Legislature(2001 - 2002)

02/12/2002 01:35 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
             SB 274-PHYSICIANS' LOCUM TENENS PERMITS                                                                        
                                                                                                                                
CHAIRMAN STEVENS announced SB 274 to be up for consideration.                                                                   
                                                                                                                                
SENATOR  OLSON,  sponsor of  SB  274,  thanked the  committee  for                                                              
bringing up this bill. It allows  the State Medical Board to issue                                                              
a locum tenens permit to a physician  or osteopath for purposes of                                                              
employment evaluation.                                                                                                          
                                                                                                                                
     Their  Association  believes that  the  use  of a  locum                                                                   
     tenens permit  in this way will enhance  the recruitment                                                                   
     of qualified doctors for permanent  positions within the                                                                   
     state.                                                                                                                     
                                                                                                                                
     The  issue  of recruitment  is  a matter  of  increasing                                                                   
     concern for the Medical Association  because of both the                                                                   
     aging population of Alaskan  practitioners and the small                                                                   
     number  of Alaskans  that graduate  from medical  school                                                                   
     every year.  Over 50 percent  of Alaska's 2,000  medical                                                                   
     doctors  are past the  age of  50. Typically, the  WWAMI                                                                   
     medical  program produces  eight new  doctors per  year.                                                                   
     Replacement of  retiring physicians and  osteopaths will                                                                   
     increasing   depend   on   the    recruitment   success.                                                                   
     Statistics indicate that the  Alaska physician workforce                                                                   
     is already  under represented  in comparison with  other                                                                   
     western states.                                                                                                            
                                                                                                                                
     SB  274  temporarily  permits an  invited  physician  to                                                                   
     practice   medicine   for   60   days   for   employment                                                                   
     evaluation. This  bill also allows the medical  board to                                                                   
     further  extend a  240  day time  limit  in a  situation                                                                   
     where a locum tenens doctor,  who is substituting for an                                                                   
     Alaskan   physician,  is   providing   a  critical   and                                                                   
     essential service.                                                                                                         
                                                                                                                                
CHAIRMAN STEVENS asked  if he could explain his  last sentence and                                                              
if the 240 day time limit exists now.                                                                                           
                                                                                                                                
SENATOR OLSON  replied that it does.  In order for a  physician to                                                              
get a  substitute, if there  are five slots,  they all have  to be                                                              
filled.  Otherwise the  pressure  on  the other  four  gets to  be                                                              
intense,  especially  when dealing  with  four-wheeler  accidents,                                                              
gunshot incidents or trying to get  people out to villages to have                                                              
village clinics.  This allows a physician  to get a permit  for 60                                                              
days  as  a  substitute  for  a   returning  doctor.  The  Medical                                                              
Association has  requested this legislation  to give  clinics time                                                              
to see if a  temporary doctor would complement  the other doctors'                                                              
specialties.                                                                                                                    
                                                                                                                                
SENATOR AUSTERMAN asked what happens currently.                                                                                 
                                                                                                                                
SENATOR OLSON explained that now  when someone gets a locum tenens                                                              
permit, the  physician has to leave  the site before he  fills the                                                              
position.                                                                                                                       
                                                                                                                                
SENATOR TORGERSON asked who the "designee" is.                                                                                  
                                                                                                                                
SENATOR  OLSON replied  that  the Medical  Board  is comprised  of                                                              
physicians  who are  practicing  within the  state,  two from  the                                                              
general public,  and one who is  a physician assistant.  They meet                                                              
four times  a year. When something  comes up and a  decision needs                                                              
to be  made, the  designee to  make the  decision is normally  the                                                              
executive director who currently is Ms. Leslie Abel.                                                                            
                                                                                                                                
MR.  RANDALL BURNS,  Chief Executive  Officer, Alaska  Psychiatric                                                              
Institute (API) supported SB 274.  He said in many cases hospitals                                                              
have  staff physicians  and when  they  have a  vacancy, they  use                                                              
locum tenens  to fill the vacancy  while they try to choose  a new                                                              
doctor. They  are not substituting  doctors; they actually  have a                                                              
vacancy.  The  Medical  Board  has taken  the  position  that  the                                                              
current statute doesn't allow for  locum tenens to be used in that                                                              
capacity [to  fill a  vacant position that  does not  have another                                                              
doctor coming  back to work]. He  said he had language  that would                                                              
fix that problem.                                                                                                               
                                                                                                                                
MS.   CATHERINE   REARDON,   Executive   Director,   Division   of                                                              
Occupational Licensing,  said she staffs the State  Medical Board,                                                              
which is  a group of volunteers  that meets quarterly.  She emails                                                              
the members on issues of concern  between meetings. At this point,                                                              
she  has heard  from  only  two members  on  this bill,  but  both                                                              
expressed  concern  and  individual   opposition.  The  Board  has                                                              
regulations implementing the locum  tenens statute and 12AAC40.036                                                              
says:                                                                                                                           
                                                                                                                                
     A physician who is not currently  licensed in this state                                                                   
     may apply for  a locum tenens permit for  the purpose of                                                                   
     substituting for a physician  licensed in this state who                                                                   
     (1) is temporarily absent from  the practice location at                                                                   
     which the applicant  applies, or (2) is not  expected to                                                                   
     return  to the  practice location,  if  issuance of  the                                                                   
     locum tenens permit is necessary  to temporarily provide                                                                   
     essential medical  services to the public or  to protect                                                                   
     the public health and safety.                                                                                              
                                                                                                                                
