Legislature(2009 - 2010)CAPITOL 106
01/29/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Health Care Professional Workforce Development | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 29, 2009
3:07 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative John Coghill
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
MEMBERS ABSENT
Representative Lindsey Holmes
OTHER LEGISLATORS PRESENT
Senator Bettye Davis
COMMITTEE CALENDAR
PRESENTATION: HEALTH CARE PROFESSIONAL WORKFORCE DEVELOPMENT
- HEARD
PREVIOUS COMMITTEE ACTION
No Previous Action to Record
WITNESS REGISTER
JAY BUTLER, M.D.
Chief Medical Officer
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Moderator and presenter during the panel
presentation.
KAREN PERDUE, Associate Vice President
Health Programs
University of Alaska (UAA)
Anchorage Alaska
POSITION STATEMENT: Presented a power point and answered
questions during the panel presentation.
MARILYN KASMAR, Executive Director
Alaska Primary Care Association, Inc. (APCA)
Anchorage, Alaska
POSITION STATEMENT: Presented a power point and answered
questions during the panel presentation.
ROD BETIT, CEO
Alaska State Hospital & Nursing Home Association (ASHNHA)
Juneau, Alaska
POSITION STATEMENT: Presented a power point and answered
questions during the panel presentation.
DELISA CULPEPPER, Chief Operating Officer
Alaska Mental Health Trust Authority (AMHTA)
Anchorage, Alaska
POSITION STATEMENT: Presented a power point and answered
questions during the panel presentation.
EVANGELYN DOTOMAIN, President & CEO
Alaska Native Health Board (ANHB)
Anchorage, Alaska
POSITION STATEMENT: Presented a power point and answered
questions during the panel presentation.
ACTION NARRATIVE
3:07:50 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:07 p.m.
Representatives Keller, Herron, Cissna, and Seaton were present
at the call to order. Representatives Lynn and Coghill arrived
as the meeting was in progress. Senator Davis was also in
attendance.
^Presentation: Health Care Professional Workforce Development
3:08:10 PM
CO-CHAIR KELLER announced that the only order of business would
be a Power Point presentation by the Health Care Professional
Workforce. He introduced the participants to the presentation.
3:10:11 PM
JAY BUTLER, M.D., Chief Medical Officer, Office of the
Commissioner, Department of Health and Social Services (DHSS),
said that the four pillars of health care were access, cost,
quality, and prevention and that each of those pillars was
interrelated in order to support the health care system.
[Included in the members' packets were copies of the Power Point
presentation, "Alaska's Health Care Workforce: Shortage &
Solutions"]
3:11:41 PM
KAREN PERDUE, Associate Vice President, Health Programs,
University of Alaska, said that she had studied health care work
issues for 6 years. She shared that health care included 119
occupations and was eight to nine percent of the employment
sector in Alaska. She observed that the jobs were in both urban
and rural communities. She referred to slide 3, titled "Key
Points," and said that there was always a shortage of health
care providers in Alaska. She identified labor as a major
expense for health care. She announced that DHSS, University of
Alaska, and the health care industry were working together for
solutions to Alaska's health care problems.
3:14:50 PM
MS. PERDUE directed attention to slide 4, titled "Big Industry,"
and pointed out that there was a 62 percent job growth in Alaska
health care from 1992 to 2002. She mentioned that the
Department of Labor & Workforce Development (DLWD) had indicated
that nine of the ten fastest growing Alaska jobs were in health
care. She disclosed that half of the health care jobs were at
the associate or the direct service workers levels.
3:15:58 PM
MS. PERDUE indicated slide 5, "Where The Health Care Workers
Are," and pointed out that 25 percent of the jobs were in rural
Alaska. She acknowledged that the University of Alaska worked
to meet student needs for all areas of Alaska. She summarized
that 40 percent of health care jobs were in hospitals, 50
percent were in doctor offices or community settings, and 10
percent were in nursing homes or residential care facilities.
