Legislature(2005 - 2006)HOUSE FINANCE 519

02/14/2005 01:30 PM FINANCE

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* first hearing in first committee of referral
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= bill was previously heard/scheduled
Moved Out of Committee
Moved Out of Committee
Moved CSHB 115(TRA) Out of Committee
Bills Previously Heard/Scheduled
HOUSE BILL NO. 102                                                                                                            
     An Act relating to the licensure of foreign medical                                                                        
     graduates; and providing for an effective date.                                                                            
BEN MULLIGAN,  STAFF, REPRESENTATIVE BILL  STOLTZE, explained                                                                   
the  legislation,  noting  that   the  purpose  was  to  help                                                                   
alleviate  the shortage  of physicians  in Alaska, which  are                                                                   
more noticeable in the specialty fields.                                                                                        
The legislation will  allow, at the discretion  of the Alaska                                                                   
State  Medical  Board, individuals  graduating  from  foreign                                                                   
medical schools, the ability to  practice medicine in Alaska.                                                                   
Currently, there  is a 2-year United States  graduate medical                                                                   
education  residency  program   requirement.    The  proposed                                                                   
legislation  would make  it easier  to  practice medicine  in                                                                   
Alaska.   The requirements will  remain as stringent  as they                                                                   
currently are  for persons graduating from medical  school in                                                                   
the United States.                                                                                                              
Mr.  Mulligan  pointed  out  that  the  last  section  offers                                                                   
recommendations for  the board; they may choose  not to adopt                                                                   
those stipulations.                                                                                                             
1:54:47 PM                                                                                                                    
Representative  Hawker questioned if  this idea had  been run                                                                   
by either Providence or Regional Hospital.                                                                                      
Vice-Chair Stoltze  advised that he  had not "run it  by" the                                                                   
actual  hospitals, however,  it  has been  looked  at by  the                                                                   
hospital  representatives he  met in  the Capitol hall's  and                                                                   
they offered "a thumbs up".                                                                                                     
Representative Weyhrauch  asked the definition  of an "active                                                                   
medical practice"  as outlined  in Section  3.  Mr.  Mulligan                                                                   
offered to check  that out.  He pointed out  that Jim Jordan,                                                                   
the   Executive  Director   of  the   Alaska  State   Medical                                                                   
Association was on line.                                                                                                        
Representative  Weyhrauch referenced Section  3 and  asked if                                                                   
the doctor was  a general practioner, would  they be carrying                                                                   
a  board  certified  "specialty"  license.      Mr.  Mulligan                                                                   
advised  that would  not  fall under  the  American Board  of                                                                   
Medical Specialties but thought  that it would fall under the                                                                   
American  Medical  Board.   He  offered  to  provide  further                                                                   
information on that concern.                                                                                                    
Representative Weyhrauch asked  if the physician did not have                                                                   
a current  board specialty  but did have  a long  practice of                                                                   
general medicine,  would they be excluded from  being able to                                                                   
practice under the proposed bill.   Mr. Mulligan advised that                                                                   
the stipulations  are only guidelines  and may or may  not be                                                                   
decided to be worthy requirements.                                                                                              
Representative   Weyhrauch    questioned   why    those   two                                                                   
requirements had  been set apart from all the  other possible                                                                   
requirements.    Mr.  Mulligan  explained  that  one  of  the                                                                   
specifics was the medical specialty  and that the legislation                                                                   
attempts to fill vacancies for specific medical practices.                                                                      
Representative Weyhrauch  asked why the listed  two hospitals                                                                   
had been the only included.  Mr.  Mulligan offered to provide                                                                   
that information.                                                                                                               
Co-Chair Meyer  noted that there are testifiers  on-line that                                                                   
could address these concerns.                                                                                                   
1:58:54 PM                                                                                                                    
RICK URION,  DIRECTOR, OCCUPATIONAL LICENSING,  DEPARTMENT OF                                                                   
COMMUNITY     AND     ECONOMIC     DEVELOPMENT,     testified                                                                   
enthusiastically in support for  the legislation.  He claimed                                                                   
that  licensing laws  are written  in  such a  way that  they                                                                   
leave no  discretion.  HB 102  would solve some  problems and                                                                   
would provide  the Board with  opportunities to  make choices                                                                   
while  protecting  the public.    He  emphasized that  it  is                                                                   
important to pass the legislation.                                                                                              
Representative  Kelly questioned  if background checks  would                                                                   
be made on these applicants.   Mr. Urion advised that most of                                                                   
these people  are living in the  United States and  have been                                                                   
for many years.  He did not foresee any problems.                                                                               
2:01:19 PM                                                                                                                    
JIM  JORDAN,   (TESTIFIED   VIA  TELECONFERENCE),   EXECUTIVE                                                                   
DIRECTOR, ALASKA STATE MEDICAL  ASSOCIATION, ANCHORAGE, noted                                                                   
he  had  submitted written  testimony  included  in  member's                                                                   
packets.  (Copy on File).  Mr.  Jordan stated that the Alaska                                                                   
State Medical Association strongly supports HB 102.                                                                             
Mr. Jordan reiterated  physician shortages that  exist in the                                                                   
Anchorage hospitals.   Providence Medical system  did a study                                                                   
in 2002,  which indicated at that  time, they were  short 200                                                                   
physicians.   He stressed the  fact that there is  a shortage                                                                   
and  as the  State moves  forward toward  2009, the  shortage                                                                   
will  become bigger.    The numbers  will  only grow  without                                                                   
passage of  the bill.  He thought  that HB 102 could  help to                                                                   
address these alarming concerns.                                                                                                
Mr.   Jordan  mentioned   physicians   currently  in   active                                                                   
