Legislature(1999 - 2000)

02/11/1999 01:35 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
          SB  29-REQUIREMENTS FOR PHYSICIAN'S LICENSE                                                                           
MARK HODGINS, legislative aide to Senator Jerry Ward, sponsor of SB
29, made the following comments about the measure.  SB 29 will                                                                  
increase the time limits from one to three years for an applicant                                                               
to satisfactorily perform the duties of resident physician or                                                                   
intern at a recognized hospital.  SB 29 will amend current Alaska                                                               
statute to read, "...lawfully residing in the United States," to                                                                
comply with the 1996 federal immigration law.  That law proposes a                                                              
new class of VISA called an H1B; currently most foreign doctors                                                                 
train in the United States under a J1 VISA.  The Alaska medical                                                                 
board would prefer SB 29 to be more comprehensive, however Senator                                                              
Ward chose to keep the focus of CSSB 29 narrow to enhance its                                                                   
chance of passing both houses.  The Alaska medical board is very                                                                
interested in getting SB 29 enacted.  He asked committee members to                                                             
adopt the committee substitute as the working document of the                                                                   
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                                                                
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                                                                
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'                                                                
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                                                             
MR. HODGINS asked Dr. Hudson if his concern was with the domestic                                                               
requirement of two years, and not the foreign requirement of three                                                              
DR. HUDSON said that is correct and he would like to see the                                                                    
domestic requirement decreased to one year.                                                                                     
MR. HODGINS noted from the testimony received today, the  conflict                                                              
appears to center around the change to the domestic requirement,                                                                
and not to the foreign requirement.  He added he will speak to the                                                              
sponsor about removing the change to the domestic requirement.                                                                  
CHAIRMAN MACKIE stated CSSB 29 would be held in committee while                                                                 
some of the concerns expressed are resolved.  He asked Mr. Hodgins                                                              
to provide the committee with a sectional analysis of the bill.                                                                 

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