Legislature(2025 - 2026)BELTZ 105 (TSBldg)
04/16/2025 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| SB170 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 89 | TELECONFERENCED | |
| *+ | SB 170 | TELECONFERENCED | |
SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
1:35:32 PM
CHAIR BJORKMAN announced the consideration of SENATE BILL NO. 89
"An Act relating to physician assistants; relating to
collaborative agreements between physicians and physician
assistants; relating to the practice of medicine; relating to
health care providers; and relating to provisions regarding
physician assistants in contracts between certain health care
providers and health care insurers."
1:36:07 PM
SENATOR LOKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 89. She presented a brief recap of
SB 89 and stated that the legislation aims to modernize statutes
governing physician assistants (PAs) by reducing administrative
burdens and providing a pathway to independent licensure. While
PAs are not doctors, they receive extensive education and
clinical training comparable to nurse practitioners. SB 89
ensures PAs can practice fully within their scope, maintain
competitiveness, and provide high-quality care. PA's require
completion of accredited education, licensure exams, and at
least 4,000 postgraduate clinical hours before independent
practice. SB 89 also incorporates safeguards for specialty
transitions, with oversight from the state medical board, and
holds PAs to the same medical standards as MDs and DOs, ensuring
patient safety and accountability.
1:40:29 PM
CHAIR BJORKMAN asked how many hours a PA must work under a
doctor's supervision before practicing independently. He also
about the number of hours required by other states.
1:41:09 PM
SENATOR TOBIN replied that at least seven states have created
pathways for PAs to obtain independent licensure. She stated
that the required number of supervised clinical hours varies
widely across those states. Wyoming has no minimum hours, Iowa
requires 4,000, South Dakota 6,000, Montana 8,000, and New
Hampshire and Utah range from 8,000 to 10,000. She said rural
states like Alaska, North Dakota, and Wyoming prioritize access
to care and tend to have lower or no minimums. Given PAs similar
scope of practice to nurse practitioners, stakeholders in Alaska
agreed on a compromise of 4,000 supervised hours, acknowledging
it is somewhat arbitrary.
1:42:37 PM
CHAIR BJORKMAN asked whether the medical community has
professional guidance on the optimal number of supervised hours
needed to achieve the best patient outcomes.
1:42:55 PM
MACKENZIE POPE, Staff, Senator Loki Tobin, Alaska State
Legislature, Juneau, Alaska, answered questions for SB 89 and
stated that as mentioned earlier other advanced practice
providers (APP), like nurse practitioners, require zero
supervised hours. She said research suggests zero hours is
sufficient, and there is no consensus among stakeholders on an
ideal number, resulting in a wide rangefrom zero to 10,000
hoursacross states.
1:43:40 PM
CHAIR BJORKMAN stated that North Dakota's statute includes
provisions requiring physician assistants to practice near their
supervising physicians. He asked for the reasoning behind North
Dakota's statute and what safeguards SB 89 includes to address
the absence of a proximity requirement.
1:44:18 PM
SENATOR TOBIN replied that current law does not require
physician assistants to practice near their collaborating
physicians. She said about 14 percent of those physicians live
outside Alaska. SB 89 does not change this arrangement. While
collaborating physicians must review PAs work and hold quarterly
check-ins, compliance varies. Federally recognized health
clinics already provide stronger oversight; however SB 89 does
not change current practices regarding where PAs and
collaborating physicians live or work.
1:45:36 PM
CHAIR BJORKMAN requested more information on how Federally
Qualified Health Centers (FQHCs) provide oversight. He asked
whether the relationship between a supervising physician and a
physician assistant (PA) includes requirements for case reviews
or peer evaluations. He also asked how SB 89 addresses the
oversight structure for this relationship.
1:46:09 PM
MS. POPE replied that the policies and procedures of the Alaska
State Medical Board define collaborative agreements in detail
through regulation rather than statute, which SB 89 preserves.
