Legislature(2007 - 2008)BUTROVICH 205
02/21/2007 08:00 AM Senate SPECIAL COMMITTEE ON EDUCATION
| Audio | Topic |
|---|---|
| Start | |
| HB18|| SB73 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| HB 18 | |||
| = | SB 73 | ||
HB 18-POSTSECONDARY MEDICAL & OTHER EDUC. PROG.
SB 73- WWAMI MEDICAL SCHOOL
CHAIR STEVENS announced HB 18 to be under consideration; its
companion bill, SB 73, was also before the committee.
8:05:05 AM
REPRESENTATIVE MEYER, sponsor of HB 18, explained that it
doubles the enrollment of the current Wyoming, Washington,
Alaska, Montana, and Idaho medical school partnership with the
University of Washington (WWAMI).
8:05:22 AM
CHAIR STEVENS remarked that doubling the WWAMI enrollment is the
most expensive option for increasing Alaska's physician
population, and asked why other ideas aren't being explored.
REPRESENTATIVE MEYER said that WWAMI is highly successful, and
other options like recruiting programs will be the next step.
CHAIR STEVENS agreed that different approaches should be
considered.
8:07:18 AM
SENATOR OLSON asked if there is a contingency plan if the price
of oil drops.
REPRESENTATIVE MEYER said that he is aware that a change in
state funds could happen, but that the shortage of physicians is
already costly and it is a question of investing now or paying
more later.
8:08:29 AM
SENATOR OLSON asked why the bill could not be folded into the
University of Alaska budget.
REPRESENTATIVE MEYER said that he was not sure why that approach
hadn't been considered.
SENATOR WILKEN said that keeping the WWAMI funding separate
would be best to maintain control of the appropriations.
8:09:45 AM
CHAIR STEVENS asked Representative Meyer to talk about the
differences between the companion bills, and why the House bill
has a zero fiscal note.
REPRESENTATIVE MEYER replied that the House Finance Committee
zeroed the fiscal note because the teaching staff won't need to
be increased for only ten more students.
8:11:12 AM
SENATOR WILKEN asked which of two available fiscal notes the
committee should be considering.
REPRESENTATIVE MEYER said that the 2007 fiscal note is accurate
for the bill, and the second is the University of Alaska's note
that was zeroed out by House Finance. He added that another
reason for zeroing the fiscal note is so the WWAMI process can
be revisited.
SENATOR WILKEN mentioned the committee's previous discussion on
changing the date of interest accrual commencement in SB 73, and
asked Representative Meyer if the same topic had been discussed
in the House.
8:13:54 AM
REPRESENTATIVE MEYER asked for clarification on the committee's
opinion of interest accrual.
SENATOR WILKEN explained that having interest accrue from the
end of medical studies would be a better incentive for WWAMI
students to return to the state.
REPRESENTATIVE MEYER said that his concern is that there is
limited room for residency in Alaska, and some students may be
forced to spend their residency elsewhere.
8:16:34 AM
MIKE PAWLOWSKI, aide to Representative Meyer, said that the
House bill's important difference was that a student wouldn't be
penalized, and have to make immediate repayments, if they could
not find a residency program in the state.
SENATOR WILKEN said that he did not understand why existing law
would be changed to give a break to students not coming back to
Alaska. He said he had a conceptual amendment available, but
proposed hearing from Diane Barrans first.
8:18:43 AM
SENATOR OLSON said that he agreed with interest accrual
beginning at residency, and that he didn't understand how Mr.
Pawlowski's comments related to the issue.
MR. PAWLOWSKI said that the House's discussions were centered on
the incentives of the WWAMI program, and he simply wanted to
point out other changes in the bill.
SENATOR OLSON said that the most important incentive for
students to return to Alaska would be the earlier interest
accrual.
REPRESENTATIVE MEYER said that he had no objection to a
conceptual amendment.
8:22:41 AM
SENATOR OLSON asked why interest should start accruing at the
beginning of residency rather than the end of medical school,
because sometimes students have no intention of starting
residency right away.
DIANE BARRANS, Executive Director for the Alaska Commission on
Postsecondary Education (ACPE), said that the bill will have
interest accruing at the end of medical school studies. The
proposed change came from the UA system.
She added that the need for the expanded program is universally
recognized and supported.
CHAIR STEVENS asked her for her comments on the zeroed fiscal
note.
MS. BARRANS said that she had none.
8:25:43 AM
PAT PITNEY, Director of Budget and Institutional Research for
the UA, said that the rationale for zeroing the fiscal note was
that it would be discussed in the context of the UA budget.
Barring any gubernatorial amendments, the current legislation is
$2.5 million below fixed costs and new additional program
funding; the zeroed fiscal note is simply helping the bill move
forward.
