Legislature(2019 - 2020)SENATE FINANCE 532
03/25/2019 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Overview of Alaska's Wwami Program | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
March 25, 2019
9:01 a.m.
9:01:54 AM
CALL TO ORDER
Co-Chair Stedman called the Senate Finance Committee
meeting to order at 9:01 a.m.
MEMBERS PRESENT
Senator Natasha von Imhof, Co-Chair
Senator Bert Stedman, Co-Chair
Senator Lyman Hoffman
Senator Peter Micciche
Senator Donny Olson
Senator Mike Shower
Senator David Wilson
MEMBERS ABSENT
Senator Bill Wielechowski
Senator Click Bishop
ALSO PRESENT
Suzanne Allen MD MPH, Vice Dean for Academic, Rural and
Regional Affairs, University of Washington School of
Medicine; Senator Cathy Giessel; Senator Gary Stevens.
SUMMARY
^OVERVIEW OF ALASKA'S WWAMI PROGRAM
9:03:47 AM
SUZANNE ALLEN MD MPH, VICE DEAN FOR ACADEMIC, RURAL AND
REGIONAL AFFAIRS, UNIVERSITY OF WASHINGTON SCHOOL OF
MEDICINE, discussed the presentation, "WWAMI School of
Medical Education, Senate Finance Committee, March 25,
2019" (copy on file). She offered a brief personal
background.
9:04:29 AM
Ms. Allen highlighted Slide 2. The slide showed photographs
of the students currently enrolled in the program. She
relayed that Alaska had been Washingtons first partner in
the program, back in 1971. The program allowed students
from each partner state to participate in medical school
and complete most of their medical training within their
home state.
9:04:54 AM
Ms. Allen looked at Slide 3, "Alaska WWAMI Students are
from Diverse Backgrounds." The slide showed the communities
from which the current WWAMI student hailed. She stressed
that the goal of the program was to improve community
health by providing a physician workforce that met the
needs of the communities within each partner state.
9:05:16 AM
Ms. Allen highlighted Slide 4, "Physician Workforce Needs
in Alaska":
Chronic shortages
? Primary Care, Psychiatry, Emergency Medicine
? Rural areas
Annual Need
? Approximately 60 new physicians/year
? Population growing older- greater need for care
? Alaska Physicians (40 percent over age 55)
Recruitment, retention
? Expensive ($100K-$1M), difficult to retain
? Compete with entire nation which has a shortage of
primary care physicians
Need for public medical education in Alaska
? Alaska residents more likely to return to Alaska to
practice
9:07:19 AM
Ms. Allen looked at Slide 5, "Medical Education":
Every State in our country funds medical education
? Publicly funded medical schools through their
respective University systems
? Through cooperative compacts such as WWAMI
WWAMI uniquely suited to Alaska
? Opportunity for 20 Alaska students each year to
attend one of the top 10 medical schools in the
country
? Alaska students may complete entire medical
education in Alaska with exception of two clinical
rotations at University of Washington in Seattle
9:08:16 AM
Ms. Allen discussed Slide 6, "Medical Education":
? Cost to Alaska
? $750,000 per year from UA (.0023 percent of
UA's FY19 UGF spend;
.00084 percent of UA's total budget) for
classroom teaching in the first year
? $3.1 million per year from State of Alaska
funding for years 2 4 including second year
classroom teaching
? This is $5.50/Alaskan compared to >$20.00/North
Dakotan, a state with a similar population
9:09:38 AM
Senator Wilson queried the cost for a student to complete
the program.
9:09:42 AM
Ms. Allen replied that tuition for the program was $35,000,
per year. The total number of credit hours needed to
graduate is 140, she did not know the cost per credit hour.
9:10:11 AM
Co-Chair von Imhof wondered about the return on investment
for the program.
9:10:22 AM
Ms. Allen replied that return on investment would be
discussed in future slides.
9:10:40 AM
Senator Shower understood that there were 80 total students
currently benefitting from the program.
9:10:52 AM
Ms. Allen replied in the affirmative.
9:10:59 AM
Co-Chair Stedman understood that the program was at
capacity.
9:11:02 AM
Ms. Allen replied in the affirmative.
9:11:09 AM
Co-Chair von Imhof asked about trends in program interest.
9:11:14 AM
Ms. Allen said that there was slight variation from year to
year, generally between 80 and 90 students applied per
year, 20 were selected.
