Legislature(2009 - 2010)CAPITOL 106
03/30/2009 08:00 AM House EDUCATION
| Audio | Topic |
|---|---|
| Start | |
| HB204 | |
| HB58 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 204 | TELECONFERENCED | |
| += | HB 58 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 204-POSTSECONDARY MEDICAL EDUC. PROG. 8:04:50 AM CHAIR SEATON announced that the first order of business would be HOUSE BILL NO. 204, "An Act increasing the number of students pursuing a medical education who are provided postsecondary educational services and programs; and providing for an effective date." 8:05:16 AM SAMUEL DIX, Staff to Representative Nancy Dahlstrom, Alaska State Legislature, informed the committee that the Wyoming, Washington, Alaska, Montana, and Idaho (WWAMI) program has evolved to provide three out of four years of medical school education within Alaska. According to a 2006 Alaska Physician th Supply Task Force, Alaska ranks 17 lowest in the nation in terms of physician-to-population ratio. The task force also estimates that Alaska has 375 fewer doctors than needed. This shortage is likely to worsen as Alaska's population increases and ages. Furthermore, one-third of the state's physicians are likely to retire within the next 10-15 years. Mr. Dix told the committee that at this time 50 percent of Alaskans who enter the WWAMI program ultimately practice within the state. The aforementioned percentage increases to almost 90 percent when WWAMI graduates from other states are included. MR. DIX explained that during the first year of the WWAMI program students study at the University of Alaska Anchorage, whereas in the second year students from all five WWAMI states study at the University of Washington's School of Medicine in Seattle. The third and fourth years of study consist of clinical clerkship and rotations in the various medical specialty areas. He noted that these clerkships can be taken in any of the five WWAMI states. However, the Alaska track provides students the ability to complete nearly all third- and fourth-year clerkships in the state. Mr. Dix stated that the overall goal of the program is to incrementally increase the amount of students to 30. At this time, only an additional four seats are being asked for because that's all that the University of Alaska Anchorage can handle with its current facilities and faculty. 8:07:09 AM REPRESENTATIVE GARDNER noted that she was a supporter of the past legislation that doubled the number of students allowed in the WWAMI program. However, the House Finance University Budget Subcommittee discussed that the strongest indicator of where a student will practice medicine is the location of the student's residency. Therefore, the real impediment to increasing the number of new physicians in Alaska is having enough residency spots in Alaska. She asked if the sponsor has explored what it would take to simply offer more spots for residency. MR. DIX pointed out that three out of the four years of the WWAMI program are spent in Alaska. He then highlighted that since the inception of the WWAMI program, the number of physicians practicing in Alaska has increased. 8:09:09 AM SUZANNE TRICK, Regional Program Director, School of Medicine, University of Washington, stated support for HB 204. She informed the committee that prior to doubling the class size for the Alaska WWAMI program, Alaska ranked last in the nation in the number of medical school seats per person. Although Alaska isn't at the bottom, the state still ranks low and thus the state has a need for more medical school slots in the state. Ms. Trick then noted her agreement with the earlier mentioned notion that students practice where they receive the majority of their training. She pointed out that Alaska only has a residency program in family medicine and thus there are only a few types of residents that can be captured for training in the state. Therefore, the state needs physicians in more specialty areas than family medicine. Ms. Trick informed the committee that she is working on a residency program in pediatrics and psychiatry, as well as rotations in internal medicine. Many WWAMI residency students rotate in Alaska in order to determine whether Alaska is a site at which they would like to practice. The WWAMI return rate of nearly 9 out of 10 physicians is very high. In fact, it probably exceeds most residency training programs that place physicians on the ground. 8:12:26 AM MS. TRICK, in response to Representative Gardner, clarified that for every 10 physicians the WWAMI program pays for about 8.8 initiate their practice in Alaska. Of those, 5 of the physicians are from Alaska and 3.8 start in another WWAMI state. 8:12:47 AM REPRESENTATIVE GARDNER asked if there are impediments that could be removed to improve the residency numbers. MS. TRICK said that there are three areas of barriers. First, the ways in which residency programs are financed. She explained that residency programs are usually financed with federal funds as well as funds from the state in which the program is located. However, since the federal funding is capped, the program is constantly working with the federal government regarding the number of residents they will fund. Second, there have to be enough physicians and volume of patients for residents to receive adequate training. The aforementioned is particularly true in specialty areas. In areas such as internal medicine, there aren't enough people to train residents. The third barrier is technical assistance residency programs take a long time to develop and the accreditation process takes a year after the site and faculty are identified. Ms. Trick said that at this point she didn't see anything that she would recommend changing. 