3:16:44 PM
MS. PERDUE discussed slide 6, titled "Shortages: An Overview,"
which reflected the number, rate, and mean replacement time for
health care job vacancies. She added that this data did not
reflect those communities that had foregone the search for many
health care positions.
3:17:32 PM
MS. PERDUE referred to slide 7, "Health Professions
Retirements," and noted that 43 percent of the future openings
in health care positions would just be to replace retiring
workers. She acknowledged that this made worker replacement
even more difficult.
3:18:04 PM
MS. PERDUE introduced slide 8, "Industry Perspective," and
explained the extra layer of unnecessary recruitment costs to
hire itinerant providers.
CO-CHAIR KELLER welcomed Senator Davis, Chair of the Senate
Health and Social Services Standing Committee.
3:19:10 PM
REPRESENTATIVE SEATON asked if there were nurses in Alaska not
able to find jobs.
MS. PERDUE replied that, generally, all the University of Alaska
graduates were obtaining jobs. She pointed out that these
graduates did not yet have the specialty skills.
REPRESENTATIVE SEATON asked the reason for the nursing shortage.
MS. PERDUE explained that there were different levels of nurses.
She pointed out that the University of Alaska currently had 700
students who wanted to be nurses.
REPRESENTATIVE SEATON asked why, with so many nursing students,
there was a nursing shortage.
MS. PERDUE explained that the Anchorage nursing program had
expanded to include ten other sites. She cited the success of
keeping graduates in their graduation community. She said that
this had not allowed for an expansion of the Anchorage program,
until recently. She recounted problems with a shortage of
faculty and hospital clinical space for students.
3:23:48 PM
REPRESENTATIVE CISSNA asked if retention was a problem.
MS. PERDUE agreed, but noted that tracking for the last three
years had indicated that more students were hired and stayed in
Alaska.
3:24:52 PM
SENATOR DAVIS asked about the money source to expand the nursing
program and what was the percentage of nurses hired from out of
state.
MS. PERDUE indicated slide 9, "Possibles: Alaska," and recounted
that there were 26,000 employed health care workers. She
pointed out that there were 4,300 health care students but only
1,200 students graduated each year. She went on to explain that
the strategy to increase the numbers had to also account for
retirement and attrition.
MS. PERDUE offered her belief that it would be a long time
before Alaska did not need to import health care professionals.
She indicated slide 10, "Possibles," and explained the "Grow
Your Own" strategy, which included early age education, training
cooperatives, apprenticeships, and loan repayment programs.
3:28:38 PM
MS. PERDUE described slide 11, "Approach to Health Programs at
the University of Alaska." She explained that the expensive
programs could not be duplicated around the state so instead,
the programs would be exported and to where the students were.
3:29:28 PM
CO-CHAIR HERRON asked about the success of the regional training
centers.
MS. PERDUE said that this was the way to go. She displayed
slide 12, "University of Alaska Health Programs," and detailed
the programs.
3:30:22 PM
MS. PERDUE pointed to slide 13, "University of Alaska Health
Students," which showed annual comparative graphs of UA Health
Students with those who completed the Health program.
3:30:39 PM
MS. PERDUE examined slide 14, "UA Health Students," which listed
Health Program study areas and its enrollment percentage on each
campus for 2007.
3:31:16 PM
MS. PERDUE discussed slide 15, "Major Recent Initiatives," which
listed the significant program growth since 2002. This included
double the enrollment for the Masters in Public Health program,
double the nursing program graduates, and twice the admissions
for the physician assistant program.
3:32:23 PM
CO-CHAIR HERRON asked which success was most rewarding for Ms.
Perdue.
MS. PERDUE responded that she was most proud of nursing.
3:32:54 PM
MS. PERDUE pointed to slide 16, "Admissions to Basic Nursing
Programs," which compared the increase in current enrollment for
each program to the 2001 enrollment.
3:33:46 PM
MS. PERDUE noted that slide 17, "AAS Nursing Program Sites,"
depicted a map of Alaska with the Nursing program sites. She
summarized slide 18, "AAS Nursing Program Graduates," which
compared the graduate percentages between Anchorage and the
Outreach programs for the 2008 Nursing program.
