Legislature(2009 - 2010)HOUSE FINANCE 519
04/14/2009 08:30 AM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB204 | |
| HB222 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 204 | TELECONFERENCED | |
| + | HB 222 | TELECONFERENCED | |
| + | TELECONFERENCED |
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."
REPRESENTATIVE NANCY DAHLSTROM, SPONSOR, related that the
bill would add four students to the medical education
program.
9:19:22 AM
SAM DIX, STAFF, REPRESENTATIVE NANCY DAHLSTROM, explained
that the purpose of the bill is to add four more medical
students and eventually establish a 30-student program. It
is an attempt to maximize the facilities at the University
of Alaska - Anchorage.
Vice-Chair Thomas asked if the bill pertains only to medical
doctors. Mr. Dix said that was correct. Vice-Chair Thomas
hoped to see the bill expanded to include dentists. He
asked if the administration supports the bill.
Representative Dahlstrom reported that the administration
does support the bill. She offered to work on expanding the
bill to include other areas.
Vice-Chair Thomas expressed frustration and thought he might
not support the bill.
9:21:38 AM
Representative Dahlstrom offered to work on that problem.
Representative Austerman inquired about the cost of the
program. He wondered, since it is a loan program, why
general fund dollars would be needed. Representative
Dahlstrom stated that it was a loan forgiveness program.
9:23:02 AM
DIANE BARRANS, EXECUTIVE DIRECTOR, POSTSECONDARY EDUCATION
COMMISSION, DEPARTMENT OF EDUCATION, agreed with
Representative Austerman that the program is funded with
state general funds. The existing program operates in
excess of $2 million a year. She reported that it is a work
obligation program with a trigger if someone in the program
fails to return to Alaska.
Representative Austerman asked how long the obligation was.
Ms. Barrans replied that students have 15 years to pay if
they fail to return to the state and provide three to five
years of service.
Representative Austerman presented an example of a doctor
who returns to the state, provides service, and has the loan
forgiven. Ms. Barrans agreed with his analysis. She
clarified that the service obligation is in lieu of
repayment.
9:24:38 AM
Representative Fairclough reported that she followed the
bill last year and the discussions in the HESS committee.
She asked about the dismal return rates and wondered if a
residency program would help solve the program.
Ms. Barrans explained that past return rates proceeded the
loan obligation period of the program. The actual return
rate of Alaskans varied between 45 and 55 percent and should
now increase. Out of state WWAMI students also chose to
participate in Alaska. She explained how the residency
requirements work. It takes about seven years to complete
the program. The cohort of students that would have
completed a three-year residency in the fall of 2008 was the
first group with the contractual service obligation.
9:27:27 AM
Co-Chair Hawker asked for more information about return
rates.
DENNIS VALENZENO, DIRECTOR AND PROFESSOR, WWAMI PROGRAM,
UNIVERSITY OF ALASKA, ANCHORAGE, via teleconference, related
that the return rate of Alaskans is actually quite good
compared to outside programs. About 50 percent come back to
the state to practice. Students coming to the state from
other states to do short clinical experiences impact the
statistics. The overall return on the investment is about
88 percent since the beginning of the program in 1971. It
takes about seven years to complete the program. Residency
is the most important factor as to where doctors choose to
practice. Where students go to school is the second most
important factor. Through WWAMI Alaska is able to offer
three of the four years of medical school.
9:30:39 AM
Representative Fairclough had heard a different scenario.
She wished to research the statistics further.
Co-Chair Hawker asked if the state would benefit more by
increased residency programs or by more students in the
WWAMI program.
SUZANNE TRIPP, DIRECTOR, REGIONAL PROGRAMS, UNIVERSITY OF
WASHINGTON SCHOOL OF MEDICINE, via teleconference, first
addressed Vice-Chair Thomas's concerns about dentists. She
related that through the University of Washington, there was
an option for developing dental programs in Alaska based on
the WWAMI model.
Ms. Tripp turned to the issue of residency training. She
maintained that it was a huge factor in WWAMI. Residency
programs are being developed currently. She spoke of
overcoming obstacles related to developing residency
programs in Alaska. There needs to be sufficient technical
expertise, adequate finances - based on Medicare bed rates,
and enough case volume in order to qualify to take on
residents. Branch programs in pediatrics and in psychiatry
are currently being developed. Internal medicine programs
will be next.
9:33:11 AM
Representative Fairclough summarized that residency is the
number one factor. She wished to check further.
Representative Gara agreed with the expansion of family
practice residency. He voiced support for the bill. He
mentioned a concern about an acute shortage of internists,
family care physicians, and gerontologists. He suggested
focusing scholarships in those areas.
Representative Dahlstrom offered to meet to discuss this
issue and to include the Committee's concerns. She added
that she has concerns with lack of medical care in parts of
the state.
9:36:22 AM
Representative Gara said he was open to a conversation.
Co-Chair Hawker asked for an opinion of Representative
Gara's comments.
Mr. Valenzeno agreed that targeting an area of medical
practice was a good idea. He thought it would be difficult
to hold a student to that choice. Representative Gara hoped
there was a way to make it work.
