Running of the Reindeer

Third-year residents (left to right) Drs. Theresa Dulski, Eric Foote, Patti Clay and John Hawes at the Running of the Reindeer in Anchorage.

When she graduated from Atlanta’s Emory University School of Medicine in 2012, Dr. Theresa Dulski had three things on her wish list: to be a pediatrician, to train in a top children’s specialty hospital and to someday be a primary care doctor.

If she’d wanted to stay in Georgia, Dulski would have had five pediatric residency programs to choose from. If she’d wanted to return to her home state of Illinois, she would have had 11 choices. If she’d been aiming for New York, she would have had 30 potential pediatric residency matches.

But Dulski set her sights on the road less traveled: Alaska, a state with 183,000 people under age 18 spread across more than 570,000 square miles – and fewer than 60 pediatricians to care for them all.

For this, she just had one choice: the University of Washington–Seattle Children’s residency program’s Alaska Track, which was brand new the year she finished medical school. She and three other new doctors – Drs. Patricia (Patti) Clay, Eric Foote and John Hawes – were the first to step on the primary care-focused Alaska track. This summer, they will be its first graduates.

During each of their three years of residency, Alaska track residents spend eight months in Seattle and four in Alaska.

In Seattle, they are fully immersed in inpatient and subspecialty care, learning side-by-side with the other residents in the UW–Seattle Children’s program.

In Alaska, the residents are embedded in primary care settings in Anchorage, Fairbanks and Bethel, where they learn from and work with seasoned doctors, nurses and other health professionals. Each resident returns to the same training sites during their annual Alaska sojourn, developing relationships with patients, families, staff members and others in the community.

Training More Primary Care Doctors for Kids in the Region

The Alaska track was the brainchild of Dr. Bruder Stapleton, senior vice president and chief academic officer, as one way to address a shortage of primary care pediatricians in parts of our region.

“There’s a strong correlation between where doctors train and where they go into practice,” says Stapleton. “States with the most training programs have the highest pediatrician-to-child ratios.”

The UW–Seattle Children’s residency program is the only pediatric training program in the five-state region known as WWAMI (Washington, Wyoming, Alaska, Montana and Idaho), and even though about half its graduates pursue careers in primary care, that’s not enough to meet the needs of kids and families in the region.

Montana, Wyoming, Idaho and Alaska have some of the lowest pediatrician-to-child ratios in the nation.

Stapleton reasoned that the new track could improve the educational experience for residents committed to a career in primary care. Moving them to Alaska for a significant chunk of their training would give them on-the-ground experience in rural and underserved areas and, hopefully, boost the chances of keeping them in the region when they finish their training.

In 2007, he pulled together a dream team to design the Alaska track:

  • Dr. Richard Shugerman, who at the time was director of the pediatric residency program and is now pediatric WWAMI program director
  • Dr. Sandy Melzer, senior vice president and chief strategy officer
  • Dr. John Coombs, a pediatrician and family doctor who at the time was dean for regional affairs at UW School of Medicine
  • Dr. Matt Hirschfeld, a graduate of the UW–Seattle Children’s residency program who was then a hospitalist at Alaska Native Medical Center and now heads maternal and child health there
  • Dr. Harold Johnston, a family practice doctor who in 1997 started the first graduate medical education program in Alaska, a family medicine training program that has the highest in-state retention rate of any residency program in the country
  • Dr. Richard Mandsager, chief executive of Providence Alaska Medical Center
  • Susan Tryck, who was then the director of Alaskan Regional Programs at the UW School of Medicine

For its first on-the-ground director, the team chose Dr. Christine Tan Cadogan, a pediatrician at the Southcental Foundation in Anchorage, the primary care arm of the Alaska Native Medical Center and one of the Alaska track training sites.

Growing a Program

Alaska Heart Run

Running together: Dr. Amy Tan Cadogan (at right), co-director of the Alaska track, joins the third-year residents at the Alaska Heart Run.

Tan Cadogan, who now co-directs the program with Dr. Amy Schumacher, says it’s been thrilling to watch the Alaska track grow from an idea into a full-fledged program.

Each year since 2012, the program has added a new class of four residents through the national resident matching program, and now has a full complement of first-, second- and third-year residents. Each class spends a different portion of the year in Alaska, which means the Alaska training sites now have UW–Seattle Children’s residents year-round.

Tan Cadogan says the track attracts individuals who are adventurous, open-minded and flexible, qualities that serve them well during their training and beyond. “Practicing in Alaska is unlike practicing anywhere else,” she says. “Culture, access and weather play a big role in how we deliver healthcare.”

Each resident splits their annual Alaska rotation between two sites: one private practice and one within the Alaska native healthcare system. Pediatricians in each location supervise and mentor residents, and the residents meet with each other, Tan Cadogan and Schumacher weekly via video teleconference.

In its first year, 126 medical students applied for the Alaska track. The next year, applicants jumped nearly 20% to 149. This year, Tan Cadogan and her team are evaluating 228 applicants for the four Alaska track positions.

A New Primary Care Pediatrician for Alaska

Dr. Theresa Dulski

Dulski will move back to Alaska to practice when she finishes residency.

Dulski chose the Alaska track because it met her criteria: she could train with specialists in a top children’s hospital and also learn to practice primary care in a place where resources are limited and specialists are few and far between. It also appealed to her spirit of adventure, and she looked forward to spending time outdoors in spectacular settings.

She was prepared to be interested in Alaska, and expected to grow there by leaps and bounds. What she didn’t expect was that she would fall in love with the place and its people.

“After my first rotation in Alaska I thought, ‘I really like this,’” says Dulski. “The second year I thought, ‘I could see myself working here.’ And this year I knew I wasn’t ready for my Alaska experience to be over.”

Before she left Alaska during her final rotation there last fall, Dulski was offered – and accepted – a position at Southcentral Foundation in Anchorage, one of the sites where she trained. “If I hadn’t trained in Alaska, I would have been far less likely to end up practicing there,” she says.

Dulski may be the first Alaska track resident to accept a job in WWAMI, but she won’t be the last. If just half the residents in the track make a similar choice to practice primary care in the region, it could significantly alter the doctor-patient balance in areas that desperately need pediatricians – just the outcome Stapleton and his team hoped for when he started dreaming up the Alaska track.

Who’s on the Alaska Track?

First-year residents are in Alaska from March to June; second-year residents from November to February; and third-year residents from July to October.

Class of 2017 (R1)

  • Dr. Gwen Gottlieb
  • Dr. Lilian Ho
  • Dr. Elizabeth Sanseau
  • Dr. Eric Seymour

Class of 2016 (R2)

  • Dr. Emily Hogeland
  • Dr. Brooke Jardine
  • Dr. Elizabeth Little
  • Dr. Matthew Serna

Class of 2015 (R3)

  • Dr. Patricia Clay
  • Dr. Theresa Dulski
  • Dr. Eric Foote
  • Dr. John Hawes



The five-state region for which the University of Washington School of Medicine offers the only pediatric residency program:

  • Washington
  • Wyoming
  • Alaska
  • Montana
  • Idaho


The four-state region Seattle Children’s serves as pediatric specialty hospital:

  • Washington
  • Alaska
  • Montana
  • Idaho

Published Feb. 19, 2015