Legislature(2007 - 2008)BUTROVICH 205
02/14/2007 08:00 AM Senate SPECIAL COMMITTEE ON EDUCATION
| Audio | Topic |
|---|---|
| Start | |
| SB73 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| * | SB 73 | ||
SB 73- WWAMI MEDICAL SCHOOL
CHAIR STEVENS announced SB 73 to be up for consideration.
8:01:39 AM
SENATOR ELLIS, sponsor of SB 73, explained that it relates to
the expansion of the Wyoming, Washington, Alaska, Montana, and
Idaho partnership with the University of Washington (UW) School
of Medicine (WWAMI). The bill will increase the WWAMI enrollment
threshold from 10 to 20 people.
8:04:13 AM
SENATOR HUGGINS asked for the difference between the WWAMI and
WICHI acronyms.
SENATOR ELLIS explained that the Western Interstate Compact for
Higher Education (WICHI) is a collaboration of western states on
higher education, which sponsors various undergraduate programs
including the Western Undergraduate Exchange (WUE). Alaska
participates in these programs because it is a young state
without the resources for its own graduate schools.
8:05:16 AM
SENATOR HUGGINS asked if the WWAMI program expansion would allow
students to spend three of their four years of medical school in
Alaska.
SENATOR ELLIS replied that students spend the first year at the
University of Alaska Anchorage (UAA) and then spend the
remaining three at the UW.
8:06:37 AM
SENATOR OLSON asked how WWAMI would increase residency placement
in Alaska.
SENATOR ELLIS said that residency placement was not included in
the legislation, but that it was a recommendation of a task
force assembled to address the issue. Returning medical school
graduates to Alaska have no residency program to enroll in, and
thus must complete their residencies in other states or enter
more lucrative professions than family practice to repay their
debt. Completing residency in another state means that students
are less likely to return to Alaska. SB 73 does not address the
issue of increasing residency availability, but it is an
important issue.
8:09:35 AM
DIANE BARRANS, Executive Director of the Alaska Commission on
Postsecondary Education (ACPE), explained that the WWAMI program
has been in place for over 30 years in Alaska, and that clinical
care units in Alaska allow for students to return to Alaska
after their second year of school, at the UW.
CHAIR STEVENS asked about the success of the program.
MS. BARRANS said that the return rate of Alaska residents in the
WWAMI program to Alaska is nearly 70 percent, and around 85
percent for all WWAMI participants who attend school in Alaska.
Doctors tend to remain where they establish a practice.
8:11:52 AM
CHAIR STEVENS asked about the state of the ACPE student loan
program.
MS. BARRANS replied that the program currently offers around $70
million in loans through federal and state education loans. The
interest rates are among the best in the country.
CHAIR STEVENS asked if the extension of the WWAMI program was a
cause of fiscal concern for the ACPE.
MS. BARRANS replied that the ACPE acts as a fiscal agent for the
WWAMI program and considers the WWAMI students to be taking out
loans from the commission. Previously WWAMI students had no
contractual obligation to return to Alaska when they finished
their studies, and this spring will be the first wave of
students who will be monetarily encouraged to return to the
state.
8:14:03 AM
CHAIR STEVENS remarked that there are less expensive options to
attract doctors to Alaska, and asked Ms. Barrans for her
opinion.
8:14:49 AM
MS. BARRANS said that there is currently no fiscal incentive
program for non-Alaskan residents. The WICHI program is loan-
only and includes no repayment or forgiveness features.
CHAIR STEVENS referenced a chart that showed that students
generally take seven years to become practicing physicians at a
cost of $250,000. The WWAMI program is beneficial but it's
important to realize that other options exist.
8:17:00 AM
SENATOR OLSON asked if WICHI only applied to select programs of
study.
MS. BARARNS replied that WICHI de-funded their law study support
in 1987. WICHI used to apply to two groups of students, those
who had limited access to certain fields of study and needed
WICHI support, and those whose admission to a program could be
aided by WICHI but where it wasn't necessary. In the late 1990s
student loan corporation receipts began to be used to fund WICHI
loans, which must be fully recovered with interest.
SENATOR OLSON asked about the average medical school debt.
MS. BARRANS replied that medical students can borrow up to
$60,000 through the supplemental education loan program. They
also often take out federal loans, which have no cap. Typically
the total amount is between $80,000 and $100,000.
SENATOR OLSON asked how many WWAMI students participate in the
ACPE loan program.
MS. BARRANS replied that the number is close to 90 percent, and
generally students do not default on their loans.
8:20:45 AM
SENATOR OLSON asked about the number of students who take out
loans and do not finish medical school.
MS. BARRANS replied that there have not been any withdrawals for
academic reasons, but that very occasionally a medical reason is
cause for withdrawal from WWAMI.
8:22:22 AM
SENATOR HUGGINS asked for a loan repayment figure for a student
who would not return to Alaska after graduation.
MS. BARRANS said that according to SB 73 such students would owe
half the amount the state paid for their schooling for years two
through four, which would be around $76,000.
SENATOR HUGGINS asked for Ms. Barrans' opinion on the return of
the state's investment.
MS. BARRANS said that many factors must be considered, including
the student's job choices after graduation. If the debt
obligation is so onerous that a student can not contemplate any
other post-graduate possibility, it might act as a dis-incentive
to the program. Currently the student is responsible for the
tuition differential between Alaska and Washington.
8:25:17 AM
SENATOR HUGGINS asked how much money a non-returning student
would owe by present standards.
MS. BARRANS said that the amount would be $150,000.
CHAIR STEVENS asked for the difference between the current
repayment rule and the change that SB 73 proposes.
