Legislature(2007 - 2008)HOUSE FINANCE 519
02/07/2007 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB18 | |
| HB34 | |
| HB87 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 18 | TELECONFERENCED | |
| + | HB 34 | TELECONFERENCED | |
| + | HB 87 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 18
An Act amending the functions and powers of the Alaska
Commission on Postsecondary Education; and relating to
the repayment provisions for medical education and
postsecondary degree program participants.
MICHAEL PAWLOWSKI, STAFF, CO-CHAIR MEYER, explained that HB
18 is intended to increase the number of students in the
WWAMI program. The WWAMI program is Alaska's medical school
program and is a partnership between Washington, Wyoming,
Alaska, Montana and Idaho (WWAMI), in which each of those
states contributes to the Medical School at the University
of Washington (UW) based on the amount of students they have
entering the program. For Alaska, that number has
traditionally been 10. The WWAMI student pays in-state
tuition at the University of Washington and agrees to return
to Alaska to practice medicine.
Mr. Pawlowski continued, a student must repay a portion of
the State's subsidy if they do not return to Alaska to
practice medicine. The State forgives 20% of the obligation
for each year they practice in Alaska. The WWAMI program
has been immensely successful and has received national
recognition for several years. It has been ranked the #1
Family Medical Education program in America for 15
consecutive years.
Mr. Pawlowski noted that Alaska needs to expand WWAMI
because the State is facing a significant physician
shortage; a shortage which leads to more expensive and less
available medical care throughout Alaska. HB 18
accomplishes the following:
· Expanding the WWAMI program in section 1
· Allowing students to serve their residency outside
Alaska without accumulating interest in Section 2 -
(There are limited opportunities to pursue residency in
Alaska now with only 12 slots at Providence);
· Envisioning 20 students entering WWAMI a year, which
means that eight of those would have no opportunity to
pursue their residency in Alaska
Expanding the WWAMI program was one of the key
recommendations in the recently released report, "Alaska
Physician Supply Task Force" included in the packets.
Alaska already has fewer physicians per capita than the rest
of the U.S. And as our physicians are approaching
retirement age, the State needs to do everything possible to
recruit more and HB 18 is a first step toward bridging that
gap.
1:46:36 PM
Representative Thomas referenced language "sufficient to
accommodate 20 new people each year" & wondered if that
amount would be compounded each year. He wanted to be on
record, clarifying that would only be 20 students a year.
Mr. Pawlowski acknowledged it was not a compounding equation
and would only be 20 new freshmen each year.
Representative Gara hoped to finely tune the legislation.
He pointed out the shortage in the State of certain types of
doctors. He noted that many doctors come to Alaska because
they make a lot more money. He proposed tying eligibility
for participants that are willing to go into the fields the
State has serious shortages. Mr. Pawlowski thought it would
be difficult to adjust for a career path, not understanding
specifics when entering into the medical path.
Representative Gara recommended adding incentives for
specific areas & if those were not met, the student would
not be given the subsidies and the annual loan payments
would not be forgiven.
1:50:41 PM
Representative Nelson inquired why the proposed legislation
stopped at the number 10, given the serious need throughout
the State. Mr. Pawlowski explained that the bill intends to
"establish the floor", understanding capacity issues in both
the University of Alaska and the University of Washington.
Increasing the number could be worked out over time.
1:52:08 PM
JOEL GILBERTSON, (TESTIFIED VIA TELECONFERENCE), REGIONAL
DIRECTOR, STRATEGIC DEVLEOPMENT & ADMINISTRATION, PROVIDENCE
HOSPITAL, ANCHORAGE, discussed that the physician shortage
in the State of Alaska at this time is a serious public
health threat. There is a physician shortage in all
specialty types making for fragmented and reduced access to
care. In the Anchorage market place, there are a number of
seniors unable to receive basic primary care services.
Mr. Gilbertson recommended increasing the WWAMI class size,
a move that Providence Hospital strongly supports. The
WWAMI program has been a key element for retention.