3:34:11 PM
MS. PERDUE talked about slide 19, "Behavioral Health," which
reflected the joint work of University of Alaska, DHSS, and
Alaska Mental Health Trust Authority.
3:34:40 PM
MS. PERDUE said that slide 20, "Distance Courses, Rural Allied
Health Training," showed the courses available outside of
Anchorage.
3:35:23 PM
MS. PERDUE discussed slide 22, "Alaska's AHEC," and explained
that AHEC (Area Health Education Center) was a federal program
to help Alaskans enter into health careers.
3:36:10 PM
MS. PERDUE referred to slide 23, "What's On The Horizon," and
noted the $1.8 million that Governor Palin had allocated in the
proposed FY 2010 budget for New Program Development. She
explained that this would include establishment of a Ph.D.
pharmacy program in Alaska in relationship with Creighton
University, a Physical Therapy/Assistant program, and Bachelor
of Science (BS) programs in Nutrition and Dietetics, among
others. She also noted that Governor Palin's proposed FY 2010
budget included $2.2 million for the Family Practice Residency
program at Providence Hospital.
3:38:33 PM
MS. PERDUE continued on to slide 24, "Physician Assistant," and
noted that students were being interviewed for the 2009 summer
program.
3:39:09 PM
MS. PERDUE pointed out the map depicting the "UAA Health Science
Building" on slide 25.
3:39:50 PM
MS. PERDUE reviewed slide 26, "Science Space at UAF," and talked
about the need for teaching and research space. She expressed
hope for this building project to move forward.
3:41:08 PM
REPRESENTATIVE CISSNA offered her belief that solutions for the
long term problems began at the primary school level with life
skill development.
MS. PERDUE acknowledged the early need for kids to see role
models.
3:43:47 PM
CO-CHAIR HERRON asked if admission space for Alaskans to the
University of Washington (UW) Physician Assistant (PA) program
was based on population and was comparable to other states.
MS. PERDUE explained that UAA currently accepts ten students to
the UW program and she expressed her support for admitting
twenty UAA students to the program.
CO-CHAIR HERRON confirmed that space was based on what UAA could
handle.
3:45:03 PM
CO-CHAIR HERRON asked if these needs and requests were being
introduced to the upcoming Health Care Commission.
MS. PERDUE explained that workforce was a part of health care
reform.
3:46:06 PM
REPRESENTATIVE LYNN asked about the background for most of the
PA applicants.
MS. PERDUE reported that most of the applicants had clinical
experience, including Emergency Medical Technicians (EMT) and
nurses.
3:47:47 PM
MARILYN KASMAR, Executive Director, Alaska Primary Care
Association, Inc. (APCA), noted that Alaska employed four times
the national average of PA's.
3:48:43 PM
MS. KASMAR presented her Power Point [included in the members'
packets] entitled "Alaska's Healthcare Workforce: View from the
Safety Net." She said that APCA was a membership organization
of Alaska community health centers and other safety net
providers. She pointed out slide 2, "The CHC Model," and
described Community Health Centers (CHC). She noted that the
CHC had been an effective presence in Alaska since 2001, and
that there were now 141 sites in the state. She emphasized that
CHC were non-profit, served the entire community, and would not
turn anyone away, regardless of the ability to pay.
3:51:28 PM
MS. KASMAR directed attention to slide 3, "CHC Model: The Safety
Net," and explained that the CHC provided comprehensive,
primary, and preventive care, which included medical, dental,
and behavioral health care. She commented that the CHC reduced
the use of the more costly Emergency Room visits.
3:52:40 PM
REPRESENTATIVE COGHILL asked about the professional credentials'
required of CHC employees.
MS. KASMAR reported that the site providers were physicians,
PA's, nurse practitioners, and other board certified workers.
REPRESENTATIVE COGHILL asked if there was a baseline
certification level to maintain federal funding for each CHC.