She said these agreements must be written, filed with the board,
and outline how the collaborating physician and PA will
communicate. Each plan is customized and must include regular,
typically quarterly, check-ins and reviews, with minimum
standards set by law.
MS. POPE added that policies and procedures dictate a physician
must have a method of quality assurance and at a minimum 2 days
each quarter of direct personal contact for reviewing a PAs
performance.
1:48:31 PM
JENNY FAYETTE, Board Member, Alaska Academy of Physician
Assistants (AKAPA), Anchorage, Alaska, testified by invitation
on SB 89 and replied that regulations already authorize the
State Medical Board to oversee collaborative agreements,
requiring them in writing. The board is updating these rules to
streamline the process, and SB 89 specifies that such
regulations will also apply to PAs with fewer than 4,000
clinical hours.
1:49:21 PM
CHAIR BJORKMAN asked if it would be beneficial to specify in
regulation or statute the number of charts or cases a PA must
review with their supervising physician as part of their
collaborative agreement.
1:49:40 PM
MS. FAYETTE stated her belief that overly restrictive
collaborative plan requirements make it harder to employ PAs. SB
89 aims to safely expand employment opportunities, and there is
no research indicating that specifying a set number of case
reviews improves quality of care.
1:50:22 PM
CHAIR BJORKMAN asked whether it would be appropriate for a PA to
review the top 10 most complex or uncertain cases with their
supervising physician as a baseline for collaboration.
1:50:48 PM
SENATOR TOBIN replied that PAs often seek input from various
medical professionals, not just their collaborating physicians.
With PAs consulting multiple experts on complex cases, a chart
review by one physician may not provide the same quality of
oversight, reflecting the collaborative nature of
multidisciplinary medical practice.
1:51:29 PM
CHAIR BJORKMAN asked who is permitted to use the title "doctor"
or similar terms, and whether nurse practitioners with a PhD
should use that title in clinical settings, given potential
confusion for patients.
1:52:13 PM
SENATOR TOBIN replied that SB 89, Section 17, page 9, lines 21-
26, clearly [AS 08.64.380(6)(B)] defines in statute how medical
professionals may display their titles so patients can identify
their credentials, requiring PAs to visibly identify themselves
as physician assistants, similar to nurse practitioners. Second,
individuals who earn a doctorate, such as in psychology or other
fields, have the right to use the title "Doctor" to reflect
their academic achievement.
1:53:39 PM
CHAIR BJORKMAN opened public testimony on SB 89.
1:54:37 PM
CANDACE HICKEL, representing self, Anchorage, Alaska, testified
in support of SB 89 and advocated for addressing healthcare gaps
in areas facing provider shortages. PAs and nurse practitioners
perform similar clinical roles, but only nurse practitioners
have independent licensure. She said current laws requiring
collaborative agreements create barriers, as a PA cannot
practice if their supervising MD moves, leaving communities
without care. These agreements are seen as outdated
administrative burdens, unnecessary for ensuring quality. SB 89
proposes independent licensure for PAs to improve access and
allow them to practice fully within their training and
capabilities.
1:56:47 PM
KARI BERNARD, representing self, Anchorage, Alaska, testified in
support of SB 89 and stated that as a PhD-trained PA, she does
not use the title "Doctor" to avoid patient confusion and to
comply with Alaska law. She said National research shows PA-
delivered care is safe, effective, and sometimes superior, with
lower complications, mortality, hospitalizations, and re-
admissions, while also being cost-effective. PAs can help reduce
healthcare costs through shorter hospital stays and fewer
visits. SB 89 supports removing administrative burdens on PAs,
enabling them to better serve rural, vulnerable, and well-
resourced communities while filling provider gaps affordably.