So, she  said, the current  Board regulations  do provide  for the                                                              
possibility of  a locum  tenens for a  vacancy rather than  just a                                                              
substitute  while someone  is on  leave, but the  Board must  feel                                                              
that it is necessary to provide essential  medical services to the                                                              
public or  protect the  public health and  safety and  she thought                                                              
that  was  where  the  issue  has come  up.  The  Board  has  this                                                              
regulation  that  acknowledges  that  sometimes a  vacancy  is  an                                                              
appropriate  reason for  locum  tenens; the  Board  feels that  it                                                              
needs to  be essential,  not just whenever  you have a  vacancy or                                                              
not  because   you  aren't  proceeding   promptly  to   fill  your                                                              
vacancies.                                                                                                                      
                                                                                                                                
CHAIRMAN STEVENS asked if they were  taking regulation and putting                                                              
it into statute.                                                                                                                
                                                                                                                                
MS. REARDON  said no; she doesn't  agree that the Board  no longer                                                              
issues locum tenens  for vacancy reasons. She thinks  that they do                                                              
and she is differing  with Mr. Burns whether the  Board will issue                                                              
for vacancy purposes. This Board  has sent out the message that it                                                              
should only be  used for vacancy purposes when all  other means of                                                              
getting a completely licensed physician have been exhausted.                                                                    
                                                                                                                                
SENATOR TORGERSON  asked where was  the letter of  opposition from                                                              
the Board.                                                                                                                      
                                                                                                                                
MS. REARDON replied that she just  informal wording in emails from                                                              
the two members, which she would show him.                                                                                      
                                                                                                                                
SENATOR TORGERSON  asked when the  Board would have a  position on                                                              
the bill.                                                                                                                       
                                                                                                                                
MS. REARDON  replied that their next  regular board meeting  is in                                                              
April. She will probably get more  individual comments until then.                                                              
                                                                                                                                
MR.  JIM   JORDAN,  Executive   Director,  Alaska  State   Medical                                                              
Association, said  that basically there were two  reasons why they                                                              
were interested in the enactment of this bill.                                                                                  
                                                                                                                                
     The  first and primary  reason is  recruitment. The  one                                                                   
     area that is  not currently allowed for under  the locum                                                                   
     tenens  permitting  system is  for the  use  of a  locum                                                                   
     tenens permit  in the circumstance  when a physician  is                                                                   
     being  evaluated  for potential  employment  at a  later                                                                   
     date.  That  is the  primary  reason the  State  Medical                                                                   
     Association wants this bill.                                                                                               
                                                                                                                                
He  said Alaska  has  relatively  few  doctors compared  to  other                                                              
states  and we  have a  workforce that  is rapidly  aging and  the                                                              
replacement task  is going  to be quite  large. The second  reason                                                              
has to do with the extension of the  240-day limit in the two-year                                                              
period in which  locum tenens circumstances are  allowed for. They                                                              
want to provide physicians in areas that are underserviced.                                                                     
                                                                                                                                
2:10 p.m.                                                                                                                       
                                                                                                                                
SENATOR AUSTERMAN  asked what the  definition was of  locum tenens                                                              
and asked if physicians and radiologists  were classified the same                                                              
way.                                                                                                                            
                                                                                                                                
SENATOR  OLSON replied  that the interpretation  for locum  tenens                                                              
has  to  do  with the  temporary  permitting  of  a  physician  to                                                              
practice medicine  in whatever location  he is called to.  He said                                                              
that radiologists are  covered in this bill; they  are a medically                                                              
licensed person  who has either  an MD degree  or a DO  (Doctor of                                                              
Osteopathy)  who has  done a residency  in radiology  and in  many                                                              
cases has fulfilled the number of  years to become Board eligible.                                                              
Many have gone on the take the Board exams and become certified.                                                                
                                                                                                                                
CHAIRMAN STEVENS  asked if he would  work through the  concerns of                                                              
API  within two  weeks and asked Ms. Reardon if  she would convene                                                              
the State Board and get a recommendation within that time, also.                                                                
                                                                                                                                
SENATOR TORGERSON  suggested looking  at a different  timeline for                                                              
filling vacancies instead of the 240 days.                                                                                      
                                                                                                                                
MS.  LORRAINE  DERR,  Alaska  State   Hospital  and  Nursing  Home                                                              
Association, supported SB 274. She  said that Mr. Burns is part of                                                              
her organization and  the problem comes in in  interpretation. The                                                              
Board is talking about temporary  or essential services. Using the                                                              
Fairbanks Hospital  that was trying  to find a psychiatrist  as an                                                              
example,  she said  that they  are  difficult to  find right  now.                                                              
There becomes a  difficulty between are they recruiting  to find a                                                              
psychiatrist or are they using locum  tenens to fill the position.                                                              
"There has been a tug of war there."                                                                                            
                                                                                                                                
There has  also been a  tug of war  in the interpretation  of what                                                              
temporary is.  This legislation is  an attempt to clarify  some of                                                              
those issues. The Association supports  reworking the definitions.                                                              
                                                                                                                                
CHAIRMAN STEVENS  said they would  hold the bill for  further work                                                              
and adjourned the meeting at 2:15 p.m.                                                                                          

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