9:38:10 AM
Representative Austerman wondered whether returning doctors
are required to serve high-need areas or rural areas.
Ms. Barrans reported that there is an incentive to
accelerate the discharge of the financial obligation by
choosing a rural area.
9:39:12 AM
Vice-Chair Thomas asked what the average obligation to the
state was. Ms. Barrans said it was $90,000, which would
increase by about 4 to 6 percent per year. That amount is
in addition to about $100,000 of education debt the student
has already incurred. Vice-Chair Thomas asked if $190,000
was the amount forgiven. Ms. Barrans explained that the
$100,000 was owed to the federal government or other
lenders.
Vice-Chair Thomas wondered why 15 years was allowed for
paybacks. He suggested the payback be accelerated if the
student does not return to the state. Ms. Barrans observed
that collectability must be considered. It is difficulty to
leverage an accelerated repayment on such a large amount
without collateral.
9:41:56 AM
Representative Fairclough inquired about the delinquency
rate of the loans. Ms. Barrans reported that currently
there is zero delinquency.
Representative Austerman asked about the forgiveness period
and amount collected. Ms. Barrans reported that $170,000 is
the amount collected with interest by the state if they
don't return and work in the state.
Representative Austerman asked if the $90,000 original loan
was forgiven if the student returns to the state to work for
five years. Ms. Barrans said that was correct.
9:43:37 AM
Representative Salmon asked about incentives to bring
physicians to come to Alaska to work. Ms. Barrans was not
aware of such a program.
Co-Chair Hawker opened public testimony.
9:44:27 AM
Ms. Tripp clarified that the average amount of debt for an
Alaska WWAMI graduate is about $130,000 because they pay
tuition in addition to state support. The amount of money
the state sends to the University of Washington is
equivalent in context, not amount, to the amount of general
fund used by the University of Alaska. It makes the
partnership of the University of Washington and the state's
medical school, similar to any publically funded medical
school. The money the state pays is not a scholarship or a
grant; it is the state's support for medical education. In
addition, students may receive scholarships or loans and pay
tuition to the University of Washington and the University
of Alaska. Students usually have more than $200,000 worth
of obligation upon completion of their education. In Alaska
there is a need for primary care physicians. There is a
correlation between debt and the type of medicine practiced.
9:46:39 AM
Co-Chair Hawker closed public testimony.
Co-Chair Hawker requested information about the fiscal note.
Mr. Dix explained that in 2012 the total operating budget
would be $210,300. For 2013 it would be $425,200. For 2014
it would be $550,300 and for 2015 it would be for $557,400.
Co-Chair Hawker asked why it accelerates over the years.
Ms. Tripp related that it accelerates because there are more
students in the program every year. Co-Chair Hawker
concluded that it was a cumulative bill.
9:48:37 AM
Representative Gara asked if the WWAMI subsidy was for four
years of medical school, but not for the residency because
the students would be getting paid. Ms. Tripp said that was
correct.
Representative Austerman inquired if the amount was for four
new students. He asked if there was already $2 million in
the program. Ms. Tripp said that was correct.
Vice-Chair Thomas asked if the fiscal note covers the
student that has an assistant. Ms. Tripp stated that it
does include all expenses. Vice-Chair Thomas asked how many
more teachers would be added. Ms. Tripp explained the
apprenticeship program and how sites are found. Additional
persons are then brought on, however, she did not know how
many.
9:50:57 AM
Vice-Chair Thomas thought extra individuals were hired to
supervise the students. Ms. Tripp recalled that there was a
coordinator who would help students navigate through medical
school, as well as career counselors. In the third and
fourth year additional supervisors are involved. Vice-Chair
Thomas wanted to know the costs in addition to funding the
students.
9:52:04 AM
Representative Joule wondered what the shortage of doctors
would look like without this program. He asked where
residencies take place. Ms. Tripp reported that residency
training can happen in a number of sites, determined by the
population of the town and type of residency. One of the
requirements for pediatricians is that a doctor be available
on site for training. In Bethel the residents go out to
various rural sites for one month.
Ms. Tripp addressed the issue of physician training and the
physician shortage in Alaska. There is a need for 30 more
physicians a year in order to address the shortage of
doctors in the state. There are currently 260 WWAMI doctors
in the state. A primary care physician has about 3,000
patient visits a year.
Representative Joule thought that was a "pretty good
picture" of the situation.
9:54:58 AM
HB 204 was heard and HELD in Committee for further
consideration.
9:55:47 AM
| Document Name | Date/Time | Subjects |
|---|---|---|
| Frequently Asked Questions.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 204 |
| AARP.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 204 |
| HB222-DHSS-MS-04-11-09NEW.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 222 |
| HB222-DHSS-BHMS-04-11-09NEW.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 222 |
| HB 222 Sectional.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 222 |
| HB 222 Sponsor Statement.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 222 |
| Stateof AlaskaDeptHSS.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 204 |
| Sponsor Statement WWAMI (3).pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 204 |
| Physician Shortage Fact Sheet Header.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 204 |
| HB 204 - Increase WWAMI Class Size.pdf |
HFIN 4/14/2009 8:30:00 AM |
HB 204 |