Legislature(2007 - 2008)SENATE FINANCE 532

02/26/2007 09:00 AM FINANCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 49 COMMEMORATIVE PLATES: STATEHOOD ANIV. TELECONFERENCED
Moved CSSB 49(STA) Out of Committee
+ SB 75 EXTENDING COUNCIL ON DOMESTIC VIOLENCE TELECONFERENCED
Scheduled But Not Heard
+ HB 120 EXTENDING COUNCIL ON DOMESTIC VIOLENCE TELECONFERENCED
Moved SCS CSHB 120(FIN) Out of Committee
+ HB 18 POSTSECONDARY MEDICAL & OTHER EDUC. PROG. TELECONFERENCED
Heard & Held
                                                                                                                                
     SENATE CS FOR CS FOR HOUSE BILL NO. 18(SED)                                                                                
     "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."                                                                                
                                                                                                                                
                                                                                                                                
This was  the first hearing for  this bill in the  Senate Finance                                                               
Committee.                                                                                                                      
                                                                                                                                
AT EASE 9:15:18 AM / 9:15:38 AM                                                                                               
                                                                                                                                
9:15:52 AM                                                                                                                    
                                                                                                                                
MIKE PAWLOWSKI,  Staff to Representative Kevin  Meyer, the bill's                                                               
sponsor, characterized the  State's continuing physician shortage                                                               
to be "at  the edge of crisis". The situation  has been a subject                                                               
of discussion  for many years.  The Alaska Physician  Supply Task                                                               
Force has  recommended that the  State "should seriously  look at                                                               
both recruiting more physicians and growing our own."                                                                           
                                                                                                                                
Mr. Pawlowski explained  that this bill would  further the effort                                                               
to solve the  State's physician shortage by doubling  the size of                                                               
the  State's  participation  in the  post  secondary  Washington,                                                               
Wyoming, Alaska, Montana, and Idaho Biomedical Program (WWAMI).                                                                 
                                                                                                                                
9:17:05 AM                                                                                                                    
                                                                                                                                
Mr.   Pawlowski    specified   that   each    state's   financial                                                               
participation  in WWAMI,  a program  in which  students from  the                                                               
five  aforementioned states  are  educated at  the University  of                                                               
Washington  School  of Medicine,  is  based  upon the  number  of                                                               
students they have enrolled in  the program. Historically, Alaska                                                               
has admitted ten new participants to the program annually.                                                                      
                                                                                                                                
Mr.  Pawlowski  announced  that approximately  one-third  of  the                                                               
physicians  in  Alaska could  be  retiring  within the  next  ten                                                               
years. To that point, this  legislation would increase the number                                                               
of new participants in the WWAMI program each year to 20.                                                                       
                                                                                                                                
Mr.  Pawlowski detailed  the particulars  of  the WWAMI  program.                                                               
After being accepted to the  University of Washington (UW) School                                                               
of  Medicine,  program  participants  attend  the  University  of                                                               
Alaska Anchorage their first year  and then transfer to UW. After                                                               
completing  their  UW training,  they  enter  residency and  work                                                               
toward becoming a full-fledged physician.                                                                                       
                                                                                                                                
Mr. Pawlowski stated  that, in addition to  increasing the number                                                               
of students participating  in the program, this  bill would allow                                                               
participants to  conduct their residency outside  of Alaska. This                                                               
is because  the only residency  program in Alaska "is  limited to                                                               
general  family practice  doctors" and  the State  is in  need of                                                               
other types  of physicians. Allowing  students "to  conduct their                                                               
residency out of state" would be beneficial to the program.                                                                     
                                                                                                                                
Mr.  Pawlowski  noted  that  the   Senate  Special  Committee  on                                                               
Education bill  before the Committee changed  language pertaining                                                               
to  how interest  accrues  on  a WWAMI  student  loan during  the                                                               
participant's  out-of-state   residency  period:  it   would  not                                                               
require that  "repayment" until the  participant returned  to the                                                               
State  "to  fulfill their  obligation  or  leave their  residency                                                               
program or assorted service."                                                                                                   
                                                                                                                                
