Legislature(2009 - 2010)BELTZ 211
02/27/2009 08:00 AM Senate EDUCATION
| Audio | Topic |
|---|---|
| Start | |
| SB18 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 18 | TELECONFERENCED | |
SB 18-POSTSECONDARY MEDICAL EDUC. PROG.
8:02:16 AM
CHAIR ELTON announced the consideration of SB 18.
SENATOR DAVIS moved to adopt the CSSB 18 ( ), labeled 26-
LS0139/S, as the working document. There being no objection,
version S was before the committee.
8:02:49 AM
SENATOR WIELECHOWSKI, sponsor of SB 18, said this bill follows
up on a bill Senator Meyer introduced to increase the number of
Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) student
positions. One of the primary recommendations of the 2006 task
force suggestions was to increase the number of positions to 30,
and the initial bill did that, but the University advised him
that anything over 24 students would result in significant
additional costs to it in terms of new infrastructure and
administration. So he changed the number to 24, which is the
maximum number the University can handle without significant
incremental cost increases. The state is about 350 doctors
short, and this will begin to address the problem.
8:05:12 AM
SENATOR STEVENS questioned whether this bill is necessary,
because the original bill says "accommodate at least 20
students."
8:05:57 AM
MICHELLE SYDEMAN, staff to Senator Wielechowski, explained that
the University wanted them to put this in statute although it
could have been done through a budget appropriation increasing
the amount going to the WWAMI program. Having the fiscal note
with the statutory approach is helpful to the University of
Washington (UW) and the University of Alaska (UAA) for planning
their budgets. It was decided that the words "at least 24" would
be acceptable to both universities.
8:07:04 AM
CHAIR ELTON assumed since the fiscal note addresses the previous
version of the bill, it would probably be less with the
reduction from 30 to 24 in the CS.
8:07:39 AM
SENATOR HUGGINS joined the meeting.
MICHELLE SYDEMAN said that is true. An informal revised fiscal
note from the UAA indicates that as the program steps up to
having the full suite of 24 students, the cost will increase
incrementally over the next five years to $550,000 in 2014.
8:08:44 AM
CHAIR ELTON asked Ms. Sydeman to discuss the history of the
WWAMI program.
8:08:58 AM
MS. SYDEMAN explained that the program began in 1971 or 1972 and
along the way got up to 10 students. It increased to 20 students
two years ago.
8:10:35 AM
PAT LUBY, Advocacy Director, AARP Alaska, said anything that can
be done to increase the number of physicians in Alaska would be
welcome.
8:11:23 AM
SENATOR HUGGINS asked Mr. Luby if he sees any rationale in the
requirement for a physician that took advantage of this program
to be required to participate in some level of Medicare or
Medicaid.
MR. LUBY replied if that were legal, he would support it, and
that our congressional delegation is working now to find some
way to increase the number of physicians seeing Medicare
patients.
SENATOR HUGGINS remarked that we obviously need more physicians,
and we don't need to require onerous things of them, but on the
other hand, if the state is paying their way, they could think
about being more open minded about Medicare and Medicaid for
some period of time.
MR. LUBY said he would check on the status of that issue with
the WWAMI staff.
CHAIR ELTON said part of that analysis should include whether it
would also discourage physicians from coming back the state to
practice.
8:12:57 AM
SENATOR OLSON said that the first graduates won't start
practicing until 2019, and many people now in need won't even be
around then. He asked how he thought the number of physicians
could be increased now.
MR. LUBY answered that many of their members are using community
health centers throughout Alaska where they will see you if you
simply walk in their door. Another idea is to use a nurse
practitioner for primary care and refer to a physician as
necessary.
8:15:24 AM
SUZANNE TRYCK, Director of Regional Programs, University of
Washington-side of the Alaska-WWAMI Partnership Program, said
she doesn't have a definitive answer to that question now but
felt it would be a disincentive to physicians to return to the
state. She could respond by the beginning of next week.
8:16:32 AM
MS. TRYCK wanted to speak to the issue of mid-level
practitioners and other methods available to expand
practitioners in the state. Under the WWAMI umbrella, she said,
both universities are expanding their physician's assistants
program and making it more Alaskan by doubling the number. In
addition, they are working on graduate medical education
residency programs in psychiatry and pediatrics. All of those
things will be necessary to resolve this problem.
SENATOR OLSON asked how many members are on the Admissions
Committee and where they are from.
8:18:20 AM
DENNIS VALAENZENO, faculty member, UAA, and Director, WWAMI
Biomedical program at UAA, said he is also Associate Dean for
Medical and Pre-Medical programs. He said the Admissions
Committee in Alaska works with the UW Admissions Committee.
The committee has four members from the different geographical
areas of Juneau, Anchorage, and North Pole. Next year they hope
to go to five members. Alaskan applicants interview either in
Anchorage or Seattle, and typically two or three students are
interviewed for each one admitted.
