Legislature(2007 - 2008)BUTROVICH 205


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08:04:24 AM Start
08:05:05 AM HB18|| SB73
09:24:40 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Consideration: Requirement for 70% of
Funds to be Spent on Instruction
<Above Item Removed from Agenda>
Moved SCS CSHB 18(SED) Out of Committee
Bills Previously Heard/Scheduled
Heard & Held
        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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
[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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
SENATOR  HUGGINS  asked  if  the   council  will  include  public                                                               
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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