MS. KASMAR noted that when a physician left a CHC, another CHC
would offer support personnel until the position was filled.
REPRESENTATIVE COGHILL observed that this would be talked about
during the workforce discussion.
MS. KASMAR explained that the CHC do work collaboratively.
3:55:10 PM
CO-CHAIR HERRON, with reference to the sliding scale fee, asked
if it was necessary to have some minimal payment.
MS. KASMAR offered her belief that patients' wanted to
contribute. She emphasized that the fee was not intended to be
a barrier for care, but it was intended to help with
accountability.
3:56:37 PM
CO-CHAIR KELLER asked about the federal grant.
MS. KASMAR explained that the grants were provided by the Health
Resources Services Administration, Bureau of Primary Health
Care, and that there were project officers who furnished
oversight.
CO-CHAIR KELLER asked what percentage of the operating costs was
covered by the grant.
MS. KASMAR said that this depended on the size of the operation,
but that it ranged from 33 to 67 percent.
3:57:58 PM
MS. KASMAR introduced slide 4, "Community Health Centers Alaska
- 2009," and recounted that the CHC served 81,000 Alaskans for
more than 331,000 visits.
3:59:14 PM
MS. KASMAR pointed out that slide 5, "Alaska's Community Health
Centers," was a map marking the centers.
3:59:35 PM
MS.KASMAR explained that the pie chart on slide 6, "Many Alaska
CHC patients are Poor," indicated the target population's income
relative to the Federal Poverty Level.
4:00:08 PM
MS. KASMAR spoke to slide 7, "Many Alaska CHC patients are
Uninsured," which illustrated the sources for patient payment.
She noted the growing percentage of uninsured in Alaska.
4:01:20 PM
MS. KASMAR summarized that the map on slide 8, "Geographic
Disparities in Health Insurance Coverage," showed that there
were more uninsured people the further away from urban areas.
4:01:38 PM
MS. KASMAR related that slide 9, "The Aging of Alaska's
Population Will Continue to Create a Strong Demand for Health
Care Services," demonstrated that as people age, the health
conditions become more complex, and the health care needs become
more numerous. She pointed out that the retirement of providers
was leading to the further shortage of health care workers.
4:02:10 PM
MS. KASMAR explained that the graph on slide 10, "Growth in
Health Center Dental & Mental Care, 2000-2005," revealed the
growth of Dental and Mental Health services, but she reminded
that there was still a shortage of personnel.
4:02:47 PM
MS. KASMAR pointed out that slide 11, "Healthcare Workforce
Shortage: Giant Problem for Alaska's CHC's," listed the problems
associated with the shortage, which included the expense and
difficulty to recruit and retain workers.
4:03:48 PM
MS. KASMAR compared the difficulties of urban to rural hiring
listed on slide 12, "The Shortage Problem in the Nation".
4:04:32 PM
REPRESENTATIVE SEATON asked what solutions were being used to
offset the shortage of health care providers in rural settings.
MS. KASMAR replied that the "Grow Our Own Initiative" which
funneled students from rural areas into the training programs,
loan repayment programs, and recruiting services were all tools
used nationally for rural programs. She pointed out that Alaska
did not have a loan repayment program, and that the recruiting
services had not had success with rural Alaska placements.
REPRESENTATIVE SEATON asked if there were any specific programs
to train and hire from the home community.
MS. KASMAR referred to the AHEC program mentioned earlier. She
explained that the CHC was very interested in placing students
for rural rotations.
4:10:17 PM
MS. KASMAR presented slide 13, "What are Factors that are
Driving this Shortage?" and said that studies showed that 75
percent of the practitioners would do their work within 50 miles
of their residency. She also mentioned that although the
current leadership was preparing to retire, the next group was
not quite ready to take over.
4:11:45 PM
MS. KASMAR compared the statewide and rural vacancies and
vacancy rates for primary caregivers outlined on slide 14, "The
Shortage Problem- in Alaska Primary Care Occupations."