1:58:59 PM
DR. MOLLY SOUTHWORTH, M.D., representing self, Anchorage,
Alaska, testified in opposition to SB 89 and acknowledged the
value of supporting PAs but argued they are not trained for
independent practice, and safety in such settings has not been
demonstrated, as existing studies reflect supervised care. She
proposed focusing on providing high-quality medical care through
strategic planning rather than licensing professionals beyond
their training. She said data from 2023 shows that only 43
percent of Alaskan PAs practice primary care, down from 47
percent in 2021, and independent licensure alone will not
increase this. Improving primary care and making it more
attractive requires addressing administrative burdens,
inequitable compensation, poor support, and burnout. Physician
leaders are developing a coordinated plan and invite
collaboration from others.
2:01:40 PM
JARED WALLACE, representing self, Kenai, Alaska, testified in
support of SB 89 and stated that Odyssey Family Practice in
Kenai serves over 6,000 patients, but care is constrained by the
requirement of a collaborative plan. He said he has experienced
collaborative physicians dying or losing licensure, making it
increasingly difficult to secure collaborators. He said
currently he pays $96,000 annually to maintain a collaborated
plan. Over 15 years, he has built strong professional
relationships with various specialists, which guide patient care
regardless of formal collaborative agreements. He argued that
professional relationships, not collaborative plans, are key to
delivering quality care. Collaborative agreements, in their
experience, act as barriers, risking patient access if
disrupted, rather than improving outcomes.
2:04:16 PM
KATHY TODD, Physician, Alaska Academy of Family Physicians,
Valdez, Alaska, testified in opposition to SB 89 and explained
that while PAs and nurse practitioners are capable, their
training is less extensive than that of physicians or even
advanced medical students. She said physicians undergo 1115
years of education, compared to six or seven for PAs, and the
proposed 4,000 additional supervised hours would not equal the
rigor of medical training. She argued that PAs are not prepared
for independent practice. She recommended amendments requiring
more supervised training and a team-based structure with
physicians. She added that independent practice for PAs or nurse
practitioners would reduce the quality of care, especially in
Alaska's complex and remote healthcare environment.
2:06:48 PM
MICHAEL MICHAUD, representing self, Mat-Su Valley, Alaska,
testified in support of SB 89 and stated that as a PA he has
practiced in both urban and rural Alaska, including the Alaska
Native Medical Center and Southcentral Foundation. He said in
rural and remote clinics, PAs often work independently without a
physician present. He stated that SB 89 would modernize
regulations to reflect the independent practice that already
occurs throughout Alaska.
2:08:37 PM
MARGARET CARLSON, President, Alaska Academy of Family
Physicians, Anchorage, Alaska, testified in opposition to SB 89
and stated that she is a physician who has collaborated with PAs
for the past 10 years. She said she recognizes the value and
limitations of PAs. She urged lawmakers to consider amendments
that individual physicians have submitted, such as requiring
more training hours like Utah's 10,000-hour model, to strengthen
skills and confidence. She stressed the importance of
maintaining team-based, collaborative care, warning that
independence could erode that structure. She noted there is no
data supporting PA independence and argued that physician
oversight helps reduce costs and improve care quality. She
cautioned that SB 89 could increase costs and worsen access, as
independently practicing PAs may not choose primary care.
2:11:08 PM
KATHERINE VAN ATTA, representing self, Wasilla, Alaska,
testified in support of SB 89 and described extensive experience
working as a PA in remote Alaska communities such as Adak and
Naknek. She pointed out that SB 89 concerns independent
licensure, not independent practice, and noted that most
healthcare professionals already hold independent licenses. She
explained that independent licensure allows continued
collaboration with physicians while ensuring continuity of care
despite physician shortages. Without it, frequent physician
turnover could force her to stop working and reduce patient
access. She concluded that SB 89 would expand hiring flexibility
and improve access to healthcare, especially in rural areas.
2:13:28 PM
JENNIFER PERKINS, representing self, Anchorage, Alaska,
testified with concerns on SB 89 as written and praised the
skill and dedication of PAs she has worked with in both rural
and urban settings. She noted that medicine is increasingly
complex and that physicians receive over 12,000 supervised
clinical hours, giving them broader exposure and deeper
training. While acknowledging that experienced PAs can be highly
capable, she believes 4,000 hours of supervised training is
insufficient for independent practice. She supports potential
amendments but emphasized the need for more extensive
preparation to meet Alaska's unique healthcare challenges.
