Clinic director warns of surging locum costs; proposes Portland House walk-in clinic

Donald Memorial Clinic Director Al Wall told the Skagway assembly on May 7 that the clinic faces rising costs in its locum-tenant line after staff changes and a marked increase in emergent services in 2025. Al Wall said the municipality shifted roughly $375,000 into payroll lines when two providers were hired as staff, and that one provider left in March, creating a budget gap that required moving funds back into the locum-tenant account.

Wall described two primary cost drivers: higher rates charged by locum‑agency teams (which include administrative fees and daily availability payments) and a near‑200% increase in emergent services in 2025 that required expanded provider teams. "A locum team can run upwards significantly higher than $60,000 a month as a team," Wall said, adding that those short‑term teams were the bulk of last year’s expenditures.

To reduce long‑term expense, Wall proposed contracting directly with some long‑term providers (converting them to independent contractors) and opening a nonprofit, cash‑only walk‑in clinic at the Portland House aimed at tourists’ minor needs — prescriptions, strep tests and similar low‑acuity visits. He estimated the walk‑in clinic could see about five patients per day during the season and, if successful, could allow the main clinic to reduce weekend hours and weekend payroll costs.

Finance committee members asked for further budget detail; Wall said he would continue quarterly meetings with the finance committee and the budget manager to refine projections and present options, and that a formal midyear budget update is possible if costs continue to escalate.