SENATOR OLSON said that he wanted to find an alternative way to
implement the funding without attaching it to a bill.
MS. PITNEY said that the UA can accommodate any mechanism. The
current WWAMI program is funded as part of the whole budget,
which is planning for the expanded WWAMI class in the fall of
2007.
CHAIR STEVENS asked of Ms. Pitney could explain what the SB 73
fiscal note represents.
MS. PITNEY said that the note represents the costs of two
additional faculty, additional staff time, and non-personnel
costs. Instruction varies in each state, and must be coordinated
so that all students enter the University of Washington with the
same background.
8:32:02 AM
SENATOR DAVIS said that she did not object to the amendment, but
thought it would be more appropriately addressed in the finance
committee.
[There was general agreement to accept the conceptual amendment]
8:33:17 AM
MIKE HOGAN, Executive Director of Alaska Physicians and
Surgeons, said that the bill is very timely, and the state needs
to do everything it can to produce new doctors and attract
others to Alaska.
CHAIR STEVENS asked if he could recommend any other solutions to
the lack of physicians.
MR. HOGAN said that he is a part of Alaskans for Access to
Healthcare, a coalition of hospitals and associations that's
goal is to improve the physician shortage in Alaska.
8:34:58 AM
SENATOR OLSON asked how many people registered with Alaska
Physicians and Surgeons were WWAMI students.
MR. HOGAN said he didn't know, but graduates think very fondly
of the program.
8:35:23 AM
JIM JORDAN, Executive Director of the Alaska State Medical
Association, said that he supports HB 18, and participated in
the task force that presented the report on the physician
shortage. Further measures are needed to actively pursue and
retain physicians.
CHAIR STEVENS said that he hopes the task force can continue.
MR. JORDAN said that he agrees, and the task force made a list
of issues including the need for identifying specialties that
are the most in demand.
8:37:48 AM
CHAIR STEVENS asked if the additional 10 students in the WWAMI
programs will help to solve to shortage problem.
MR. JORDAN replied that the program has been a marked success
over the years, and will continue to improve the state's
situation as part of the solution to the shortage.
CHAIR STEVENS asked Mr. Jordan to comment on the governor's new
health care council.
MR. JORDAN said that he was unfamiliar with the council.
SENATOR HUGGINS asked Mr. Jordan to comment on the possibility
of creating a medical school in Alaska.
MR. JORDAN said that a full consideration of the possibility was
outside the scope of the task force, but it was agreed that the
idea should be considered.
8:42:08 AM
SENATOR HUGGINS asked if the concept is too much for
consideration right now.
MR. JORDAN said that he thinks a medical school could not be
completed in the short term and will require more concerted
study.
SENATOR OLSON asked what kind of physicians is needed most
immediately in Alaska.
MR. JORDAN replied that the most acute shortage is in the area
of primary care. Anchorage currently has 18 general internal
medicine physicians, compared with twice that number three years
ago.
8:43:43 AM
DENNIS VALENZENO, Director of the WWAMI program at the
University of Alaska Anchorage, said that the WWAMI program
functions as Alaska's own medical school and the enrollment
increase is much needed. He cautioned that interest accrual
often leads doctors to choose more lucrative practices rather
than family or general practice.
SENATOR HUGGINS asked what functions the two additional faculty
members will fulfill.
MR. VALENZENO said that the members will aid in intensive, one-
on-one courses such as Introduction to Clinical Medicine; they
will also expand the knowledge base of the faculty, because it's
difficult for any one faculty member to maintain expertise in
more than one field.
8:48:33 AM
SENATOR HUGGINS asked if students can spend up to three years of
their education in Alaska, and how many do so.
MR. VALENZENO said that is a possibility, and some students do
choose to do so. However many students who plan to practice in
Alaska spend their school years in other states to expand their
knowledge base.
SENATOR HUGGINS asked for the scope of WWAMI operations in
Alaska.
MR. VALENZENO said that the first year is done on the UA campus,
the second in Seattle, and the third and fourth years are spent
in clinical sites around Alaska.
SENATOR HUGGINS asked if faculty members travel to different
sites for overseeing study.
MR. VALENZENO said that traveling faculty is usually from the
University of Washington.
8:50:29 AM
SENATOR OLSON asked Mr. Valenzeno if the students must pass part
one of the national medical board exams before starting their
clinical studies.
MR. VALENZENO said that was correct.
SENATOR OLSON asked if Mr. Valenzeno is part of the WWAMI
admissions committee.
MR. VALENZENO replied that he is not.
SENATOR OLSON asked for the number of rural students in the
WWAMI program.
MR. VALENZENO said that the WWAMI population is representative
of the entire state.
SENATOR OLSON asked if rural students are qualified.