MS. BARRANS replied that the significant change is that SB 73
would postpone interest accrual until after the completion of
residency or other service obligations.
8:28:21 AM
SENATOR HUGGINS asked if SB 73 would change the program to a
minimum or maximum of 20 students.
MS. BARRANS replied that the bill would allow for a class of 20
beginning in 2007. In 2006 there were over 70 applicants, 40 of
which were seriously considered.
8:28:42 AM
SENATOR WILKEN said that SB 73 may not give a greater incentive
to return to Alaska because it would allow for less interest
accrual and thus less necessity of loan forgiveness.
CHAIR STEVENS asked how other states compete to attract doctors.
MS. BARRANS replied that all but the WWAMI states have their own
medical schools, and students can attend them with no obligation
to remain. A lack of viable medical study options in Alaska
means a student may choose to get residency in another state.
8:32:34 AM
SENATOR HUGGINS asked if there is any military incentive or
connection with the WWAMI program.
MS. BARRANS said she did not know.
8:34:01 AM
SENATOR WILKEN asked if there is a WWAMI provision for graduates
who enter the military.
MS. BARRANS said that there are general military deferments of
payments and interest, including an interest accrual cap.
8:35:39 AM
SENATOR WILKEN related a personal story regarding medical
school.
8:37:26 AM
CHAIR STEVENS related a personal story regarding medical school,
and asked if there are other programs that pay students'
tuition.
MS. BARRANS said that employers are increasingly providing loan
repayment programs.
SENATOR WILKEN said that Indian Health Services forgives $20,000
in debt yearly for a medical student.
8:39:47 AM
SENATOR HUGGINS asked why the state cannot provide more
forgiveness programs.
MS. BARRANS replied that it's a matter of available money. An
example of such an alternative program is the Teacher Education
Loan program, which has a return rate of around 25 percent.
8:42:12 AM
CHAIR STEVENS remarked that 50 percent of Alaskans who enter
WWAMI practice in the state, and the rate of WICHI return is 18
percent.
SENATOR WILKEN asked what the amount of the ACPE loan budget is.
MS. BARRANS replied that the 2007 bonds total around $75
million.
8:42:58 AM
ROD BETIT, President of the Alaska State Hospital and Nursing
Home Association (ASHNHA), said that the bill is his
association's top priority for addressing the gap between
physician supply and demand in Alaska. The state needs a net
gain of 59 physicians per year, up from the current number of
38. The $250,000 spent for a WWAMI student is for the full
medical school education; $60,000 represents the cost of closing
the funding gap in the family practice program. The actual cost
for a residency position per year is $100,000. If SB 73 is
passed early enough in the current legislative session, the
additional 10 students could be allowed into WWAMI in 2007.
8:46:57 AM
CHAIR STEVENS said that he would like to see increased retention
of physicians addressed in particular.
SENATOR HUGGINS asked if Mr. Betit wants the bill to be passed
by mid-March.
MR. BETIT replied that the UW is currently reviewing WWAMI
applications and if the bill passes by March, the UW will be
able to select another 10 students.
8:48:32 AM
SENATOR OLSON asked what incentives are put forth by individual
hospitals to attract staff.
MR. BETIT replied that hospitals help set up practices, provide
good salaries, and spend a lot of money on recruitment.
8:50:41 AM
LAURIE HERMON, Regional Director of Government Affairs for
Providence Health System, said that the return on the WWAMI
investment is phenomenal; nearly 80 percent of the Alaska
residents in the program return to the state to practice, which
is a better rate of return than states with their own medical
schools. The physician shortage in Alaska is a multi-faceted
problem, and is being addressed with increased residency
positions. Physician rotation would help the problem by exposing
more people to the possibility of living in Alaska.
8:55:21 AM
CHAIR STEVENS asked if the WWAMI program is the most cost-
effective way of enticing physicians to Alaska.
MS. HERMON said that the increase of the program is an important
first step in the process, but other goals should not be set
aside.
8:56:32 AM
DR. ROLAND GOWER, President of the Alaska State Medical
Association, said that SB 73 is a timely bill, because Alaska
has an aging general and medical population; the average
physician age in Alaska is 52. There are many local youth who
wish to become physicians but are unable to enter the WWAMI
program. He related a personal story about the WWAMI program.
He asked the committee to consider a reasonable payback
provision, and said that competition for doctors throughout the
country is fierce. Alaska has a good climate for practicing
medicine, and more effort should be spent on recruitment.
9:04:18 AM
SENATOR OLSON asked why more emphasis is not being placed on
residency needs.
DR. GOWER said that residency programs do need more funding, and
that in-state training programs are limited. Some areas may not
even have enough patients for training.
SENATOR OLSON asked how long Alaska could expect to not have
HMOs in the state.
DR. GOWER replied that HMOs are not an issue in Alaska because
of the isolation and small population.
CHAIR STEVENS said that Alaska needs ten percent more physicians
than the rest of the nation because of the rural aspect, and
asked if telemedicine could be beneficial.
9:07:53 AM
DR. GOWER said that Alaska is on the cutting edge of medical
technology, but better telecommunications and more manpower are
needed.
9:09:34 AM
ALICE SAMUELSON, representing herself, related a personal story
regarding the difficulties inherent in applying to medical
schools and the WWAMI program.
9:11:11 AM
CHAIR STEVENS said that he intended to hold SB 73 in committee,
and asked Ms. Barrans to look into the Health Resources and
Services Administration loan program.
SENATOR WILKEN said that he had an amendment he wants the
committee to consider in the next meeting regarding physician
loan forgiveness.
CHAIR STEVENS thanked the testifiers for their participation
and, seeing no further business, adjourned the committee meeting
at 9:13:18 AM.
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