REPRESENTATIVE COGHILL asked for a comparison to national
averages.
MS. KASMAR said that she would supply that information, and she
offered her belief that Alaska vacancies lasted longer due to
the remoteness of rural Alaska.
4:13:13 PM
CO-CHAIR KELLER asked if these figures only reflected the CHC.
MS. KASMAR replied that slide 14 was statewide vacancy studies,
but that slide 15, "Dentist Vacancy Rates at Health Centers
(2004)," did reflect the vacancy differential from rural to
urban areas, and was specific to Community Health Centers.
4:13:54 PM
MS. KASMAR pointed out that good health care was a community
affair, as quoted on Slide 16, especially with regard to
recruitment and retention.
4:14:30 PM
MS. KASMAR agreed that the health professional deficit would get
worse, as quoted on slide 17, "Will the Shortage Get Better or
Worse?"
4:16:11 PM
MS. KASMAR attributed slide 19, "A Problem that Must Be
Resolved," to a discussion with a recruiter who claimed that the
primary reason for the difficulty in filling Alaska health care
positions was the lack of a state loan repayment program.
4:17:03 PM
MS. KASMAR remarked that community health center personnel are
mission driven, but that, as slide 20, "What Does National
Expert Opinion Say?" indicated, the loan repayment option was
very important to them.
4:18:24 PM
MS. KASMAR summarized slide 21, "APCA-2009 Legislative
Priorities Healthcare Workforce," which stated that the loan
repayment plan and the PA expansion program were the most
important solutions to the workforce shortage.
4:19:28 PM
ROD BETIT, CEO, Alaska State Hospital & Nursing Home Association
(ASHNHA), referred to slide 2, "Hospital and Nursing
Facilities," which showcased a map of Alaska with the member
organizations.
4:20:34 PM
MR. BETIT presented slide 3, "Big Employers," and noted that
Providence Health System was the largest employer in Alaska. He
pointed out that 24 of the top 110 biggest employers in Alaska
were health care services.
4:21:07 PM
MR. BETIT directed attention to slide 4 "Industry Perspective,"
and said that more than $1.5 million had been saved in nurse
recruiting costs since local training programs had begun.
4:22:01 PM
MR. BETIT continued on to slide 5, "Nurse Overtime Survey
Results," and said that there was still a problem keeping enough
patient care staff and this was an even bigger problem in the
rural areas.
4:23:24 PM
MR. BETIT explained that the "Cromer Report," shown on slide 6,
was a 20 minute health attitudes survey asked to 1,700 Alaskans
which revealed that the public felt hospitals were responsible
for filling all the workforce shortages in healthcare, not just
the major shortages.
4:24:09 PM
MR. BETIT reviewed slide 7 "Access to Care: Community
Innovations," and said that workforce improvement was not being
handled in isolation from other programs. He said that there
would be a proposal for a loan repayment program. He gave
examples of some of the new programs in Kenai, Ketchikan,
Fairbanks, and Anchorage.
4:25:58 PM
MR. BETIT skipped slides 8 and 9. He pointed to the "Trained
Professionals" on slide 10 and noted that there was a lot of
competition for practitioners. He acknowledged that smaller,
rural communities had the most difficulty finding professional
health care staff.
4:27:28 PM
MR. BETIT jumped to slide 14, "Examples of Other States with
Support-for-Service Programs," (SFSP), and slide 16, "SFSP
Options...," and spoke about loan repayment and direct incentive
programs as solutions for the workforce shortage in Alaska. He
advised that it would be necessary to receive financial support
from the legislature for this approach to be successful.
4:28:20 PM
MR. BETIT skipped to slide 20, "Health Care Professions Loan
Repayment & Incentive Program-Interagency Planning Group," and
discussed how this group was formed and how this program came
together.
4:29:41 PM
MR. BETIT pointed out that slide 21, "The 'Big Ten'
Occupations," listed a starting point for the most needed
occupations. He explained that the planning group advised for
nine positions within each of these ten listed occupations which
would bring 90 additional health care professionals to Alaska.