Approximately 85% of the students graduating through the
program have remained in Alaska. Those individuals are
involved in core services of the State. It has been a great
investment. He acknowledged that the problem is still acute
statewide.
Representative Crawford commented on concerns voiced by
constituents in Anchorage that medical access is at a crisis
point. He thought that the bill would provide a beginning
step, however, worried about how to address the short-term
fix. Mr. Gilbertson agreed that there is a need for both
short and long term fixes. The bill would not be the sole
solution; core problems need to be addressed. The U.S.
Congressional delegation has taken an interest in access to
care.
There are a number of efforts in the Anchorage area that are
happening right now. One is the Anchorage Neighborhood
Health Center, which handles many Natives coming from rural
communities. The program has inadequate facilities and can
not meet the volume demand. The clinic is undergoing an
assessment through the Denali Commission to look at ways to
grow the center. The other large primary care facility
practicing in Anchorage is the Family Medicine Residency
Program. That clinic trains residents, receiving some
federal support, however, has been loosing money on an
annual basis. Most states support their programs through
direct funding and reimbursements. Alaska's reimbursement
thus far, has barely kept up with what is happening in other
states. There is interest in strengthening the residency
program.
Representative Crawford questioned what was needed to
enhance the program. Mr. Gilbertson explained that there is
no one solution to solving the crisis. The Neighborhood
Health Center is largely a capital project. That revenue
structure is stronger as they have access to cost base
reimbursement; their issue is physical space and capacity.
It is a capital project. He urged that both clinics be
strengthened & expanded and requested further funding.
2:01:15 PM
Representative Gara understood that where a person goes to
medical school has a relationship on where they end up
practicing, and where the residency program is done has an
even stronger affect on where they end up practicing. Mr.
Gilbertson agreed that was true.
Representative Gara noted that the residency programs
offered in Alaska are not as substantial as they could be.
Mr. Gilbertson advised that the residency program would like
to expand the number of slots available in Alaska. Given a
more predictable revenue stream, they would be able to
expand their actual office hours. A secondary benefit of
more residents coming out of the program, would be more
doctors feeding out into rural areas.
Representative Gara questioned if the residency program
provided practitioners for both the rural and urban areas.
Mr. Gilbertson explained that a good percentage have gone on
to work in rural areas through the Native Health
Corporations. It helps with the long-term training, being
around primary care and internal medicine.
Representative Gara recommended that a quicker solution for
those closer to practicing, would be consideration of
expanding State support of the residency program, especially
in family care.
2:05:04 PM
DR. PETER MARSHALL, (TESTIFIED VIA TELECONFERENCE), FAMILY
AND GENERAL PRACTICE, CHAIR OF WWAMI ADMISSIONS, NORTH POLE,
referenced the letter he submitted to the member's packets.
(Copy on File).
Dr. Marshall discussed the dire need for medical doctors in
the bush areas and in Fairbanks & Anchorage. He addressed
the barriers that Alaska students encounter when applying to
other schools. Alaska, currently, only has 10 spots and
last year, there were 78 applicants. The students
attempting to get into the program apply against other
states; states tend to be "stringy" with the spots,
reserving them for their own residents. Well qualified
students are at a disadvantage in trying to apply to other
medical schools. Doubling the class size to 20, would
increase the ration and would help the situation.
2:08:46 PM
Representative Crawford commented that Amendment 1, 25-
LS0131\K.1, Mischel, 2/06/07, could have increased the
program number from 20 to 30. He was informed there was
not enough physical space to accommodate that many. He
agreed to not offer the amendment at this time. He asked
when the program could be expanded. Dr. Marshall responded
that he was not equipped to answer that. The University of
Washington (UW) has made a decision to increase their class
size over the next few years. He believed eventually,
Alaska could have 30 students in the program and supported
such a plan.
2:11:10 PM
ROD BEATTIE, PRESIDENT, ALASKA STATE HOSPITAL & NURSING HOME
ASSOCIATION (ASHNHA), JUNEAU, noted that the membership of
his agency has identified the proposed issue as their most
critical concern this legislative session. He referenced
the agency handout. (Copy on File).