9:11:37 AM
Ms. Allen addressed Slide 7, "Strong Return on Investment":
Financial plus for Alaska
? >70 percent of funds invested by the state are
spent in Alaska
? Classroom instruction
Management of 59 clerkships and 20
volunteer preceptorships
Creates jobs
? Faculty and staff who educate 80 medical
students per year
? New physicians contribute to the growth of
Alaska's healthcare industry
? Economic impact of one primary care physician
estimated at over $1 million per year
WWAMI graduates return to Alaska
? Return on investment of 71 percent, 61 percent
returning Alaskans
? 11 percent of licensed Alaska physicians are
WWAMI graduates
? Largest contributing medical school to
Alaska physician workforce
9:13:30 AM
Senator Hoffman aske what percentage of students from the
program, that returned to the state, were practicing in
rural Alaska.
9:13:49 AM
Ms. Allen agreed to provide the information to the
committee.
9:14:10 AM
Senator Hoffman also requested information about how many
people from rural Alaska were applying for, and being
accepted to, the program.
9:14:32 AM
Senator Shower requested additional information about
clerkships and volunteer preceptorships.
9:14:45 AM
Ms. Allen related that student spent 3 semesters in the
classroom; 4 days a week in the classroom and 1 day per
week doing clinical work. The volunteer preceptors were
people who mentored the students during their clinical work
in the first 3 semesters. After the classroom work,
students began rotations in various required fields of
medicine, including clinical rotations. The rotations were
4 to 6 weeks in length.
9:16:35 AM
Senator Shower asked about the 59 clerkships.
9:16:37 AM
Ms. Allen replied that the clerkships were rotations
students performed in a myriad of medical fields. She
shared that a future slide contained a map of the state
that showed where the clinical clerkships occurred.
9:17:11 AM
Co-Chair Stedman asked whether the program had a drop out
factor.
9:17:38 AM
Ms. Allen shared that the program had a low rate of non-
completion. She said that there had been a handful of
students over the years that had not completed medical
school for various reasons, but that it was less than 1
percent of students who were not successful for academic
reasons.
9:18:11 AM
Senator Olson asked whether vacancies could be filled if a
student failed to finish the program.
9:18:26 AM
Ms. Allen responded that once the student left the program,
the University of Washington no longer billed the state for
that students education.
9:18:58 AM
Senator Micciche asked whether there had ever been a number
requirement for years of service to the state, post
completion of the program.
9:19:22 AM
Ms. Allen replied that students were required to work in
the state once they were fully licensed, 3 years for rural
area work and 5 years for urban area practice. She said
that if students did not return to the state, they are
required to pay back 50 percent of what the state paid for
their education.
9:19:52 AM
Ms. Allen addressed Slide 8, "WWAMI Program Founding
Goals":
Access to Publicly Supported Medical Education
? WWAMI is Alaska's medical school
? UWSOM receives >6000 out of state applications/yr
and admits 0.3 percent of those applicants
? 1 in 300 chance of Alaska student acceptance to
UW School of Medicine
? Publicly funded schools give significant
preference to their own state residents
? WWAMI guarantees 20 Alaska students admission with
in-state tuition
? 1 in 4 chance of acceptance to UW School of
Medicine
Avoid excessive capital costs by using existing
educational infrastructure
? Recent new medical schools >$100M
Create Community-Based Medical Education
Clinical training in Alaska has grown to 59
clerkship sites
9:21:32 AM
Ms. Allen looked at Slide 9, "Alaska WWAMI Program Site
Map, 2018-2019."The map showed where the program offered
clinical training opportunities in the state.
9:21:49 AM
Senator Wilson understood that not all sites on the map
were continually utilized.
9:21:52 AM
Ms. Allen agreed. She explained that the intent was to
place students all around the state, but occasionally
clinical sites were implementing new systems and were not
prepared to take on a training student.
9:22:28 AM
Ms. Allen addressed Slide 10, "WWAMI Program Founding
Goals":
Expand GME (residency programs) across WWAMI
? Alaska Family Medicine Residency Program
? UW Pediatric Residency Track
? Need for Internal Medicine & Psychiatric
Residency Programs
Increase the number of primary care physicians
/address maldistribution of physicians
? AK WWAMI graduate return rate is 61 percent,
and grows to 71 percent as WWAMI grads from other
sites come to practice in Alaska
? AK WWAMI grads must payback ? of state
investment if they do not return (3 years rural,
5 years urban)
? >50 percent of AK WWAMI graduates choose
primary care
9:23:48 AM
Senator Micciche wondered about the money paid back by
student who did not finish the program. He surmised that if
39 percent did not finish the program, the payback figure
would be $604,000, per year. He queried where the paid back
money was used.
