Legislature(2001 - 2002)
02/12/2002 01:35 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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.