Mr.  Pawlowski deemed  the actions  proposed in  this bill  to be                                                               
"the first step in bridging our  physician shortage; it is a long                                                               
time lead  step" of  perhaps seven to  ten years.  That timeframe                                                               
would  be   approximately  when  the  State   would  require  new                                                               
physicians to replace  retiring ones. The effort  to increase the                                                               
number of  physicians is  welcome as it  would improve  access to                                                               
care and  perhaps assist in lowering  the cost of medial  care in                                                               
the State.                                                                                                                      
                                                                                                                                
9:19:15 AM                                                                                                                    
                                                                                                                                
In response  to a  request from  Co-Chair Stedman,  Mr. Pawlowski                                                               
explained that  Alaska, Wyoming,  Idaho, and  Montana participate                                                               
in  the  WWAMI program  in  partnership  with  the UW  School  of                                                               
Medicine  because no  medical school  is  available within  their                                                               
state. UW  essentially becomes the participating  state's medical                                                               
school.                                                                                                                         
                                                                                                                                
Co-Chair  Hoffman recalled  a recent  discussion between  Senator                                                               
Olson   and  Alaska's   Congressional   Senator  Lisa   Murkowski                                                               
regarding  the challenge  of attracting  more  physicians to  the                                                               
State.  To that  point,  Co-Chair Hoffman  assessed  the need  to                                                               
increase the number  of general practitioners to  be greater than                                                               
the need  to attract medical  specialists, particularly  in Rural                                                               
Alaska. Therefore,  he suggested  that consideration be  given to                                                               
requiring  graduates  of the  WWAMI  program  to provide  general                                                               
practice service to the State.                                                                                                  
                                                                                                                                
Co-Chair  Hoffman  also  asked  the  program's  success  rate  in                                                               
respect to  the number  of graduates who  return and  practice in                                                               
Alaska.                                                                                                                         
                                                                                                                                
Mr.  Pawlowski  stated  that  Alaska  Statute  B,  which  is  not                                                               
addressed  in this  bill,  specifies that  a  WWAMI student  loan                                                               
should  be  repaid  over  a  five year  period.  Statute  B  also                                                               
specifies  that  a  student   conducting  their  family  practice                                                               
residency  in the  State  would receive  "credit  towards my  100                                                               
percent payback for the three  years that I'm in residency". This                                                               
provides  an "implicit  benefit  to the  student  going into  the                                                               
WWAMI program to come back"  and practice general family medicine                                                               
in the State.                                                                                                                   
                                                                                                                                
Mr.  Pawlowski stressed  how challenging  it is,  when a  student                                                               
enters the program,  to determine where they  would conduct their                                                               
residency or  what specialty they would  pursue. Nonetheless, the                                                               
consensus  is  that  the  State   is  in  need  of  both  general                                                               
practitioners and specialists.                                                                                                  
                                                                                                                                
Mr. Pawlowski  emphasized, however,  that the number  of students                                                               
who  return and  practice in  the State  exceeds 80  percent. The                                                               
bill's   sponsor,   Representative   Meyer,  believes   this   is                                                               
indicative of a successful program.                                                                                             
                                                                                                                                
9:22:52 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  asked  the  timeframe  pertaining  to  the  80                                                               
percent student return rate.                                                                                                    
                                                                                                                                
Mr. Pawlowski  understood it  was based on  records for  the past                                                               
five  to seven  years.  This information  should  be verified  by                                                               
either the UW or the WWAMI program coordinators.                                                                                
                                                                                                                                
Co-Chair  Hoffman  asked  how  many   of  those  physicians  have                                                               
practiced in the State more than ten years.                                                                                     
                                                                                                                                
Mr. Pawlowski  suggested that representatives  of the UW  and the                                                               
WWAMI  program   who  were  listening   to  the   discussion  via                                                               
teleconference could  better address  the question.  He cautioned                                                               
however that such information might  have been difficult to track                                                               
prior to  the year 2000  when repayment provisions were  added to                                                               
the program.                                                                                                                    
                                                                                                                                