9:24:06 AM
Ms. Allen responded that the funds were deposited back into
the states general fund.
9:24:20 AM
Ms. Allen highlighted Slide 11, "Alaska WWAMI Graduates
Practice Throughout Alaska." She discussed slide 12,
"Alaska WWAMI":
1971: University of Alaska Fairbanks 5-10
students/year
1989: University of Alaska Anchorage 10 students/year
2007: Increased from 10 to 20 students/year
Ms. Allen reiterated that Alaska was the first state to
become program partners with Washington State in 1971. At
that time the program, located in Fairbanks, had 5
students. The program moved to Anchorage in 1989, and in
2007 the program increased from 10 to 20 students per year.
The first 20 student class graduated in 2007.
9:25:05 AM
Ms. Allen addressed slide 13, "Alaska WWAMI Admissions":
Alaska WWAMI Admissions Committee:
Katie Sheridan MD, Chair: WWAMI alumna Family Medicine
Soldotna
Nora Nagaruk MD: WWAMI alumna Internal Medicine Nome
Donna Galbreath MD WWAMI alumna Family Medicine ANMC
Bob Urata MD WWAMI alumnus Family Medicine Juneau
Pete Schaab MD Orthopedic surgeon (retired) Anchorage
Interviews at UAA decisions made jointly with UWSOM
Admissions Executive Committee
80-95 applicants/year for 20 students (also select 10
alternates)
Have the pipeline applicants to grow to 30 excellent
students/year
9:26:01 AM
Senator Olson asked whether there were any non-physicians
on the Admissions Committee.
9:26:10 AM
Ms. Allen said that there had previously a public member,
who was no longer on the committee, and who had not been
replaced.
9:26:39 AM
Senator Hoffman asked how long members served on the
Admissions Committee.
9:26:47 AM
Ms. Allen replied 6 years; 3-year terms, renewable one-
time.
9:27:21 AM
Senator Hoffman asked whether the committee was voluntary.
9:27:24 AM
Ms. Allen replied in the affirmative.
9:27:56 AM
Ms. Allen looked at Slide 14, "WWAMI Curriculum 2018-2019":
Enhanced integration, active learning, patient care
focus
Three Phases
?Foundations Phase at UAA
? 18 months (3 semesters, equivalent of years 1
and 2) clinically focused curriculum
? UAA Alaska model chosen as new curriculum
template
?Patient Care Phase (clinical training required
clerkships)
?Exploration and Focus Phase (advanced clinical
training, research, residency prep)
9:28:27 AM
Ms. Allen highlighted Slide 15, "WWAMI Curriculum 2018-
2019":
Alaska WWAMI Clinical Training Communities:
? Anchorage
? Eagle River
? Palmer / Wasilla
? Talkeetna
? Fairbanks
? Delta Junction
? Galena
? Homer
? Seward
? Soldotna
? Juneau
? Sitka
? Haines
? Petersburg
? Ketchikan
? Craig
? Metlakatla
? Kodiak
? Unalaska
? Bethel
? Nome
? Naknek
? Dillingham
? Valdez
? Utqiagvik
? Kotzebue
? Unalakleet
9:28:40 AM
Ms. Allen highlighted Slide 16, "WWAMI Rural Programs":
RUOP (Rural Underserved Opportunities Program)
? Began 1989
One-month clinical experience between 1st 2nd
year
? 53 percent of students who participated in RUOP
go into primary care
WRITE (WWAMI Rural Integrated Training Experience)
? Began 1996
? Longitudinal integrated clerkship family
medicine, internal medicine, pediatrics, and
psychiatry clinical rotations in Patient Care
Phase
? 67 percent in primary care 42 percent family
medicine, 16 percent internal medicine, 9 percent
pediatrics
? 35 percent in rural
TRUST (Targeted Rural Under Served Track)
? Began 2016
? Longitudinal integrated curriculum across 4
years in continuity community
9:30:21 AM
Co-Chair von Imhof asked whether the other states involved
in the program had rural areas served by WWAMI students.
9:30:53 AM
Ms. Allen relayed that the rural programs were within all
the states involved in the program. She said that students
could go between states; students were placed in rural
areas where opportunity existed and in their home states
when possible.
9:32:01 AM
Co-Chair von Imhof understood that there could be more
interest in areas than clinical sites to accommodate them.
She wondered whether housing was an issue in placement.