2:15:17 PM
NICHOLAS COSENTINO, representing self, Anchorage, Alaska,
testified in opposition to SB 89 and acknowledged the passion on
both sides of the SB 89 debate, noting that patient care is
complex and often uncertain. He emphasized that physicians rely
on years of intensive education and residency to make critical
decisions, and 4,000 hours of PA training cannot match that
depth. While recognizing PAs as valuable team members who often
deliver excellent care, he noted that errors and missed details
still occur. He stressed the importance of collaboration between
physicians and PAs to maintain high-quality patient care. He
urged lawmakers to vote against SB 89, arguing that teamwork,
not independence, ensures the best outcomes for Alaskans.
2:18:20 PM
CHAIR BJORKMAN closed public testimony on SB 89.
2:18:51 PM
CHAIR BJORKMAN asked what role the Division of Corporations,
Business and Professional Licensing (CBPL) play in overseeing
this process of licensing PAs and transitioning them from
practice under a physician to independent practice.
2:19:19 PM
SYLVAN ROBB, Director, Division of Corporations, Business and
Professional Licensing (CBPL), Department of Commerce, Community
and Economic Development (DCCED), Anchorage, Alaska, answered
questions on SB 89. She responded that the division's role is to
ensure that all the necessary documentation and requirements
have been met for licensure and that the role would continue
under SB 89.
2:20:14 PM
CHAIR BJORKMAN asked if the division has any concerns about any
potential liability that might come from the concepts in SB 89.
2:20:41 PM
MS. ROBB replied that she does not anticipate any great burden
on the legislature. The division submitted a zero fiscal note
for SB 89, noting it will not significantly impact their
workload. She said as collaborative plan requirements phase out
over time, the administrative burden will decrease. This change
is expected to reduce the amount of paperwork the division must
process and track.
2:21:32 PM
SENATOR YUNDT asked if similar legislation has been passed in
other states.
2:21:57 PM
SENATOR TOBIN replied yes. She said several states, including
North Dakota, Wyoming, Iowa, South Dakota, Montana, New
Hampshire, and Utah, have created pathways for independent PA
licensure. These states share similarities with Alaska, such as
rural populations and challenges in attracting qualified medical
providers.
2:22:35 PM
SENATOR YUNDT asked how the number of required clinical hours in
other states' legislation compares to each other and to Alaska.
2:22:52 PM
SENATOR TOBIN replied that states requirements vary, from none
in North Dakota to 10,000 in Utah. SB 89 does not change current
PA education standards, which already include 2,000 clinical
hours during a 27-month program. It adds 4,000 additional hours
before a PA can seek independent licensure, totaling 6,000
clinical hours overall.
2:24:04 PM
CHAIR BJORKMAN held SB 89 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB170 ver I.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 170 |
| SB170 Sponsor Statement ver I.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 170 |
| SB170 Sectional Summary ver I.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 170 |
| SB170 Fiscal Note DOR-TAX 04.14.25.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 170 |
| SB89 Public Testimony-combined 03.10 and 03.12.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 89 |
| SB89 Public Testimony-Email Rachel Samuelson 03.14.25.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 89 |
| SB89 Public Testimony-Email-Delissa Culpeppper 04.15.25.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 89 |
| SB89 Public Testimony-Email-Emily Olsen 03.13.25.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 89 |
| SB89 Public Testimony-Letter-AK Academy of Family Physicians 03.14.25.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 89 |
| SB89 Public Testimony-Letter-AK Academy of Pediatrics 03.13.25.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 89 |
| SB89 Public Testimony-Letter-AK State Medical Board-REVISED 03.21.25.pdf |
SL&C 4/16/2025 1:30:00 PM |
SB 89 |