ASHNHA strongly supports passage of HB 18. There are
approximately seven ways to get additional physicians into
Alaska:
· Medical schools
· Residency programs statewide
· Federal assignments
· Self selection
· Loan repayment programs
· Recruitment bonuses
· Travelers
Mr. Beattie reiterated that HB 18 is critical legislation.
He pointed out that Alaska currently suffers from a shortage
of over 300 physicians. The public is not receiving the
care needed. He urged that the bill move swiftly out of
Committee and that the University of Washington is looking
for a quick response; timing is critical.
2:16:14 PM
Co-Chair Meyer questioned how soon ASHNHA needs to know if
passage of the bill could happen. Mr. Beattie replied that
the deadline to complete the contract negotiations is the
beginning of March 2007.
Representative Gara asked the areas of the most acute
shortages. Mr. Beattie responded a lot of the newer
specialty areas and elder care, OB's, surgeries, cardiology,
and internal medicine. He added that targeting students
into specific areas would be problematic.
Co-Chair Meyer asked if the State's residency program could
accommodate all 20 students; he understood that only
Providence Hospital offered a residency program. Mr.
Beattie replied that was correct and that it currently
offers a 12-position residency program.
2:18:07 PM
DR. ROLAND GOWER, (TESTIFIED VIA TELECONFERENCE), PRESIDENT,
ALASKA STATE MEDICAL ASSOCIATION (ASMA), GENERAL SURGEON,
ANCHORAGE, provided a copy of his testimony. (Copy on
File).
Dr. Gower pointed out that ASMA strongly supports HB 18. He
echoed the crisis given the doctor shortage throughout
Alaska. There is a nationwide shortage and recruitment will
not get any easier in the future for Alaska. He thought
that it made sense for Alaska to "grow our own students"
into the field. There are Alaska students that want the
training but do not have a school to go to. The State
providing a reasonable payback acts as an incentive. It is
important to nurture this resource. He offered to answer
questions of the Committee.
Representative Gara inquired how the legislation would
increase the family residency program throughout the State.
Dr. Gower explained he was not an expert on that program.
There is a critical mass consideration of the number of
physicians that can be trained in that area. He commented
on specialty training and thought it would be possible to
provide some training to specialists in Alaska but many of
that type training can not happen in the State. He
recommended perhaps creating rotations in the Alaska
hospitals with residents from other states.
2:24:21 PM
PAT LUBY, (TESTIFIED VIA TELECONFERENCE), ADVOCACY DIRECTOR,
ALASKA ASSOCIATION OF RETIRED PERSONS (AARP), ANCHORAGE,
stated that AARP supports HB 18. He claimed that AARP
members tend to see physicians more often than the younger
set. Now seniors are staying in the State after retirement
since the health services are improving. HB 18 is an
excellent first step in addressing the statewide physician
shortage. He urged support.
2:26:12 PM
Co-Chair Meyer noted that Representative Crawford had
WITHDRAWN his amendment.
Co-Chair Meyer pointed out the fiscal notes, highlighting
the new note by the University of Alaska. Representative
Hawker noted the number of new positions being added into
the system and the note associated. He worried that the
student-faculty ratio was excessive. He pointed out the
capital expenditure request included. Representative Hawker
requested a better evaluation.
Co-Chair Meyer agreed that the capital request should be
addressed in the Capital Budget. Mr. Pawlowski clarified
that under the program, until the actual slots are added,
the incoming class at UAA would not be above 20 people.
2:29:43 PM
PAT PITNEY, VICE PRESIDENT OF PLANNING & BUDGET, UNIVERSITY
OF ALASKA, advised that the fiscal note before the committee
was precise. There would not be two part-time positions; of
the $344 thousand, approximately $44 thousand dollars would
be used for staffing assistance. It would add to staffing
support for the WWAMI program. The two faculty would add to
the existing faculty in the current program. There are
seven faculty in the program and approximately ½ of those
are dedicated for WWAMI teaching. They are also dedicated
to some biological and chemistry teaching positions in the
other departments and research and service. The course
curriculum in the first year is very intensive. There is
course work with lab and teaching requirements; it is more
one-on-one. It would be a significantly larger load. She
stressed that the request to move to 20 students will happen
at the beginning of next school year.