9:32:31 AM
Ms. Allen replied that the RUOP program sometimes
experience a housing bottleneck in the summer months when
the number of people visiting Alaska increased.
9:32:52 AM
Senator Wilson asked whether students from other states
involved in the program were recruited to practice in
Alaska.
9:33:16 AM
Ms. Allen responded that students could request areas to
perform their training. She said that some students
prioritized training in their own states, but others wanted
to do training in areas outside their home state.
9:34:37 AM
Senator Wilson asked whether there was as aggressive
movement to recruit students from other states involved in
the program.
9:34:51 AM
Ms. Allen stated that the different practice locations
where students went to perform their medical training would
be the strongest advocates for encouraging students to come
back and practice in that location when they graduate.
Overall, the program did not recruit people to come back to
practice in Alaska but did highlight the benefits of
returning to work in their home communities.
9:35:28 AM
Senator Hoffman asked how many WWAMI graduates were serving
in Alaska. He requested a list by community.
9:35:42 AM
Ms. Allen replied that there were currently 212 WWAMI
graduates practicing in the state. She noted that the list
of communities where those students were practicing was on
Slide 11.
9:35:55 AM
Senator Hoffman asked that the list be broken down by
number.
9:35:58 AM
Ms. Allen agreed to provide that information.
9:36:07 AM
Ms. Allen discussed Slide 17, "Trust Continuum." She
relayed that the program was recruiting from rural and
underserved communities.
9:37:06 AM
Ms. Allen addressed Slide 18, "WWAMI":
Alaska's Medical School
It takes a village??.
UAA WWAMI Foundations Faculty:
1 PhD (8 FT)
?29 MD (4 FT; 3 0.5 FTE; several 0.2 FTE), many
volunteer
?20 MD clinical preceptors (volunteer)
?12 summer RUOP preceptors (volunteer)
?8 PhD/MD summer research mentors
Faculty have UAA and UWSOM faculty appointments
9:37:37 AM
Ms. Allen looked at Slide 19, "Alaska WWAMI Clinical
Faculty":
Alaska has >200 WWAMI clinical faculty* teaching
medical students and residents in 26 communities.
? They teach first, second, third and fourth year
WWAMI medical students, and family medicine and
pediatric residents.
? 377 clinical experience opportunities across the
state for medical students and residents.
? 234 third and fourth year required and elective
clinical rotations, including four longitudinal
continuity rotations
? (6 months-Kodiak, Soldotna, Juneau, Ketchikan)
* UW School of Medicine faculty appointments
9:38:27 AM
Senator Shower asked how the performance of the clinical
faculty was measured and tracked.
9:38:59 AM
Ms. Allen stated that each person training a medical
student was required to have a license to practice and be
board certified. She said that the teachers were required
to teach 50 hours per year to keep their faculty
appointment. She shared that student evaluations were
strongly considered.
9:40:20 AM
Senator Micciche asked whether there were differences in
practice requirements, or materials covered, between a
WWAMI graduate at a participating university and a graduate
of the same medical school who had not been in the program.
Ms. Allen replied that there was no difference in training
for a student receiving medical training under WWAMI and a
student, not participating in WWAMI, enrolled in a medical
program at a participating university. All the medical
schools in the program provided the same training to
students.
9:41:42 AM
Senator Micciche asked whether the state had a foundation
that supported the cost of the program.
9:41:55 AM
Ms. Allen replied that the program was publicly funded and
did not receive funds from any foundations.
9:42:06 AM
Co-Chair Stedman surmised that the cost of the program was
$39,000, per student, per year. He noted that the state was
currently facing budgetary constraints and wondered whether
the program had explored other funding options.
9:42:48 AM
Ms. Allen replied that there had not been conversations
with other groups about alternative funding opportunities.
9:43:00 AM
Senator Micciche wondered why only 5 states participated in
the program.
9:43:07 AM
Ms. Allen replied that the program had been created during
the last expansion of medical education in the country. She
shared that the signing of Medicare into law in the 1960s
had increased the need for increased physicians to
accommodate the number of people that were not insured for
healthcare. At that time, the states surrounding
participating WWAMI states already had medical schools, the
consortium was built to provide publicly supported medical
education to increase the physician workforce. She noted
that Wyoming had not been part of the original consortium
and had joined in 1996.
9:44:25 AM
Senator Wilson queried the actual cost of running the
program. He thought that the cost to the state was
approximately $1.2 million.