8:14:43 AM MS. TRICK, in response to Chair Seaton, explained that the family practice designation once was similar to being a general practitioner. She explained that family practitioners do a three-year residency training program while general practitioners generally don't. She noted, "We don't really have general practitioners much anymore." In further response to Chair Seaton, Ms. Trick informed the committee that [the WWAMI program] is training in primary care, which is needed the most. Furthermore, [the WWAMI] program is training "the most primary of primary physicians." In response to Representative Wilson, Ms. Trick clarified that family medicine is a primary care specialty. 8:17:22 AM REPRESENTATIVE EDGMON inquired as to where the physicians that don't initiate a practice in Alaska go. MS. TRICK deferred to Mr. Valenzeno. 8:17:51 AM DENNIS VALENZENO, Director, Alaska WWAMI Program; Associate Dean, Medical and Pre Medical Program, University of Alaska Anchorage, informed the committee that Alaska WWAMI graduates who don't practice in Alaska may practice anywhere in the United States, although there may be a higher percentage practicing in WWAMI states. He noted his agreement that the primary factor in determining where medical students practice is the location of the student's residency. However, the second most important factor is where the medical student attended medical school. Therefore, he indicated the need to capitalize on the second factor. 8:20:24 AM REPRESENTATIVE KELLER related his understanding that HB 204 would cover four students. He inquired as to the percentage of the total tuition cost covered by HB 204. MR. VALENZENO explained: The budget for WWAMI is a two-part budget. The first year is at the University of Alaska Anchorage. The normal cost for a medical school nationwide is about $75,000 per year per student. In the first year, because of some economies of scale at this point, we will be able to increase to 24 just based on the tuition that our students pay as our additional compensation. That's about $20,000 per year per student. Years two through four, the budget runs through the University of Washington School of Medicine. 8:21:46 AM MS. TRICK then explained: For years two through four, the cost that you pay represent the state support for medical education. It's about $56,000 per year per student. On top of that the students pay tuition of about $20,000. 8:22:11 AM REPRESENTATIVE KELLER related his understanding that those students who do not return to Alaska receive this money as a loan, and therefore have to repay the state in full. MS. TRICK clarified that 50 percent of state support becomes a loan that would have to be repaid if the student practices in another state. CHAIR SEATON surmised then that in years two through four the state support is in the amount of $56,000 per student per year. Fifty percent of that amount is a loan, which would have to be repaid if the student doesn't [practice] in Alaska. If the student returns to Alaska, the complete loan forgiveness is three years for those who [practice] in an urban setting versus five years in a rural setting. MS. TRICK stated her agreement. 8:24:08 AM SHELLY HUGHES, Alaska Primary Care Association, stated support for HB 204, primarily based on the shortage of medical professionals that exist in Alaska. She opined that if nothing is done to reverse the trend, certain areas of the state will face a public health crisis. Therefore, the provisions in HB 204 that get WWAMI graduates in some of the harder to fill spots are something the Alaska Primary Care Association supports. Ms. Hughes informed the committee that the Alaska Primary Care Association represents primary care providers throughout the state, particularly watching out for those who are safety net providers. In the last three weeks, there has been turnover in about 28 of the 32 physicians in the community health center system. In fact, there are currently about 22 vacancies for physicians. The incentive to stay, to pay off an obligation, is very favorable. Furthermore, the longer a person is in a community, the more likely he/she will stay. Ms. Hughes characterized HB 204 as a step in the right direction. However, the shortage of physicians means that the state should not only look to grow its own physicians but also to import them from Outside. The physicians in the safety net health center system makeup about 2 percent of the physicians statewide, but represent 10 percent of the vacancies. She highlighted that it takes health centers one year to eighteen months to fill one of these vacancies. Furthermore, the patient load in health centers has increased by 57 percent [between 2000 and 2006]. She informed the committee that statewide the vacancies range from 11-27 percent, with the lower vacancy range in the urban areas while the highest vacancy rate is in the tribal clinics. Some of the health centers, she mentioned, are also tribal clinics. She highlighted the cost of recruiting, which is over $100,000. Therefore, cultivating WWAMI graduates is a cost savings to the health care system. In conclusion, Ms. Hughes reiterated support for HB 204. 