Representative Hawker did not understand the merits or
demerits of the ratio argument. He was concerned with the
travel component, the contractual & supplies. Ms. Pitney
explained that those numbers were a rough estimate and they
assume a modest salary. The travel allocation would be used
for the entire department.
Co-Chair Meyer thought the fiscal request should be analyzed
during a subcommittee process. Co Chair Chenault agreed it
should be examined during subcommittee before moving
forward; he recommended that the capital expenditure be
included in the Capital Budget Request (CBR). He asked that
the fiscal note be removed and provided to the subcommittee
for consideration.
2:34:11 PM
Co-Chair Meyer reminded members that the University received
$475 thousand dollars last year with the understanding that
the remainder would be allocated FY08.
Representative Gara inquired if the bill should pass how
that would be affecting the capital request process. He
asked if construction would be completed by then. Ms.
Pitney responded that the $475 thousand appropriated last
year was being used as the planning part of the construction
process. In the event that the bill passes, the original
$475 thousand dollars allows the planning and the second
allocation in the amount of $475 thousand dollars will cover
the overall construction. Construction completion is
planned for during the summer and will be ready for incoming
students.
Representative Gara asked if the capital upgrade was really
needed. Ms. Pitney emphasized it was.
2:36:57 PM
Co Chair Chenault referenced comments that the allocation
from last year budget was being used for planning of the
renovation. Ms. Pitney responded that the University is
preparing for success of the program as the need is high;
the planning portion was less than $475 thousand dollars.
Co Chair Chenault understood the concern to get the funding.
He worried about the funding from last year being used. Ms.
Pitney replied only a small piece of that amount was used.
2:38:50 PM
SUSANNE TRYCK, (TESTIFIED VIA TELECONFERENCE), DIRECTOR,
ALASKA REGIONAL AFFAIRS, UNIVERSITY OF WASHINGTON SCHOOL OF
MEDICINE, explained that the issue of the number of faculty
in the program is a bit difficult to grasp. At the
University of Alaska - Anchorage (UAA), the numbers for
faculty is lower than in some of other states. It is not
uncommon for a faculty in the second year at the UW, to
teach three or four lectures in a semester. There is a lot
of time involved in research, which makes the teaching time
less. The proposed numbers are in line with the other WWAMI
states.
Ms. Tryck clarified that they can not accommodate all 20
WWAMI students in the family medicine residency program
unless they only intend to practice family medicine. There
is no direct link in terms of the numbers. It would be
cumbersome to attempt to tie the shortage of statewide
doctors with those students selected for the WWAMI program.
The amount of time it takes to complete the program is
usually seven years. Ms. Tryck urged that the bill pass
from committee at this time given the deadline.
2:42:00 PM
Co-Chair Meyer recommended that the University of Alaska
fiscal note be reduced to zero.
Vice Chair Stoltze MOVED to REPORT CS HB 18 (HES) out of
Committee with individual recommendations and with the
accompanying fiscal notes including the new zero note by the
House Finance Committee. Vice Chair Stoltze briefly
OBJECTED.
Vice Chair Stoltze noted that he supports the initiative to
bring more doctors into Alaska. He worried if it had not
been mandated, it would not have come through the
University. He complimented the statewide professionals for
making the legislation happen and wanted to make sure the
leadership on the issue continues to be the medical
community. Vice Chair Stoltze WITHDREW his OBJECTION.
There being NO further OBJECTIONS, it was so ordered.
CS HB 18 (HES) was reported out of Committee with a "do
pass" recommendation and with a new zero note by the House
Finance Committee and fiscal note #1 by the Alaska
Commission on Postsecondary Education dated 1/31/07.
AT EASE: 2:44:39 PM
RECONVENED: 2:50:46 PM
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