9:24:20 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  opined  that  both the  success  rate  of  the                                                               
program and the long term  retention rate of its graduates should                                                               
be determined since consideration is  being given to doubling the                                                               
number  of students  admitted and,  thus,  the State's  financial                                                               
commitment, to the program.                                                                                                     
                                                                                                                                
9:24:38 AM                                                                                                                    
                                                                                                                                
Senator Elton  advised of  a concern communicated  to him  that a                                                               
[unspecified] provision  in the bill might  "discourage a general                                                               
practice or  a family practice  because" it might  "compel people                                                               
into a specialty  that, in fact, paid more to  deal with the loan                                                               
cost".                                                                                                                          
                                                                                                                                
9:25:15 AM                                                                                                                    
                                                                                                                                
Mr.  Pawlowski had  "heard the  same  characterization", but  was                                                               
unsure  of its  fairness.  Even though  students  in the  program                                                               
could  accumulate  "a  debt  burden  of  $150,000  to  $200,000",                                                               
conducting  their  residency  in  the  State  would  reduce  that                                                               
burden,  and thus  allow  a  student to  go  into general  family                                                               
practice. This debt forgiveness  factor could create "an adequate                                                               
hook to ensure"  that a student would come back  to the State. He                                                               
acknowledged however that the issue  could be argued two ways and                                                               
therefore would be a policy call.                                                                                               
                                                                                                                                
9:26:18 AM                                                                                                                    
                                                                                                                                
Senator  Elton  suggested  that   the  University  of  Alaska  be                                                               
provided an opportunity  to weigh in on whether this  might be "a                                                               
potential problem" before the Committee took action on the bill.                                                                
                                                                                                                                
Co-Chair  Stedman  communicated  that  the  University  would  be                                                               
provided an  opportunity to comment,  as he intended to  hold the                                                               
bill in Committee.                                                                                                              
                                                                                                                                
9:26:40 AM                                                                                                                    
                                                                                                                                
Senator Olson  advised of having  information that  might address                                                               
Co-Chair Hoffman's  earlier concern  about medical care  in Rural                                                               
Alaska.                                                                                                                         
                                                                                                                                
Co-Chair  Stedman  asked  that   the  information  referenced  by                                                               
Senator Olson  be distributed to  Members after  today's hearing.                                                               
That  would allow  Members  time  to review  it  before the  next                                                               
hearing on the bill.                                                                                                            
                                                                                                                                
Senator Olson agreed.                                                                                                           
                                                                                                                                
9:27:43 AM                                                                                                                    
                                                                                                                                
ROD BETIT,  President and Chief  Executive Officer,  Alaska State                                                               
Hospital and  Nursing Home  Association, spoke  on behalf  of the                                                               
organization's 37  members which  included "all of  the military,                                                               
State,  tribal, and  private  facilities in  the  State with  the                                                               
exception of one". This legislation  is the "number one priority"                                                               
of the Association.  Members' packets include a  January 16, 2007                                                               
letter  [copy on  file] to  Representative Kevin  Meyer from  the                                                               
Association to that effect.                                                                                                     
                                                                                                                                
Mr.  Betit  spoke to  the  effort  Association members  exert  to                                                               
attract physicians to meet the needs  of the State. Also, being a                                                               
member  of  the  aforementioned   Task  Force,  he  shared  their                                                               
conclusion that the  State must experience an annual  net gain of                                                               
59 physicians rather than the current  net gain of 38 in order to                                                               
adequately   address  the   State's  physician   shortage,  which                                                               
currently   exceeds  300.   The   Task   Force  considered   this                                                               
legislation  "a  very  significant step"  toward  addressing  the                                                               
problem.                                                                                                                        
                                                                                                                                
Mr.  Betit  advised  that annually,  approximately  half  of  the                                                               
students  who participated  in the  WWAMI program  return to  the                                                               
State  to  practice. Another  three  or  four students  from  the                                                               
partnering states  who were  exposed to Alaska  as part  of their                                                               
clinical training also chose to  practice in the State. "That's a                                                               
pretty healthy return rate."                                                                                                    
                                                                                                                                
