Legislature(2001 - 2002)
02/12/2002 01:35 PM Senate L&C
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* first hearing in first committee of referral
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SB 274-PHYSICIANS' LOCUM TENENS PERMITS
CHAIRMAN STEVENS announced SB 274 to be up for consideration.
SENATOR OLSON, sponsor of SB 274, thanked the committee for
bringing up this bill. It allows the State Medical Board to issue
a locum tenens permit to a physician or osteopath for purposes of
employment evaluation.
Their Association believes that the use of a locum
tenens permit in this way will enhance the recruitment
of qualified doctors for permanent positions within the
state.
The issue of recruitment is a matter of increasing
concern for the Medical Association because of both the
aging population of Alaskan practitioners and the small
number of Alaskans that graduate from medical school
every year. Over 50 percent of Alaska's 2,000 medical
doctors are past the age of 50. Typically, the WWAMI
medical program produces eight new doctors per year.
Replacement of retiring physicians and osteopaths will
increasing depend on the recruitment success.
Statistics indicate that the Alaska physician workforce
is already under represented in comparison with other
western states.
SB 274 temporarily permits an invited physician to
practice medicine for 60 days for employment
evaluation. This bill also allows the medical board to
further extend a 240 day time limit in a situation
where a locum tenens doctor, who is substituting for an
Alaskan physician, is providing a critical and
essential service.
CHAIRMAN STEVENS asked if he could explain his last sentence and
if the 240 day time limit exists now.
SENATOR OLSON replied that it does. In order for a physician to
get a substitute, if there are five slots, they all have to be
filled. Otherwise the pressure on the other four gets to be
intense, especially when dealing with four-wheeler accidents,
gunshot incidents or trying to get people out to villages to have
village clinics. This allows a physician to get a permit for 60
days as a substitute for a returning doctor. The Medical
Association has requested this legislation to give clinics time
to see if a temporary doctor would complement the other doctors'
specialties.
SENATOR AUSTERMAN asked what happens currently.
SENATOR OLSON explained that now when someone gets a locum tenens
permit, the physician has to leave the site before he fills the
position.
SENATOR TORGERSON asked who the "designee" is.
SENATOR OLSON replied that the Medical Board is comprised of
physicians who are practicing within the state, two from the
general public, and one who is a physician assistant. They meet
four times a year. When something comes up and a decision needs
to be made, the designee to make the decision is normally the
executive director who currently is Ms. Leslie Abel.
MR. RANDALL BURNS, Chief Executive Officer, Alaska Psychiatric
Institute (API) supported SB 274. He said in many cases hospitals
have staff physicians and when they have a vacancy, they use
locum tenens to fill the vacancy while they try to choose a new
doctor. They are not substituting doctors; they actually have a
vacancy. The Medical Board has taken the position that the
current statute doesn't allow for locum tenens to be used in that
capacity [to fill a vacant position that does not have another
doctor coming back to work]. He said he had language that would
fix that problem.
MS. CATHERINE REARDON, Executive Director, Division of
Occupational Licensing, said she staffs the State Medical Board,
which is a group of volunteers that meets quarterly. She emails
the members on issues of concern between meetings. At this point,
she has heard from only two members on this bill, but both
expressed concern and individual opposition. The Board has
regulations implementing the locum tenens statute and 12AAC40.036
says:
A physician who is not currently licensed in this state
may apply for a locum tenens permit for the purpose of
substituting for a physician licensed in this state who
(1) is temporarily absent from the practice location at
which the applicant applies, or (2) is not expected to
return to the practice location, if issuance of the
locum tenens permit is necessary to temporarily provide
essential medical services to the public or to protect
the public health and safety.
So, she said, the current Board regulations do provide for the
possibility of a locum tenens for a vacancy rather than just a
substitute while someone is on leave, but the Board must feel
that it is necessary to provide essential medical services to the
public or protect the public health and safety and she thought
that was where the issue has come up. The Board has this
regulation that acknowledges that sometimes a vacancy is an
appropriate reason for locum tenens; the Board feels that it
needs to be essential, not just whenever you have a vacancy or
not because you aren't proceeding promptly to fill your
vacancies.
CHAIRMAN STEVENS asked if they were taking regulation and putting
it into statute.
MS. REARDON said no; she doesn't agree that the Board no longer
issues locum tenens for vacancy reasons. She thinks that they do
and she is differing with Mr. Burns whether the Board will issue
for vacancy purposes. This Board has sent out the message that it
should only be used for vacancy purposes when all other means of
getting a completely licensed physician have been exhausted.
SENATOR TORGERSON asked where was the letter of opposition from
the Board.
MS. REARDON replied that she just informal wording in emails from
the two members, which she would show him.
SENATOR TORGERSON asked when the Board would have a position on
the bill.
MS. REARDON replied that their next regular board meeting is in
April. She will probably get more individual comments until then.
MR. JIM JORDAN, Executive Director, Alaska State Medical
Association, said that basically there were two reasons why they
were interested in the enactment of this bill.
The first and primary reason is recruitment. The one
area that is not currently allowed for under the locum
tenens permitting system is for the use of a locum
tenens permit in the circumstance when a physician is
being evaluated for potential employment at a later
date. That is the primary reason the State Medical
Association wants this bill.
He said Alaska has relatively few doctors compared to other
states and we have a workforce that is rapidly aging and the
replacement task is going to be quite large. The second reason
has to do with the extension of the 240-day limit in the two-year
period in which locum tenens circumstances are allowed for. They
want to provide physicians in areas that are underserviced.
2:10 p.m.
SENATOR AUSTERMAN asked what the definition was of locum tenens
and asked if physicians and radiologists were classified the same
way.
SENATOR OLSON replied that the interpretation for locum tenens
has to do with the temporary permitting of a physician to
practice medicine in whatever location he is called to. He said
that radiologists are covered in this bill; they are a medically
licensed person who has either an MD degree or a DO (Doctor of
Osteopathy) who has done a residency in radiology and in many
cases has fulfilled the number of years to become Board eligible.
Many have gone on the take the Board exams and become certified.
CHAIRMAN STEVENS asked if he would work through the concerns of
API within two weeks and asked Ms. Reardon if she would convene
the State Board and get a recommendation within that time, also.
SENATOR TORGERSON suggested looking at a different timeline for
filling vacancies instead of the 240 days.
MS. LORRAINE DERR, Alaska State Hospital and Nursing Home
Association, supported SB 274. She said that Mr. Burns is part of
her organization and the problem comes in in interpretation. The
Board is talking about temporary or essential services. Using the
Fairbanks Hospital that was trying to find a psychiatrist as an
example, she said that they are difficult to find right now.
There becomes a difficulty between are they recruiting to find a
psychiatrist or are they using locum tenens to fill the position.
"There has been a tug of war there."
There has also been a tug of war in the interpretation of what
temporary is. This legislation is an attempt to clarify some of
those issues. The Association supports reworking the definitions.
CHAIRMAN STEVENS said they would hold the bill for further work
and adjourned the meeting at 2:15 p.m.
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