Legislature(1999 - 2000)

02/25/1999 01:38 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
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           SB 29-REQUIREMENTS FOR PHYSICIAN'S LICENSE                                                                           
                                                                                                                                
CHAIRMAN MACKIE called the Senate Labor and Commerce Committee                                                                  
meeting to order at 2:38 p.m. and announced SB 29 to be up for                                                                  
consideration.                                                                                                                  
                                                                                                                                
MR. MARK HODGINS, staff to Senator Ward, sponsor of SB 29, said at                                                              
the end of the last meeting there was some opposition concerning                                                                
the time period for training American physicians.  So, he took out                                                              
references to American and Canadian physicians' training and kept                                                               
the requirements for foreign physicians.  The Medical Board                                                                     
continues to support this change.                                                                                               
                                                                                                                                
SENATOR LEMAN moved to adopt Lauterbach draft LS0270\H, dated                                                                   
2/11/99.  There were no objections and it was so ordered.                                                                       
                                                                                                                                
MR. HODGINS explained that the CS changes the requirements for                                                                  
foreign physicians to practice in the State of Alaska.  It requires                                                             
a three-year term that can be  either an internship, a residency,                                                               
or to satisfactory performance of the duties and functions of an                                                                
intern/resident. A candidate must submit documentation to the                                                                   
program which has to be approved by the American Board of Medical                                                               
Specialists.  One other change is the citizen language, "citizen of                                                             
the United States or lawfully residing in the United States" and                                                                
the deletion of the phrase,  "admitted for permanent residence".                                                                
                                                                                                                                
SENATOR MACKIE asked if this change was one of the three things the                                                             
committee was originally trying to accomplish.                                                                                  
                                                                                                                                
MR. HODGINS answered yes, this is one of the suggestions from the                                                               
Medical Board.  There was a lot of opposition to this bill, because                                                             
the Board had not educated people.  Therefore, they removed the                                                                 
more controversial portions.  Basically, he repeated, CSSB 29                                                                   
increases the time limit from one year to three years for a foreign                                                             
applicant to satisfactorily perform the duties of resident                                                                      
physician or intern at a recognized hospital.  The time increase is                                                             
because of a variety of different foreign curriculums across the                                                                
world.  Three years gives the Medical Board a good feeling that the                                                             
doctor has learned what is adequate for residents of the State of                                                               
Alaska.                                                                                                                         
                                                                                                                                
CHAIRMAN MACKIE asked if there was currently a shortage of locally                                                              
trained doctors and if there was a need for foreign doctors now.                                                                
                                                                                                                                
MR. HODGINS replied that there is a need for certain specialists,                                                               
not necessarily general practitioners.  The Medical Board supports                                                              
this.                                                                                                                           
                                                                                                                                
CHAIRMAN MACKIE asked if other states allow the same thing.                                                                     
                                                                                                                                
MR. HODGINS replied in other states licensure of immigrating                                                                    
doctors requires from one year to three years.  A majority of                                                                   
states require two years and above.  Alaska would be requiring the                                                              
most time.  Nine states require one year, 16 states require two                                                                 
years, and 29 states require three years.                                                                                       
                                                                                                                                
CHAIRMAN MACKIE asked if we are the only state that doesn't allow                                                               
licensure of foreign doctors right now.                                                                                         
                                                                                                                                
MR. HODGINS replied that all states allow foreign doctors; only the                                                             
residency requirements differ.                                                                                                  
                                                                                                                                
CHAIRMAN MACKIE asked if this bill does more than make the                                                                      
requirements more stringent.                                                                                                    
                                                                                                                                
MR. HODGINS said that's all it does and added that it corresponds                                                               
with the Immigration Act of 1996 which changes the classification                                                               
of visa to H1B visa, a three year requirement.                                                                                  
                                                                                                                                
SENATOR LEMAN asked what other states do for non-foreign medical                                                                
graduates regarding citizenship.  Currently, you must be a citizen                                                              
of the U.S. or be admitted for permanent residence.  The proposal                                                               
is to change that to "being a citizen" or to be "lawfully                                                                       
residing."                                                                                                                      
                                                                                                                                
MR. HODGINS responded that to be lawfully residing a person must                                                                
possess a H1B visa which he thought would bring us into conformance                                                             
with federal law and with what other states are doing.                                                                          
                                                                                                                                
SENATOR LEMAN questioned the requirements in sections 1 and 2 for                                                               
non-foreign and foreign medical graduates which don't have                                                                      
corresponding provisions for citizenship.                                                                                       
                                                                                                                                
MR. HODGINS explained that language on page 2, line 9, Section 1,                                                               
paragraph 5, "be a citizen of the United States or lawfully                                                                     
residing in the United States" covers the immigration status.                                                                   
                                                                                                                                
MS. CATHERINE REARDON, Director, Division of Occupational                                                                       
Licensing, said the division provides staff support to the Medical                                                              
Board and supports the changes in the most recent committee                                                                     
substitute.  She said there are two separate issues: can you get a                                                              
license if you don't have a green card, but you do have another                                                                 
visa you would be working under in the United States; and, if you                                                               
went to school outside the country, regardless of your citizenship                                                              
status, should you be required to have additional years of training                                                             
in the U.S.  She believed the State would not be out of compliance                                                              
with any federal law by leaving things as they are, but the Medical                                                             
Board and the department support changing them for public policy                                                                
reasons.                                                                                                                        
                                                                                                                                
MS. REARDON believed there are no other states requiring U.S.                                                                   
citizenship for a medical license.  One other Alaska licensing                                                                  
program requires U.S. citizenship, marine pilotage, which also                                                                  
requires a U.S. Coast Guard license requiring citizenship.                                                                      
Ideally, the State would like to remove the issue from the statute                                                              
altogether, but if it remains in law, it is an improvement to say                                                               
"or lawfully resides."  There are doctors in Alaska right now                                                                   
working for the federal government and they don't need a state                                                                  
license although they can't work outside of their federal jobs or                                                               
switch jobs.  While there is not a large number of these doctors,                                                               
she suspected this is what created the issue.  The Board did not                                                                
expect this to be a very controversial topic, so it did not                                                                     
highlight it in their January newsletter.  The Board did, however,                                                              
ask for changes in training requirements.                                                                                       
                                                                                                                                
MS. REARDON said that the Department of Law also suggested that,                                                                
when things like this have been contested in other states, the                                                                  
courts ruled the federal government, not the state government                                                                   
should  determine who can work.                                                                                                 
                                                                                                                                
The issue of training foreign medical graduates is a separate                                                                   
topic, because some of them could be U.S. citizens.  They could be                                                              
Americans who intentionally went outside the U.S. to get their                                                                  
medical training.  The Board's figures indicate 43 other states                                                                 
require three years of training.                                                                                                
                                                                                                                                
MS. REARDON said initially, the Board thought there wasn't much                                                                 
concern about this issue because of the poor response to the                                                                    
newsletter.  Now they are more aware of the issue and working on                                                                
it.                                                                                                                             
                                                                                                                                
SENATOR LEMAN moved to pass CSSB29(L&C) with the accompanying zero                                                              
fiscal note from committee with individual recommendations.  There                                                              
were no objections and it was so ordered.                                                                                       

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