8:28:21 AM CHAIR SEATON asked whether WWAMI graduates currently work in the health clinics. He also asked if the Alaska Primary Care Association specifically recruits WWAMI program graduates. MS. HUGHES related her understanding that there are WWAMI graduates working in [the health care centers). 8:28:55 AM REPRESENTATIVE GARDNER inquired as why the patient load has increased by 57 percent in the last six years. MS. HUGHES attributed part of the increase to the increase in the number of health care centers. Furthermore, health care centers accept patients regardless of the patient's insurance status. Ms. Hughes predicted that even more people will seek care at health care centers due to the current national economic situation. In further response to Representative Gardner, Ms. Hughes related that the most cost effective ways to get physicians and other health care providers into the state is to provide loan repayment program. Loan repayment is included in HB 206, in a sense, because the obligation is reduced. An even better incentive is in the form of cash, which would reach beyond the pool of graduates to experienced graduates and thus increase the pool of physicians. The Alaska Primary Care Association is supporting another piece of legislation that utilizes the direct incentive of cash. 8:31:58 AM REPRESENTATIVE WILSON recalled that in her district there used to be an intern program for family practice. However, that program is no longer due to the lack of population in the area. She asked if such a program is happening elsewhere in the state. MS. HUGHES answered that she wasn't aware of any such program. She informed the committee of a federal Student/Resident Experiences and Rotations in Community Health program (SERCH), not to be confused with the Southeast Alaska Regional Health Consortium, which brings students in their second and third year to Alaska for a four-week rotation. Although the aforementioned program was terminated last year, she related her understanding that it will be in place again. This program has had a good return rate. 8:33:20 AM REPRESENTATIVE KELLER, referring to Ms. Hughes' comments regarding direct grants, requested more information on the legislation to which she referred. MS. HUGHES explained that the proposed legislation would provide higher direct payments to providers who take hard-to-fill positions, which would be defined based on criteria directly related to the situation. This would be used in employer situations, such as with health centers as well as private practices in a community with a known health provider shortage. 8:35:13 AM CHAIR SEATON informed the committee that HB 204 will be referred to the House Finance Committee, following being reported from this committee. 8:35:47 AM REPRESENTATIVE KELLER expressed interest in the incentive options available. MS. HUGHES informed the committee that the other proposed legislation would allow a WWAMI student to be eligible [for direct payments], as an additional incentive for him/her to practice in Alaska. 8:37:34 AM PAT LUBY, Advocacy Director, AARP Alaska, provided the following testimony: As you well know, the entire country has a physician shortage. In Alaska, it is acute, especially access to physicians who will see Medicare patients. Certainly one of the most helpful things the legislature has done in the recent past has been the expansion of the WWAMI program from 10 to 20 slots for Alaska medical students. HB 204 will give us another four slots for Alaskans who want to attend med school. Will it solve our physician access problem? No. Will it help? Yes. AARP encourages you to pass HB 204. 8:38:51 AM KATHLEEN TODD, Family Physician, informed the committee that her daughter is participating in the WWAMI program. "The thing that a lot of people don't understand is that if you don't have a state, your chances of getting into medical school are much lower," she opined. She explained that other states only take their in-state residents. Without slots in the WWAMI program, Alaskans can only attend private medical schools. As an aside, Dr. Todd related the need for the legislature to review the regulations regarding who is an Alaskan and who isn't. Dr. Todd mentioned that the state needs primary care physicians as well as family practitioners who can perform surgeries, orthopedics, emergency room service, and obstetrics. She highlighted the need to participate to the maximum extent possible in the WWAMI program. 8:42:23 AM CHAIR SEATON, upon determining no one else wished to testify, closed public testimony. 8:42:33 AM CHAIR SEATON reminded the committee that HB 204 would not be referred to the House Health and Social Services Standing Committee and announced that HB 204 would be held over. 8:43:15 AM REPRESENTATIVE WILSON opined that it is obvious that the need exists and no testimony [in opposition to HB 204] has been heard. Therefore, she related her desire to move the legislation from committee today. 8:43:59 AM CHAIR SEATON reiterated that HB 204 would be held over in order that there be a second hearing that provides time for the public to comment.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 204 information.pdf |
HEDC 3/30/2009 8:00:00 AM HEDC 4/1/2009 8:00:00 AM HEDC 4/3/2009 8:00:00 AM |
HB 204 |
| AmendingCSHB58 verP3 28.pdf |
HEDC 3/30/2009 8:00:00 AM |
HB 58 |
| HB 58 material.pdf |
HEDC 3/30/2009 8:00:00 AM |
HB 58 |
| HB 58 fiscal note.pdf |
HEDC 3/30/2009 8:00:00 AM |
HB 58 |
| HB 58 amendment.pdf |
HEDC 3/30/2009 8:00:00 AM |
HB 58 |
| HB58EduAmendPacket.pdf |
HEDC 3/30/2009 8:00:00 AM |
HB 58 |