Mr.  Betit considered  this legislation  to be  "one of  the most                                                               
cost  beneficial things  that the  State could  do to  help close                                                               
that gap" in the State's physician shortage.                                                                                    
                                                                                                                                
Mr.  Betit urged  prompt action  on the  bill as  the goal  is to                                                               
expand the State's WWAMI class size this year.                                                                                  
                                                                                                                                
9:30:47 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman  revisited his earlier concern  about the number                                                               
of program graduates  who return to the  State; specifically that                                                               
he could  not recall any  WWAMI graduate having practiced  in the                                                               
Yukon-Kuskokwim region of  the State. He also  inquired about the                                                               
tenure of those who did practice in the State.                                                                                  
                                                                                                                                
Mr.  Betit  expressed that  this  information  was available  and                                                               
would be  provided. He agreed  that the Yukon-Kuskokwim  area "is                                                               
particularly stressed as far as  having enough physicians to meet                                                               
the needs of the people" there.  The experience at any given time                                                               
last year was  that approximately 21 more  physicians were needed                                                               
to cover the  clinics and serve the area's  residents. The Yukon-                                                               
Kuskokwim medical  facility had only  11 or 12  staff physicians;                                                               
the  balance consisted  of traveling  physicians  who would  stay                                                               
approximately  two   or  two  weeks.   This  is   detrimental  to                                                               
continuity of patient care.                                                                                                     
                                                                                                                                
Mr.  Betit informed  the Committee  that rural  representation in                                                               
the WWAMI program  was strong. Candidates were  well prepared and                                                               
had the ability to compete well for placement in the program.                                                                   
                                                                                                                                
9:32:28 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  asked whether  the  proposal  to increase  the                                                               
State's  participation in  the WWAMI  program had  been discussed                                                               
with the UW to verify the increase could be accommodated.                                                                       
                                                                                                                                
Mr.  Betit assured  that UW  had committed  to accommodating  ten                                                               
additional  program   participants  from  Alaska.  UW   had  also                                                               
requested that the State make a  decision in this regard by early                                                               
March as the selection process  for the next medical school class                                                               
was underway.                                                                                                                   
                                                                                                                                
9:33:24 AM                                                                                                                    
                                                                                                                                
Senator  Olson  asked Mr.  Betit  how  the decision  to  increase                                                               
program  participants  to  20  rather  than 25  or  30  had  been                                                               
reached,  considering  the  high  demand for  physicians  in  the                                                               
State.                                                                                                                          
                                                                                                                                
9:34:04 AM                                                                                                                    
                                                                                                                                
Mr.  Betit responded  that  the Task  Force  recognized that  the                                                               
physician shortage could  not be rectified in  short order. Thus,                                                               
the  Task Force's  goal was  "to  get our  physician capacity  to                                                               
where  it needed  to be  by  the year  2025."  A net  gain of  21                                                               
additional physicians per year would  be required to achieve that                                                               
goal. The  shortage in  the short term  would continue  since the                                                               
impact  of the  first graduates  of the  20-student Alaska  WWAMI                                                               
class  would   not  be  felt   for  approximately   seven  years.                                                               
Regardless, this legislation was considered "good strategy".                                                                    
                                                                                                                                
Mr. Betit  opined that, until  then, it would be  "unrealistic to                                                               
think  that" the  State would  attract  30 or  40 new  physicians                                                               
annually, as the  competition, nationally, is high. A  goal of 20                                                               
is considered realistic.                                                                                                        
                                                                                                                                
9:35:09 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  asked  whether housing  and  medical  facility                                                               
conditions were  considered in the effort  to recruit physicians,                                                               
as improved  housing and school facility  conditions enhanced the                                                               
effort to address teacher shortages in rural areas of the State.                                                                
                                                                                                                                