SENATOR OLSON asked the reasons for adding another member to the
committee.
MR. VALAENZENO explained that they started having interviews at
UAA at the request of a lot of residents. Anchorage doesn't have
a large pool of interviewers like Seattle does, so having only
three members limited the number of students that could be
interviewed in Anchorage. That is the reason for expanding the
committee. They also tend to use an Alaska medical student who
is rotating in their third or fourth year in the Anchorage area,
and that practice is also followed for interviews in Seattle.
SENATOR OLSON assumed all of the committee members are Alaska
residents.
MR. VALAENZENO answered yes.
SENATOR OLSON asked the reason for holding pre-admission
interviews in Seattle.
MR. VALAENZENO replied that historically, until they finally got
one of the two sessions held in Anchorage, no interviews for any
of the WWAMI participants from any state were held outside of
Seattle.
SENATOR OLSON asked if he would oppose having one member of the
committee appointed by the Legislature.
8:21:34 AM
MR. VALAENZENO answered that could be an accreditation problem.
Medical schools are accredited by a national agency and the
members of the committee have to be faculty members at the
University.
SENATOR OLSON recalled that other medical schools have at-large
admission's members that aren't even in the health care field,
let alone part of a faculty.
MR. VALAENZENO replied that they could interview students, but
can't vote as to who is admitted.
SENATOR OLSON asked how many members last year came from rural
Alaska - cities of less than 10,000.
MR. VALAENZENO said he didn't have that data in front of him;
historically they tend to represent the distribution of
population pretty well.
SENATOR OLSON said when he looked at last year's admission
numbers he did not see a good statewide distribution.
MR. VALAENZENO replied that it varies from year to year. They
look over the historical admissions.
SENATOR OLSON asked how many residency graduates are in Alaska.
MR. VALAENZENO replied that the residency program places about
75 percent of its graduates in Alaska.
SENATOR OLSON said he was thinking about last year.
MS. TRYCK answered that the overall numbers went from 78 percent
to 81 percent, and she can tell him where they are practicing by
location, but she couldn't tell him the difference between
years.
SENATOR OLSON asked how many of those went out to rural Alaska.
8:24:40 AM
MS. TRYCK replied that six are in Bethel, three in Dillingham,
one in Kotzebue, one in Haines, one in Kodiak, seven in Seward,
one in Sitka, two in Unalaska, one in Wrangell, and three are
travelling physicians.
CHAIR ELTON thanked them for their testimony and restated
Senator Olson's question about having someone appointed by the
Legislature and about how many interviewees were accepted from
rural Alaska.
CHAIR ELTON said they interview two or three students for each
one accepted and asked if that ratio is because there are not
enough slots or is it because of the qualifications of the
people they are interviewing.
MR. VALAENZENO replied this is fairly typical of medical school
admissions. In order to get the best applicants, you look for
people who are not only excellent as far as grades, but other
qualities that are often revealed by the interview. It's fairly
typical to interview two or three per slot. If they had more
slots, more could be admitted.
SENATOR OLSON asked Ms. Purdue if she is familiar with the
Western Interstate Commission for Higher Education (WICHE)
program.
8:27:55 AM
KAREN PURDUE, Associate Vice President, University of Alaska
(UAA), answered yes, but Diane Barrans knows more about it.
SENATOR OLSON asked if there is anything going on to reinstitute
the WICHE program, which he understands would be less expensive
for a resident of Alaska than for the state to put more numbers
into the WWAMI program.
MS. PURDUE replied that WICHE is a professional student exchange
program, and when the price of oil was down the state stopped
paying to be a part of it. It's a good program, but would cost a
lot of money to get back in. Their strategy is to expand WWAMI
with loan repayment incentives and more residency programs.
They've done only one thing so far mentioned in the task force
report and that is to double the WWAMI program.
SENATOR OLSON asked how she thinks the extra expense for the
WWAMI program would be affected by the lower price of oil since
the WICHE program was deleted because of the low price of oil.
8:31:55 AM
MS. TRYCK replied when the oil prices dropped last time, the
idea they had was to start cutting seats, because the contract
UW has with each state under WICHE is fairly inelastic. Each
contract pays the same amount per student leaving no room for
negotiation except to add or cut seats.
MS. PURDUE added that UW is going through significant
downsizing, but one area they are not downsizing is medical
school investment. They continue to take a lot of Alaska
students, but they also get pressure from every state to do so.
MR. VALAENZENO mentioned that the Physician Supply Task Force
did look at the cost effectiveness of the WICHE vs the WWAMI
programs. The state participated in WICHE for 40-50 years and
ended in about 1995. The issue became that WICHE had only an 18
percent return rate. So while the state paid half as much per
student for WICHE, because so few of them came back to practice
in the state, the WWAMI program was more effective.
