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