Legislature(1999 - 2000)
02/11/1999 01:35 PM Senate L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 29-REQUIREMENTS FOR PHYSICIAN'S LICENSE
MARK HODGINS, legislative aide to Senator Jerry Ward, sponsor of SB
29, made the following comments about the measure. SB 29 will
increase the time limits from one to three years for an applicant
to satisfactorily perform the duties of resident physician or
intern at a recognized hospital. SB 29 will amend current Alaska
statute to read, "...lawfully residing in the United States," to
comply with the 1996 federal immigration law. That law proposes a
new class of VISA called an H1B; currently most foreign doctors
train in the United States under a J1 VISA. The Alaska medical
board would prefer SB 29 to be more comprehensive, however Senator
Ward chose to keep the focus of CSSB 29 narrow to enhance its
chance of passing both houses. The Alaska medical board is very
interested in getting SB 29 enacted. He asked committee members to
adopt the committee substitute as the working document of the
committee.
SENATOR DONLEY moved to adopt CSSB 29(L&C). There being no
objection, the motion carried.
Number 050
SENATOR LEMAN asked Mr. Hodgins to provide the sections of the '96
federal act that require changes to Alaska statute.
MR. HODGINS offered to do so at a later date. He explained CSSB
29(L&C) will require foreign-trained doctors, who want to work in
the United States, to train in Alaska for a longer period than
domestic medical students, so that they can be monitored for
adequate training. The Alaska medical board is concerned about
training received abroad, and it also wants to recognize the fact
that two years of training is sufficient for American and Canadian
trained interns.
SENATOR LEMAN asked if the changes in CSSB 29(L&C) go beyond the
1996 immigration act changes.
MR. HODGINS said they do not.
SENATOR LEMAN noted the Alaska Medical Board's position on SB 29 is
not obvious from Dr. Isto's letter.
MR. HODGINS responded the Alaska medical board wanted the bill to
contain a one year of training period for physicians trained prior
to 1988, however Senator Ward felt that requirement could be put
into regulation at the direction of the medical board.
Number 110
SENATOR LEMAN asked Mr. Hodgins to respond to the letter from Dr.
Byron Perkins.
MR. HODGINS replied the Alaska medical board members are not 100
percent behind any one given plan regarding adequate training
periods, i.e. bush doctors on the medical board are concerned about
creating too big of a hurdle for doctors seeking to practice in the
bush. The board as a whole felt this legislation addresses some of
its concerns regarding training requirements. Senator Miller plans
to introduce legislation to help solve some of the board's other
concerns.
SENATOR LEMAN asked if the '96 immigration act provisions apply to
other professionals and whether the committee should be looking at
a fix for those professions as well.
MR. HODGINS stated he believes the act does affect other
professions, however he repeated Senator Ward chose to keep the
scope of SB 29 narrow.
CHAIRMAN MACKIE clarified that the committee substitute adopted by
the committee is the "G" version. He also noted Dr. Byron's and
Dr. Anschuetz's letters would be kept on record in the committee
file.
MR. HODGINS stated Dr. Anscheutz appears to be concerned with
opening the floodgates to immigrants into Alaska which Senator Ward
does not see as a problem at this time.
CHAIRMAN MACKIE asked if the committee substitute addresses Dr.
Byron's concern about the adverse effects on the Alaska Family
Practice Residency at Providence Hospital.
MR. HODGINS thought Dr. Byron's letter was directed to SB 29, and
noted the committee substitute does not make substantial changes
from the original bill; it further defines the training
requirements and steps to physician licensure.
Number 187
SENATOR LEMAN pointed out that Mr. Hodgins stated the committee
substitute contains only those provisions required for Alaska
compliance with the 1996 immigration act. He questioned whether
this bill affects domestic as well as foreign applicants since
Section 2, relating to qualifications for osteopath applicants,
increases the time of internship from one to two years for non-
foreign graduates.
MR. HODGINS agreed that domestic graduates will be affected. That
provision is in line with licensure requirements in other states as
Alaska has one of the shortest training requirements in the United
States. That change will place Alaska in the top third regarding
the length of training required.
Number 214
SENATOR LEMAN asked about the inclusion of a "grandfather"
provision, and how physicians, who have been licensed in states
that require shorter training periods, would be affected.
MR. HODGINS replied the guidelines for increasing the training
period for certification came from the medical board, which is not
in total agreement on the issue.
SENATOR LEMAN stated he is reticent to change the amount of
training time required of applicants until a better consensus is
reached by the medical community.
Number 262
CATHERINE REARDON, Director of the Division of Occupational
Licensing, Department of Commerce and Economic Development, gave
the following testimony via teleconference. Dr. Isto, Chair of the
Alaska medical board, has explained the board's goals in a letter
submitted to committee members. SB 29 addresses three separate
issues, the first being the citizenship requirement for licensure.
Current law requires individuals who get medical licenses in Alaska
to be permanent residents with green cards. That requirement is
problematic because some qualified individuals do not have green
cards, but have other types of VISA status that permit them to work
here. The medical board prefers to be silent on the issue of
citizenship and residency but the committee substitute is
acceptable to the board. Many licensing programs do not have
citizenship or residency requirements based on the premise that the
Immigration and Naturalization Service oversees that aspect.
CHAIRMAN MACKIE asked Ms. Reardon to provide the committee with
position papers from the department and the medical board, as well
as a sectional analysis of the bill and comments on Dr. Perkins'
concerns.
Number 325
DR. HAROLD JOHNSTON, Director of the Alaska Family Practice
Residency Program, stated his concern was with the three year
training period required in the original bill. The change in the
committee substitute to two years ranks Alaska as 7th in length of
postgraduate training requirements for U.S. graduates. He agrees
with the concept that foreign medical graduates should have a
longer training period prior to licensure. He believes there is
merit to the argument that physicians practicing in bush areas
should be required to undergo two years of training because those
areas offer very little in the way of support services for
practicing physicians. Currently residents are licensed at the
start of their second year. The issue of whether residents could
bill for their services when they are in rural locations outside of
the residency program during their second year could be worked out
with the state medical board and other state agencies, such as the
Medicaid office. DR. JOHNSTON agreed that a three year training
period prior to licensure is desirable for foreign medical school
graduates because it is not possible to adequately assess the
quality of the medical education those graduates receive.
Number 389
DON HUDSON, a practicing physician and President of the Alaska
Chapter of the American Medical Association, stated both the state
and national associations believe that one year of training is
adequate for practice of medicine in Alaska, and that a one year
rotating internship does give a broad base of knowledge to
physicians. CSSB 29 addresses the additional one to three year
residency. Both associations are opposed to the increased training
period.
MR. HODGINS asked Dr. Hudson if his concern was with the domestic
requirement of two years, and not the foreign requirement of three
years.
DR. HUDSON said that is correct and he would like to see the
domestic requirement decreased to one year.
MR. HODGINS noted from the testimony received today, the conflict
appears to center around the change to the domestic requirement,
and not to the foreign requirement. He added he will speak to the
sponsor about removing the change to the domestic requirement.
CHAIRMAN MACKIE stated CSSB 29 would be held in committee while
some of the concerns expressed are resolved. He asked Mr. Hodgins
to provide the committee with a sectional analysis of the bill.
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