8:34:21 AM
SENATOR OLSON asked how his clinical staff would be able to
handle the increased number of clerkships giving them the
exposure that they need.
MR. VALAENZENO said that is one of the major challenges in
expanding the class. They currently offer about 130 clerkships
in Alaska and that still needs to be increased. And while they
have adequate capacity now, they are working with hospitals
around the state and physicians' associations to expand the
opportunities in the future. For instance, they have a new
family medicine clerkship in Nome and have started a new rural
training experience in Juneau.
SENATOR OLSON said he thinks the medical staff with the WWAMI
program has done "an exceptional job" of using the physicians
out there and recruiting.
CHAIR ELTON said he would hold this bill since this was its
first hearing, but he would reschedule it in the near future
when they have an answer to the Medicaid/Medicare question. He
sees two big issues: the number of doctors they can get back to
practice in the state and physician access surrounding
Medicaid/Medicare.
8:38:15 AM
MS. TRYCK commented that on the issue of getting physicians back
to the state, WWAMI is always trying to balance how to keep the
physician pipeline flowing back into Alaska. UW/WWAMI rarely
takes a position on Alaskan policy issues. However, there is a
nationwide and worldwide physician shortage, so anything they
can do to get physicians will be beneficial. Currently Alaska
WWAMI graduates graduate with $117,000 - $138,000 of debt in
addition to whatever payback obligations they may have. She has
heard anecdotally that is having an effect on the people
applying to the program. So, any requirement that makes it less
attractive to come back to Alaska makes them concerned.
8:40:15 AM
SENATOR DAVIS followed up saying maybe they should look into
giving incentives to those who take Medicare/Medicaid patients
rather than penalizing those that might want to come back to the
state and not take on those patients. She asked, if we bring
these additional slots on, how soon they would be filled.
MS. TRYCK replied that the effective date of SB 18 is July 2010
and the fall of 2010 is probably the soonest new students could
be taken.
SENATOR OLSON remarked that the fiscal note says it doesn't
start until FY 2012, which would mean July 1, 2011.
DIANE BARRANS, Executive Director, Alaska Commission on
Postsecondary Education, Department of Education and Early
Development (DEED), replied the reason it doesn't appear in
their fiscal note is because the state doesn't begin to pay the
fee to UW School of Medicine until the second year.
SENATOR OLSON asked who paid for the first year.
MS. BARRANS replied that they are embedded in the first year of
the UAA programs and are covered within the UAA budget.
SENATOR OLSON asked if she could validate Mr. Valaenzeno's
numbers that 18 percent of the WICHE graduates come back to
Alaska.
MS. BARRANS confirmed Mr. Valaenzeno's numbers, but she said
there was no obligation for them to return. The relatively
higher return rate for the WWAMI program is attributed to the
fact that it is so embedded in Alaska. It is Alaska's medical
school; training was always done in Alaska as part of the four-
year program. That has only increased over time. But in addition
now they require that individuals who participate to come back
or be responsible for a substantial portion of the cost to the
state.
SENATOR OLSON speculated that the medical atmosphere has changed
from what it was 30 years ago, as well.
MS. BARRANS said she couldn't speak to that.
SENATOR OLSON remarked that from a practical standpoint when
Barrow had two doctors, they knew they were going to be on call
every other night, and that doesn't look very inviting to a
person fresh out of medical school. He asked how many states are
involved in the WICHE program.
8:44:32 AM
MS. BARRANS replied that it is a 14-state compact, and Alaska is
one of the states. She added in reference to the incentive
Senator Davis suggested for individuals who are in practices
with high levels of service to Medicaid/Medicare, one incentive
that is available within statute would be to shorten the
required period of service similar to the enhanced incentive for
rural practice as opposed to practice in urban communities.
SENATOR HUGGINS said he was interested in expanding this
conversation to physician assistants and nurse practitioners and
other programs that may help solve the medical practice
shortage.
CHAIR ELTON said he appreciated the wide discussion, but when
the bill is back before the committee the discussion would be
narrowed to the issues directly affecting it.
MS. PURDUE clarified that the UA fiscal note on SB 18 is zero
and that they could accommodate the four additional students
without additional cost.
SENATOR OLSON asked Senator Wielechowski if he's gotten any
feedback from physicians' organizations in the state.
8:47:50 AM
MS. SYDEMAN replied that they have had some response in terms of
conversations with Alaska State Medical Association indicating
support.
CHAIR ELTON held SB 18 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| AARP lttr 2-26-09.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| ADN editorials.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| SB 18 Sponsor Statement.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| SB 18 supporting documents.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| SB018-UA-Anch-2-23-09 (2).pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| SB018-EED-ACPE-02-23-09.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| CSSB 18 version S.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| comparison SB 18 to work draft.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| WWAMI response 3-2-09.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |
| AK Com. on Aging re SB 18.pdf |
SEDC 2/27/2009 8:00:00 AM |
SB 18 |