MR. VALENZENO said that occasionally the board struggles to find
qualified students, but that generally it is not a problem.
CHAIR STEVENS asked if Mr. Valenzeno anticipates a problem
filling all 20 spots if the bill passes.
MR. VALENZENO said that there are always at least 30 qualified
applicants.
8:53:03 AM
SUZANNE TRICK, Regional Programs Director for the University of
Washington (UW), said that the UW is always trying to increase
the physician workforce in partner states; Alaska's 84 percent
return on investment is calculated before the service obligation
takes effect. As the WWAMI class size is increased, the UW will
be examining how decisions such as obligations impact chosen
medical specialties. Six years ago, 36 percent of WWAMI
graduates chose primary care as their specialty; today the
number is at 12 percent.
CHAIR STEVENS asked Ms. Trick for the proposed enrollment
increase's effect on the UW medical school.
MS. TRICK said that the UW is prepared to accommodate the
additional students.
CHAIR STEVENS asked how many students enter UW annually.
MS. TRICK replied that the yearly enrollment is 182 from the
WWAMI states.
SENATOR HUGGINS asked if an incentive program could encourage
more students to choose family practice specialties.
MS. TRICK said that recruitment packages could be offered for
rural communities, and federal incentives do exist through
scholarship programs.
SENATOR HUGGINS asked for Ms. Trick's opinion on possible tax
credits.
MS. TRICK replied she thinks it is a good idea, but that she
wasn't qualified to comment on the issue.
CHAIR STEVENS asked if Ms. Trick was familiar with the Health
Resources Service Administration (HRSA) doctor's loan repayment
program.
MS. TRICK said she was not.
SENATOR DAVIS requested information regarding the number of
rural and minority students in the WWAMI program.
9:00:03 AM
RAY BAILEY, professor at the University of Alaska Anchorage,
said that over 125 physicians in the state work with the
program; there are enough clinical placements to cover all the
students but many must leave for more specialized training. New
physicians coming to Alaska are also interested in helping with
WWAMI, so despite the shortage in doctors in Alaska the training
programs are improving all the time.
9:04:14 AM
SENATOR OLSON commented that teaching improves doctors' skills,
and asked about changes and evolution in the WWAMI program.
MR. BAILEY said that it would be possible to bring the second
year of studies into Alaska, but it would be difficult. One of
the large changes in the WWAMI program is the introduction of
extensive clinical training; half of such training is now done
outside the UW.
9:07:05 AM
SENATOR OLSON asked if there are sufficient patients available
for students' clinical studies.
MR. BAILEY said this is a concern in rural and smaller
communities; the right number of patients and the proper
conditions are necessary for proper training.
SENATOR OLSON asked for the number of rural and minority
students in WWAMI.
MR. BAILEY said that currently two Native Alaskans are in the
program, and rural applicants are often better prepared than
others.
9:10:35 AM
CHAIR STEVENS asked Ms. Barrans for detail on available tuition
assistance or repayment programs.
MS. BARRANS said that the Health Resources and Services
Administration (HRSA) offers a state federal loan repayment
program, which matches state funds; specific disciplines and
practice settings are required. A similar program in Alaska
could be successful.
CHAIR STEVENS commented that a medical school in Alaska might be
a viable consideration, and said that the UA fiscal note needs
to be further examined.
SENATOR WILKEN said that HB 18 is just a step in the right
direction, and since students have such considerable debt more
loan repayment programs need to be considered. He then related a
personal story regarding medical school.
9:16:40 AM
ROD BETIT, President of the Alaska Hospital and Nursing Home
Association, said that the task force's ideas should be explored
and that the governor has created a council to deal with such
issues, working with the UA. He said that the WWAMI program
increase will help shorten the gap between Alaska's need and its
physician population.
9:19:30 AM
KARLEEN JACKSON, Commissioner for the Department of Health and
Social Services (DHSS), said that Alaska has the sixth-lowest
number of physicians per capita, and rurally ranks last. Action
needs to be taken to improve the situation, rather than spending
further resources on task forces.
9:21:18 AM
SENATOR HUGGINS asked for the name and goals of the governor's
new health council.
MS. JACKSON said that the group is called the Health Care
Strategies Council, and it plans to examine the health care
system, consolidate existing reports and studies, compile short-
and long-term action plans, and create performance evaluation
measures.
SENATOR HUGGINS asked if the council will include public
members.
MS. JACKSON replied that yes, it will, as well as a series of
public conferences.
SENATOR HUGGINS asked for the duration of the council.
MS. JACKSON said that the council will present its
recommendations by January 2008.
9:24:19 AM
SENATOR HUGGINS made a motion to move SCS CSHB 18(SED) from
committee with individual recommendations and accompanying
fiscal notes. There being no objection, the motion carried. [SB
73 was held in committee.]
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