MR. BETIT directed attention to slide 22, "Health Care
Professions Loan Repayment & Incentive Program," which listed
program and funding details in order to fill these 90 health
care professional positions.
4:32:01 PM
DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health
Trust Authority (AMHTA), referred to her Power Point
presentation, titled "Trust Workforce Development Focus Area."
She began with slide 4, "Five Focus Areas," which listed five
ways that AMHTA wanted to change the system of service to its
beneficiaries. She noted that four of the programs had begun
five years earlier, but that "Workforce Development" only became
a focus in the past year. She referred to the handout [included
in the members' packets] "Workforce Development at a Glance,
2008."
4:34:37 PM
MS. CULPEPPER shared that the problems of workforce development
included recruitment, retention, and training. She explained
that training included both educational and occupational on the
job training within the communities.
4:36:17 PM
MS. CULPEPPER reported that many of the necessary programs were
listed on slide 6, "Training."
4:36:49 PM
MS. CULPEPPER provided slide 7, "Recruitment & Retention," which
listed groups, programs, strategies, and studies to support
workforce development.
4:37:59 PM
MS. CULPEPPER referred to slide 8, "Administration/Other," and
noted that AMHTA needed to continue its vacancy studies and
support for workforce development.
4:38:27 PM
MS. CULPEPPER spoke briefly about slide 9, "FY 2008 Results
Highlights" and slide 10, "Ahead in FY 2010," which listed AMHTA
plans and accomplishments.
4:39:03 PM
MS. CULPEPPER said that there were contact names for the various
programs at the back of the "Workforce Development At-A-Glance
2008" handout.
4:39:19 PM
REPRESENTATIVE SEATON asked if there were available
opportunities for returning veterans.
MS. CULPEPPER responded that veterans were being designated for
opportunities to a second career.
4:41:42 PM
EVANGELYN DOTOMAIN, President & CEO, Alaska Native Health Board
(ANHB), introduced her Power Point, "Tribal Workforce
Development Update." She jumped to slides 3, 4, and 5, all
titled "Tribal Health Overview," which offered a background of
ANHB, including its membership, beneficiary groups, operations,
sources of funding, primary health care issues, results, and
ongoing challenges.
4:44:09 PM
MS. DOTOMAIN pointed to the map on slide 6, "The Alaska Native
Health Care System," which showed locations and service levels.
She noted that the system served the entire state, not just
tribal members, and that often it was the only health service
provider in the community.
4:44:45 PM
MS. DOTOMAIN directed attention to slides 7 and 8, "Tribal
Health Needs," which listed the services provided and the
challenges faced by Village Health Care. She noted that alcohol
and drug abuse issues accounted for about 50 percent of all the
emergency room visits in Alaska. She pointed out that the only
care many veterans received was from the tribal health community
health aides.
4:46:28 PM
MS. DOTOMAIN mentioned that slide 9, "Tribal Health among
Alaska's 100 Largest Employers," illustrated the size of
Alaska's Tribal Health providers.
4:46:45 PM
MS. DOTOMAIN explained that slide 10, "Tribal Vacancy Rates,"
illustrated many of the contributing factors for the workforce
shortage, including remote locations, lack of housing, high cost
of living, less competitive salaries, and a lack of loan
repayment programs.
4:47:16 PM
MS. DOTOMAIN spoke about slide 11, "Tribal vs. Statewide Vacancy
Rates," which reflected the much higher vacancy rates the tribal
workforce experienced. She acknowledged that a lack of Village
Public Safety Officers (VPSO) and Emergency Medical Services
(EMS) led to a higher attrition rate for community health aides.
4:48:01 PM
MS. DOTOMAIN addressed slide 12, "Basic Tribal Recruitment
Facts," which listed the average time and expense to fill health
care provider positions.