9:44:52 AM
Ms. Allen said that the cost was approximately $7 million
for the 20 students in the program each year. She cited
Slide 6. She said that the students paid their own tuition,
the state paid for what it cost for each student to
participate in the program.
9:46:10 AM
Senator Wilson asked for a cost breakdown for the program.
9:46:16 AM
Co-Chair Stedman interjected that the breakdown should go
back several years to provide a historical cost reference.
9:46:25 AM
Co-Chair von Imhof wanted to see a line item list, over 4-
years, of funding sources and the percentage return on
investment to the state. She wondered about the last bullet
point on Slide 6 and asked about the costs to other states.
She asked whether there had been any discussion of starting
an endowment to fund the program.
9:48:09 AM
Ms. Allen replied that she would provide the information.
She said that there were 160 students enrolled in the
program in Washington State; 40 in Idaho, 30 in Montana,
and 20 in Wyoming. She said that the other states funded
the program similarly to Alaska through state funding and
student tuition. She was unaware of any conversations about
creating an endowment.
9:49:01 AM
Co-Chair Stedman thought that there would be endowment
discussion in the future.
9:49:13 AM
Ms. Allen addressed slide 20, "WWAMI School of Medical
Education."
9:49:38 AM
Ms. Allen looked at slide 21, "WWAMI School of Medical
Education."
9:50:00 AM
Co-Chair Stedman asked whether Senator Olson had
participated in the program for his medical training.
9:50:04 AM
Senator Olson replied that he had not been accepted into
the program. He pointed to Slide 4, he wondered how many
physicians left the state each year to practice elsewhere.
9:50:27 AM
Ms. Allen responded that she could not provide specifics on
the reason for the annual number of physicians needed each
year in the state.
9:50:56 AM
Senator Olson asked whether other states had a payback
program for their students that chose to practice in states
other than their home state.
9:51:12 AM
Ms. Allen replied that Wyoming was the only other state
that had a payback requirement.
9:51:50 AM
Senator Olson asked about licensing requirements that might
differ from state to state.
9:52:05 AM
Ms. Allen responded that each state had a State Board of
Medicine that controlled licensing, she did not believe
that there was a difference, whether the student was from
the state or not, in the ability to receive a state license
to practice.
9:53:20 AM
Senator Shower wondered what would happen to students
currently enrolled in the program if the funding were
pulled due to the governors budget cuts.
9:53:39 AM
Ms. Allen said that current students would be allowed to
complete their education, they would be charged out-of-
state, and not in-state tuition. She said that additional
classes would not be recruited.
9:54:38 AM
Senator Micciche asked whether the potential obligation to
pay back 50 percent made a difference on the student return
rate. He wondered whether more WWAMI than non-WWAMI
graduates returned to the state.
9:55:17 AM
Ms. Allen believed that the return rate of WWAMI graduates
was higher than the national average.
9:55:47 AM
Senator Olson thought that North Dakota required their
graduates to complete their medical training at the Mayo
Clinic.
9:55:56 AM
Ms. Allen said that currently all four years were completed
within North Dakota. She said that in the 1970s the first
two years would be completed in North Dakota, after which
students were distributed between the Mayo Clinic and the
University of Minnesota to complete medical training.
9:56:18 AM
Senator Olson asked whether Alaska had considered a similar
program of covering basic science years at a lower cost
than the clinical years.
9:56:32 AM
Ms. Allen shared that the accrediting body no longer
allowed for a separately accredited first and last two
years of schooling. The closest to the previous model was
the WWAMI program, which allowed the first three years to
be performed on regional campuses, with clinical training
completion available across the five participating states.
9:57:05 AM
Senator Olson asked about programs that granted allopathic
(MD) versus osteopathic (DO) degrees and wondered whether
changes in that process had occurred.
9:57:16 AM
Ms. Allen replied that the medical school training had
similarities, DO physicians learned more about
Manipulations than MDs.
9:57:57 AM
Senator Olson queried the chairman of the Admissions
Committee.
9:58:04 AM
Ms. Allen replied the chairman was Dr. Kate Sheridan.
9:58:33 AM
Co-Chair Stedman discussed housekeeping.
ADJOURNMENT
9:59:20 AM
The meeting was adjourned at 9:59 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 032519_SFIN_WWAMI (002).pdf |
SFIN 3/25/2019 9:00:00 AM |
WWAMI |
| 032519 WWAMI Operating Budget Transactional Change Description.pdf |
SFIN 3/25/2019 9:00:00 AM |
WWAMI |