Mr. Pawlowski affirmed that  "the physician practice environment"                                                               
had  been reviewed  in the  effort to  make practicing  in Alaska                                                               
attractive, particularly in  the more remote areas  of the State.                                                               
While  further  attention  should  be devoted  to  the  physician                                                               
practice environment,  enlarging the WWAMI program  and educating                                                               
and encouraging  Alaskan students to  practice in the  State made                                                               
"more  sense" than  concentrating on  recruiting physicians  from                                                               
outside the State.                                                                                                              
                                                                                                                                
9:36:42 AM                                                                                                                    
                                                                                                                                
Senator Dyson  communicated that  "physician friends ….  who have                                                               
practiced in  Rural communities say  there are  some professional                                                               
trade-offs". For example, doing  so provided them the opportunity                                                               
to practice a  wider range of medical procedures  than they might                                                               
have  experienced in  an urban  community setting.  He asked  Mr.                                                               
Betit  to  expand  on the  different  "professional  development"                                                               
opportunities  one  might  experience  in a  small  verses  large                                                               
medical  environment;  specifically  whether  such  opportunities                                                               
might attract physicians.                                                                                                       
                                                                                                                                
9:37:37 AM                                                                                                                    
                                                                                                                                
Mr. Betit  responded that some  physicians like the  challenges a                                                               
small  rural clinic  might present  while  others do  not. It  is                                                               
importance  to  prevent  physicians  in more  remote  areas  from                                                               
feeling "isolated" and without any  professional support. To that                                                               
point, he  applauded previous  Legislative action  which provided                                                               
one million dollars toward a  tele-radiology system for hospitals                                                               
and clinics  in rural  communities. The  response to  this system                                                               
has  been very  positive, and  it  has enhanced  patient care  by                                                               
allowing  medical personnel  to send  film to  and teleconference                                                               
with larger medical resources.                                                                                                  
                                                                                                                                
Mr. Betit  stated that further  efforts should be made  to ensure                                                               
that the practice  environment in remote areas  makes a physician                                                               
feel comfortable.                                                                                                               
                                                                                                                                
9:38:53 AM                                                                                                                    
                                                                                                                                
Senator Dyson  acknowledged, but clarified that  his question was                                                               
to the  benefits physicians  might experience  by being  in rural                                                               
environments.                                                                                                                   
                                                                                                                                
9:39:28 AM                                                                                                                    
                                                                                                                                
Mr.  Betit expressed  that  the  lifestyle, size  and  feel of  a                                                               
community, and having  to cope with a lack of  managed care might                                                               
be "on the positive side" of working in a rural area.                                                                           
                                                                                                                                
9:39:59 AM                                                                                                                    
                                                                                                                                
Senator  Thomas  asked  whether  Alaska's  physician  recruitment                                                               
experiences  differed  from  those  experienced  by  other  rural                                                               
states.                                                                                                                         
                                                                                                                                
9:40:24 AM                                                                                                                    
                                                                                                                                
Mr.  Betit replied  that Alaska's  experiences were  not unusual;                                                               
the physician  shortage is widespread  and many small  states are                                                               
required  to vigorously  recruit. Nonetheless,  living in  Alaska                                                               
has  "additional challenges".  In addition,  "managing a  patient                                                               
population in this  size state isn't as efficient as  it would be                                                               
in bigger settings."                                                                                                            
                                                                                                                                
Mr.  Betit disclosed  that  Wyoming is  expanding  its number  of                                                               
WWAMI program  participants in order to  increase its opportunity                                                               
to hire in-state  students. Alaska must be  aggressive in keeping                                                               
up with the efforts of other WWAMI states.                                                                                      
                                                                                                                                
9:41:15 AM                                                                                                                    
                                                                                                                                
Senator  Thomas  inquired  to  other  measures  the  State  might                                                               
undertake  to address  the physician  shortage beyond  increasing                                                               
the number of WWAMI participants.                                                                                               
                                                                                                                                
Mr.  Betit  stated that  the  Task  Force's report  "Securing  an                                                               
Adequate Number of Physicians for  Alaska's Needs "[copy on file]                                                               
includes  several recommendations  regarding how  to improve  the                                                               
practice environment.                                                                                                           
                                                                                                                                