4:49:28 PM
MS. DOTOMAIN presented slide 13, "Tribal Health Care Fact," and
endorsed that Alaska Natives deserved a high quality health care
experience, but acknowledged that limited resources made it more
difficult to provide. She noted that slide 14, "Tribal Health
Actions," addressed the need for more efficient recruitment,
increased education for Alaska Natives to pursue health careers,
increased incentives to work in rural areas, and continued
exploration for cost effective technologies to improve access.
MS. DOTOMAIN read the supports necessary for health care
professionals at rural sites listed on slide 15, "What is
needed?"
4:50:37 PM
CO-CHAIR HERRON emphasized that our most important role models
are our parents, our care givers, and our teachers.
4:51:15 PM
REPRESENTATIVE CISSNA identified that there was a cost to the
community for not having a healthy population.
4:52:58 PM
MS. DOTOMAIN invited everyone to attend the workforce
development discussions at the upcoming ANHB meeting.
4:53:36 PM
REPRESENTATIVE COGHILL asked if the training for community
health aides could lead to a career position.
MS. DOTOMAIN explained that the aide position required six weeks
of intense training, and that annual training could lead to an
associate degree in nursing. She observed that this degree
could lead to a Bachelor degree in nursing and a PA degree.
4:55:49 PM
DR. BUTLER said that he would forego his Power Point
presentation as it was included in the members' packets. He
observed that the lack of primary care providers was a national
problem and that there was also a shortage of mid-level
providers. He stated that there were a number of reasons for
the shortages, which included life style, lower pay, debt from
public medical school, length of training, and competition.
4:59:03 PM
DR. BUTLER highlighted the importance of "growing our own"
providers in Alaska, with post graduate training in Alaska. He
emphasized the need for a loan repayment program.
5:00:54 PM
DR. BUTLER summarized that the challenges were across the board,
and that the shortages were in the public and private sectors.
5:01:31 PM
REPRESENTATIVE SEATON referred to [slide 21, "The 'Big Ten'
Occupations,"] and asked about the need for mid-level dentistry
positions in rural Alaska.
MR. BETIT replied that the list had been distilled to those ten
as a starting point, but that it could have been expanded to
include these other positions.
5:03:18 PM
REPRESENTATIVE SEATON asked if the physicians in Ketchikan were
billing a fee for service or were they on salary.
MR. BETIT explained that these were "community positions" and
that there was the "fee for service." He spoke about the
arrangement with the Ketchikan hospital to ensure the practices
remained financially solvent.
REPRESENTATIVE SEATON expressed his concern with fee for
service, and requested more information on alternative models.
MR. BETIT confirmed that the models would be tracked to see
which performed the best.
5:05:13 PM
CO-CHAIR HERRON asked what could change the path that many
doctors are taking.
DR. BUTLER observed that this was a complex issue and change
would need to be incremental. He expressed the need to identify
what can be modified and develop a 10 year plan for change.
CO-CHAIR HERRON expressed a need for more primary care doctors.
5:07:32 PM
REPRESENTATIVE LYNN asked if there was any recruitment among
medical military approaching retirement.
DR. BUTLER responded that the private sector did recruit among
the military. He did not know of any public sector programs
recruiting from that group.
5:09:14 PM
REPRESENTATIVE CISSNA said that in the past there was not a
community voice for solution. She expressed her belief that
identifying the community cost for lack of community health was
a key.
5:12:30 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:12 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| ANTHC health prof vacancies.1.29.09.doc |
HHSS 1/29/2009 3:00:00 PM |
|
| File #3 - PCA.ppt |
HHSS 1/29/2009 3:00:00 PM |
|
| Workforce Summary 1-29-09.doc |
HHSS 1/29/2009 3:00:00 PM |
|
| File #4 - ASHNHA.ppt |
HHSS 1/29/2009 3:00:00 PM |
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| File #5 - Trust.ppt |
HHSS 1/29/2009 3:00:00 PM |
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| File #6 - ANHB.ppt |
HHSS 1/29/2009 3:00:00 PM |
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| File #7 - Physician.ppt |
HHSS 1/29/2009 3:00:00 PM |