. Robotics are something to stay on top of, she says. Goss adds that “digital interaction” is changing how care is provided these days, compared to the pre-internet ‘90s. “You had to go to a brick-and-mortar doctor’s office, you had to make an appointment,” says Goss. “Now you can download an app and have your blood pressure and your pulse and your temperature taken. You can go to a drive-through lab and have your influenza shot, you can go to a drive-through lab and have your blood drawn, and you never have to see a provider in person.”

Even the environmental services department has been computerized. Since she became section lead in 2010, Areniego has seen electronic systems used to track room cleaning, ordering, and call systems.

The Digital Age also allows workers to move from company to company, so Goss sees less loyalty to a single organization. She also observes a generational difference in priorities. “Many young people coming into professions have a much healthier work-life balance than we did,” Goss says. “I remember hiring brand new nurses and them telling me, ‘No, I’m not gonna work nights and I’m not gonna work weekends.’ I was kind of like, ‘Uh, everybody does.’”

Another change is that specific fields are becoming better understood by the public. Pfeiffer says, “People now realize that PT and PTA are two separate careers that work together in providing physical therapy.” And Orin says her field of bariatric surgery has less of a stigma attached, though it is still significant. “I think people are starting to realize that it is truly the best long term solution that we have for obesity. So we’re seeing that more of these patients that would benefit from surgery are coming through our door, though that number is still very small, only a fraction of the people who qualify.”

Orin has also seen more women entering the field of medicine, as well as her specialty. Pfeiffer sees more respect for women as PTAs: “While the profession has historically been predominantly women, we are no longer misjudged for our age or size.” And female CEOs are becoming more common as well. Goss says, “When I think back over the chief executives that were in my role as I’ve come up through, they were all males. When I think about Alaska Regional, Julie Taylor was the first female chief executive over there (that I was aware of).”

Of all the hospitals and healthcare systems in Alaska, nearly half have female CEOs—a much higher rate than the national average and among the highest of any industry. Goss feels much of the change has taken place in just the last five years.

Dr. Orin chose her specialty because she could see immediate results as patients lost weight and regained mobility.

Kerry Tasker

What does the future hold for healthcare in Alaska? Orin and Spencer agree that telemedicine should become a bigger factor. Spencer would like to see the technology available for “mental health, optometry, and other disciplines not traditionally known for this type of patient-provider interaction.”

Pfeiffer, Kolanko, and Zink all point to accessibility as the biggest area in need of change. “First, we need to improve the Medicare system,” says Pfeiffer. “It is essential that this payment source be revamped to improve for payment of services. This is a barrier for many to receive quality patient care.” In Kolanko’s view, “Healthcare should always be provided based on medical necessity. It is really unfortunate when medical treatment cannot be provided because insurance won’t cover it or doesn’t believe it to be a ‘necessary’ service.” Or, as Zink puts it, make the system work for people.

Zink and Orin both would like to see more emphasis on prevention. For Zink, that includes vaccines for preventable diseases. For Orin, that means referring patients earlier for treatable obesity. “It’s not a failure on their part with diet and exercise,” she says. “This is the standard of care for obesity in 2021.”

Spencer and Pfeiffer both want to see changes in the healthcare workforce. Pfeiffer sees the need for more workers in her field: “PTAs are perfectly positioned to provide services in rural and underserved areas. At this time, PTAs are underutilized and could help to decrease the provider gap.”

Spencer figures the way to make more healthcare providers in Alaska is to make more Alaskans, by recruiting from the Lower 48. However, she says, many Outsiders “see it as too challenging because of the weather or see it as an opportunity for ‘a trip to Alaska’ for a site visit but do not want to remain here to work.” The solution, she says, is for every Alaskan to sell the state. “We are all ‘marketing’ our everyday lives to promote the benefits and rewards of living here via our social media presence, face-to-face exchange, and telephone interactions. We owe it to ourselves to present the very best we can to attract a vibrant workforce.”