Mr. Betit credited previous Legislative  action that improved the                                                               
State's tort  reform provisions  for "a  significant drop  in the                                                               
liability"  facing physicians.  That has  been "a  big factor  in                                                               
terms of being able to attract  the physicians that are coming to                                                               
the State".                                                                                                                     
                                                                                                                                
Mr.  Betit noted  that other  Task Force  recommendations address                                                               
such  things  as  the  loan   repayment  program,  the  physician                                                               
recruitment  process,  and  other  practice  environment  issues.                                                               
While  no   formal  strategies  have  yet   been  developed,  his                                                               
organization  and  others  have  committed to  assisting  in  the                                                               
endeavor.                                                                                                                       
                                                                                                                                
9:42:42 AM                                                                                                                    
                                                                                                                                
Senator  Olson understood  that  a recent  trend  in health  care                                                               
treatment  has  been  toward   utilizing  mid-level  health  care                                                               
professionals   such   as    physician   assistants   and   nurse                                                               
practitioners,  particularly in  treating  Medicare and  Medicaid                                                               
patients. He had not noticed much  emphasis placed on this in the                                                               
Task Force report.                                                                                                              
                                                                                                                                
Mr.  Betit  clarified  that  the  focus  of  the  report  was  to                                                               
physician  needs  in  the  State. However,  the  Task  Force  had                                                               
discussed  mid-level providers  and  included a  notation in  the                                                               
report that  Alaska had "a  higher proportion" of mid  level care                                                               
givers  than most  states. "The  relationship between  mid-levels                                                               
and physicians  in Alaska  is much  stronger than  it is  in most                                                               
states…." The desire  would be for that  relationship to continue                                                               
and that  more mid-level providers  be available to fill  some of                                                               
the gaps in the State's health care system.                                                                                     
                                                                                                                                
9:44:14 AM                                                                                                                    
                                                                                                                                
Senator  Huggins questioned  whether  the language  in Section  1                                                               
subsection (d),  page 1 line  9, that specified that  the program                                                               
would  "accommodate at  least 20  new  program participants  each                                                               
year" meant  that the  program could be  expanded beyond  20 were                                                               
there a large field of qualified candidates.                                                                                    
                                                                                                                                
Mr.  Betit understood  the verbiage  to  allow for  more than  20                                                               
program participants provided  additional funding was authorized.                                                               
The goal  this year was  to receive funding authorization  for an                                                               
additional  ten  program  participants. This  would,  in  effect,                                                               
increase the program size to 20.                                                                                                
                                                                                                                                
9:45:01 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman,  referring to language in  Section 2 subsection                                                               
(a), page  2 lines  3 and  4 of the  bill which  outlined student                                                               
obligations, asked whether it "would  be wise to" require program                                                               
participants returning to  the State to practice "in  some of the                                                               
most deprived areas of the State".                                                                                              
                                                                                                                                
9:45:36 AM                                                                                                                    
                                                                                                                                
Mr. Betit  expressed being  unqualified to  speak to  that issue.                                                               
However,  he  noted that  academics  have  voiced concern  "about                                                               
imposing" such a condition.                                                                                                     
                                                                                                                                
9:45:54 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman   was  concerned   that  even   though  program                                                               
participants  return  to the  State  to  practice, "the  services                                                               
aren't getting out to the areas that are most underserved…."                                                                    
                                                                                                                                
9:46:31 AM                                                                                                                    
                                                                                                                                
LEO  BUSTAD,  Cardiologist with  the  Alaska  Heart Institute  in                                                               
Anchorage testified in Juneau on  behalf of Alaska physicians and                                                               
surgeons.  His   background  included  being  a   member  of  the                                                               
University  of Alaska's  chancellor advisory  board and  previous                                                               
service  as  a clinical  professor  at  the University  of  North                                                               
Carolina.                                                                                                                       
                                                                                                                                