practice.  He acknowledged that  it is important to guarantee                                                                   
that  physicians have  guidelines  for applying  for  certain                                                                   
positions;  they  must  be  practicing  and  actively  seeing                                                                   
patients.  Mr.  Jordan advised that general  practice usually                                                                   
has  a  specialty  area.   For  board  certification,  it  is                                                                   
recognized that  to qualify for core competency,  there would                                                                   
be extensive peer review.                                                                                                       
Mr.  Jordan addressed  "accreditation  counsel" for  graduate                                                                   
medical  education from  the Royal College  of Physicians  in                                                                   
Canada.   He  commented  that is  the  entity, which  credits                                                                   
medical education  programs in the United States  and Canada.                                                                   
That college goes through extensive  accreditation procedures                                                                   
for graduate  medical education,  primarily provided  through                                                                   
2:05:43 PM                                                                                                                    
Representative  Croft asked the  justification for  the broad                                                                   
amount of  discretion that the  legislation would  provide to                                                                   
the  Board.    Mr.  Jordan  stressed   that  it  is  a  "very                                                                   
professional"  State Medical  Board,  who would  not want  to                                                                   
"water"  down any  credentials.   They  would be  determining                                                                   
other alternative measures of competency.                                                                                       
2:07:44 PM                                                                                                                    
DR.   GEORGE   STEWART,   (TESTIFIED   VIA   TELECONFERENCE),                                                                   
PHYSICIAN,  ANCHORAGE, voiced  his support  for the  proposed                                                                   
legislation.    He  noted  that he  has  been  practicing  in                                                                   
Anchorage for over  30-years and is a specialist  in the area                                                                   
of  lung  disease.   At  present  time,  there should  be  10                                                                   
physicians in  that area of critical care  medicine; however,                                                                   
there are  only 8.   He pointed out that  he is now  68 years                                                                   
old and  should have  retired  years ago but  because of  the                                                                   
shortage,  he professionally  has  not been  able  to do  so.                                                                   
Some of the other physicians with  those specialties are also                                                                   
in their 60's.                                                                                                                  
The purpose of  the proposed legislation is not  to lower the                                                                   
standard but rather provide the  Board with the discretion to                                                                   
license physicians  that are qualified,  but do not  meet the                                                                   
exact  letter  of  three  years of  practice  in  the  United                                                                   
States.  He emphasized that there  is consequently, a serious                                                                   
shortfall  of physicians  statewide, which  will only  become                                                                   
worse without passage of the legislation.                                                                                       
Dr.   Stewart  voiced   strong  support   for  the   proposed                                                                   
Vice-Chair Stoltze  noted that  his specialist  had a 3  to 4                                                                   
month  waiting  period and  asked  Dr.  Stewart if  that  was                                                                   
typical.   Dr. Stewart  replied that is  common and  for some                                                                   
new patients, the wait time can be as long as 6 months.                                                                         
Representative Weyhrauch  referenced Section  3, recommending                                                                   
a  conceptual amendment  be added  that  the practitioner  is                                                                   
able to  read and write English.   Mr. Jordan  explained that                                                                   
there are  protections in place  as the medical  boards tests                                                                   
require fluency in English.                                                                                                     
Representative  Weyhrauch  addressed  Section 3,  Section  C,                                                                   
suggesting  to  delete "means"  and  insert "includes".    He                                                                   
thought  that "means"  would  limit the  two  entities.   Mr.                                                                   
Jordan  advised that  the  correct word  is  "means", as  the                                                                   
reference in that  section goes back to the  original body of                                                                   
the  licensing   law,  which   recognizes  graduate   medical                                                                   
programs in  the United States.   The only bodies  recognized                                                                   
are the two listed.                                                                                                             
2:16:52 PM                                                                                                                    
Representative  Croft asked  why there  was a  limit to  only                                                                   
those two in  a bill promoting flexibility.   He thought that                                                                   
the  discretion  in  Section  B  was  removed  by  the  North                                                                   
American definition of "hospital".                                                                                              
Mr. Jordan  responded that  the recognized hospital  language                                                                   
relates to foreign medical graduates  that have satisfied the                                                                   
3-year medical  graduation requirement in the  United States.                                                                   
Latitude is still given, through  the regulatory process, for                                                                   
an equivalency.   However the State Medical  Board would have                                                                   
the authority to bend regulations  for that specific program.                                                                   
Representative Croft  pointed out that  Sections A &  B could                                                                   
be  either/or   and  were  narrowly  defining   the  type  of                                                                   
hospital, which the person must  have their 2-year additional                                                                   
postgraduate  training  at.     He  said  that  was  odd;  he                                                                   
suggested a regulation placed under "B" to address that.                                                                        
2:20:00 PM                                                                                                                    
Co-Chair Meyer agreed with the sponsor and Mr. Jordan.                                                                          
Representative  Foster   MOVED  to  report  HB   102  out  of                                                                   
Committee  with  individual  recommendations   and  with  the                                                                   
accompanying fiscal  note.  There being NO  OBJECTION, it was                                                                   
so ordered.                                                                                                                     
HB  102  was reported  out  of  Committee  with a  "do  pass"                                                                   
recommendation and  with a zero note #1 by  the Department of                                                                   
Community & Economic Development.                                                                                               
2:20:45 PM                                                                                                                    
AT EASE: 2:20:52 PM                                                                                                           
CONVENE: 2:24:00 PM                                                                                                           

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