Dr.  Bustad  spoke  about the  opportunities  the  State's  WWAMI                                                               
program  has  provided  to program  participants  for  20  years.                                                               
However, even  thought the State's  population and  medical needs                                                               
have risen,  the number  of participants in  the program  has not                                                               
been   increased.  Approximately   40  "well-qualified"   Alaskan                                                               
students are  denied admittance to  the program's ten  slots each                                                               
year despite the increased need.                                                                                                
                                                                                                                                
Dr. Bustad informed  the Committee that his  medical practice has                                                               
had to contract with a  recruitment search company for many years                                                               
in spite of  the fact that cardiology is an  attractive field. It                                                               
would be easier to recruit from  an Alaskan pool of applicants as                                                               
they  are  familiar with  the  State  and typically  have  family                                                               
nearby rather  than 3,000 miles  away as could be  the experience                                                               
when hiring people from outside the State.                                                                                      
                                                                                                                                
Dr.  Bustad elaborated  that the  WWAMI  program provides  Alaska                                                               
students  an  opportunity  to  attend medical  school.  It  is  a                                                               
successful program, and rather than  solely focusing on the costs                                                               
associated  with   increasing  the  program,  the   cost  of  not                                                               
increasing program  funding should  be considered.  The physician                                                               
shortage in Anchorage is the price being paid now.                                                                              
                                                                                                                                
Dr. Bustad  acknowledged the physician  shortage in  Rural Alaska                                                               
and  noted that  many students  in the  WWAMI program  "have come                                                               
from western Alaska".  It is much easier to  recruit those people                                                               
"to come back and practice in  western Alaska than it would be to                                                               
recruit  someone  from   New  York  City."  The   State  has  "an                                                               
obligation to our young people to  give them an opportunity to go                                                               
to  medical school".  The program  "is one  of the  few workforce                                                               
development programs  that has been very  successful. The dropout                                                               
rate is near zero."                                                                                                             
                                                                                                                                
Dr. Bustad asserted that a  large group of qualified students who                                                               
desire to  become doctors  are denied  admittance to  the program                                                               
each year  "despite at the  end of  the pipeline there's  a large                                                               
number  of  jobs  that  go unfulfilled.  The  university  is  the                                                               
bottleneck."                                                                                                                    
                                                                                                                                
Dr. Bustad concluded  that the cost of the program  would be more                                                               
attractive were  it viewed  in terms of  the number  of "students                                                               
completing the  program as opposed  to the cost of  the students"                                                               
going into it.                                                                                                                  
                                                                                                                                
Co-Chair  Hoffman believed  in the  program,  but contended  that                                                               
there  were  other  opportunities through  which  students  could                                                               
receive a medical education.                                                                                                    
                                                                                                                                
Dr. Bustad  stated that, were  the State-supported  WWAMI program                                                               
eliminated, students  would be forced  to attend  private medical                                                               
schools. They  would, most likely,  incur huge debt  and thereby,                                                               
might  not  be  prone  to  return to  Alaska.  In  addition,  the                                                               
opportunity to attend a private medical school is limited.                                                                      
                                                                                                                                
9:51:52 AM                                                                                                                    
                                                                                                                                
Senator  Elton  asked the  types  of  medical residency  programs                                                               
available in the State.                                                                                                         
                                                                                                                                
Dr.  Bustad  advised  that  the   family  practice  residency  at                                                               
Providence Hospital  in Anchorage  had the  capacity to  train 12                                                               
physicians  a  year.  That  program, which  "is  the  only  self-                                                               
contained residency program in the  State" is successful in terms                                                               
of retaining physicians in the  State. Other residency physicians                                                               
"rotate  through Alaska  hospitals  in  certain situations."  For                                                               
example,  the Navy  hospital provides  some  surgeon and  perhaps                                                               
some  internal medicine  opportunities.  There  are no  residency                                                               
programs  for cardiologists.  Third  and fourth  year UW  medical                                                               
students  also have  the opportunity  to  rotate through  Alaska.                                                               
Such  exposure  might encourage  students  from  other states  to                                                               
consider practicing here.                                                                                                       
                                                                                                                                
9:53:10 AM                                                                                                                    
                                                                                                                                
Senator  Elton   declared  that  residency  programs   should  be                                                               
encouraged  as  there  is  a  connection  between  residency  and                                                               
physicians deciding to stay and practice in the State.                                                                          
                                                                                                                                
Dr. Bustad  specified that simply  adding ten students a  year to                                                               
the WWAMI program should not  be lauded as the complete solution.                                                               
Alaska's  current physician  force is  aging and  while enlarging                                                               
the  WWAMI  class  this  year is  encouraged,  graduates  of  the                                                               
program might  not be available  to replace  retiring physicians,                                                               
including his fellow cardiologists, until perhaps the year 2017.                                                                
                                                                                                                                
Dr. Bustad  reiterated that  "the cost of  doing nothing  is very                                                               
high".                                                                                                                          
                                                                                                                                
Senator  Olson  observed that  allowing  Alaskan  students to  be                                                               
educated closer to home and to  their support group was a benefit                                                               
to them and the State.                                                                                                          
                                                                                                                                
Senator  Olson also  opined that,  in  addition to  the need  for                                                               
general family  practitioners, there  would be  increasing demand                                                               
for   cardiologists  and   other  specialists   as  the   State's                                                               
population aged. He asked Dr. Bustad's perspective on this.                                                                     
                                                                                                                                
9:56:22 AM                                                                                                                    
                                                                                                                                
Dr. Bustad remarked  that the number of specialists  in the State                                                               
is  not  keeping  pace  with  demand  even  now.  He  experienced                                                               
difficulty  finding   specialized  treatment  for  some   of  his                                                               
patients, even  in Anchorage. Providence  Hospital, which  is the                                                               
largest medical  complex in the  State, has only  two internists.                                                               
The  internist who  would accept  Medicaid patients  was a  WWAMI                                                               
student.                                                                                                                        
                                                                                                                                
Dr.  Bustad ranked  the lack  of primary  care physicians  as the                                                               
State's  largest medical  "deficit,  however, there  was also  an                                                               
inadequate number  of specialists.  The State must  do "something                                                               
dramatically  different"  or  the  situation  would  continue  to                                                               
deteriorate.                                                                                                                    
                                                                                                                                
9:57:39 AM                                                                                                                    
                                                                                                                                
Senator Huggins asked the effect of tort reform on physicians.                                                                  
                                                                                                                                
9:58:01 AM                                                                                                                    
                                                                                                                                
Dr. Bustad expressed that the  State of Washington's current tort                                                               
reform measures resemble those of  Alaska's before Alaska changed                                                               
theirs.  Spokane  Washington  has   experienced  a  net  loss  of                                                               
physicians:  they moved  out of  state  due to  the state's  tort                                                               
reform.                                                                                                                         
                                                                                                                                
Dr. Bustad  opined that  Alaska's physician  recruitment problems                                                               
were not attributable to its  tort reform provisions but resulted                                                               
from   the   State's   distance  from   other   places.   Medical                                                               
professionals and  their families  hesitate to come  here because                                                               
they would be far from family.                                                                                                  
                                                                                                                                
9:58:50 AM                                                                                                                    
                                                                                                                                
Senator  Olson asked  whether the  medical climate  in the  State                                                               
might shift toward managed  care organizations, commonly referred                                                               
to as Health Management Organizations (HMOs).                                                                                   
                                                                                                                                
Dr. Bustad  did not think that  shift would occur because  of the                                                               
State's  remoteness, its  limited  opportunities,  and its  small                                                               
population base.                                                                                                                
                                                                                                                                
9:59:51 AM                                                                                                                    
                                                                                                                                
After consulting  with Co-Chair Stedman, Mr.  Pawlowski agreed to                                                               
work with Finance staff to  develop a list of Committee questions                                                               
to be  addressed by WWAMI program  managers in Alaska and  at UW.                                                               
The responses would be provided in writing.                                                                                     
                                                                                                                                
Co-Chair Stedman ordered the bill HELD in Committee.                                                                            
                                                                                                                                
AT EASE 10:01:07 AM / 10:01:42 AM                                                                                           
                                                                                                                                

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