Legislature(2023 - 2024)BELTZ 105 (TSBldg)
01/25/2023 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Hospital and Healthcare | |
| Presentation: South Central Foundation Workforce Overview | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
January 25, 2023
1:33 p.m.
MEMBERS PRESENT
Senator Jesse Bjorkman, Chair
Senator Click Bishop, Vice Chair
Senator Kelly Merrick
Senator Forrest Dunbar
MEMBERS ABSENT
Senator Elvi Gray-Jackson
COMMITTEE CALENDAR
PRESENTATION: ALASKA HOSPITAL AND HEALTHCARE
- HEARD
PRESENTATION: SOUTH CENTRAL FOUNDATION WORKFORCE OVERVIEW
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JARED KOSIN, President and CEO
Alaska Hospital and Healthcare Association (AHHA)
Anchorage, Alaska
POSITION STATEMENT: Presented an overview titled Alaska's
Healthcare Workforce "Problem."
KAREN MCINTIRE, Vice President of Workforce
Southcentral Foundation
Anchorage, Alaska
POSITION STATEMENT: Presented "Workforce Overview from the
Medical Industry Perspective."
ACTION NARRATIVE
1:33:26 PM
CHAIR JESSE BJORKMAN called the Senate Labor and Commerce
Standing Committee meeting to order at 1:33 p.m. Present at the
call to order were Senators Dunbar, Merrick, Bishop, and Chair
Bjorkman.
^PRESENTATION: ALASKA HOSPITAL AND HEALTHCARE
PRESENTATION: ALASKA HOSPITAL AND HEALTHCARE
1:34:05 PM
CHAIR BJORKMAN announced a presentation by the Alaska Hospital
and Healthcare Association (AHHA). He invited Mr. Kosin to put
himself on the record and begin his slideshow of the medical
industry's workforce challenges.
1:35:48 PM
JARED KOSIN, President and CEO, Alaska Hospital and Healthcare
Association, Anchorage, Alaska, presented an overview titled
Alaska's Healthcare Workforce "Problem." He advanced to slide 2,
which pictures a map showing Alaska locations with critical
access hospitals (co-located nursing homes), rural demo
hospitals/sole community hospitals, acute care hospitals,
other/specialty hospitals, and standalone nursing homes. The
slide contains the following description of the association:
Advancing Healthcare for Alaska
For 70 years, the Alaska Hospital & Healthcare
Association (AHHA) has served as a non-profit trade
association representing Alaska's hospitals, nursing
homes, and other healthcare partners across the
continuum of care.
AHHA members play an invaluable role, both as
community providers and essential employers, in
cities, towns, and villages across Alaska.
AHHA provides policy and advocacy expertise, leads and
hosts opportunities for education and training, and
brings together members and stakeholders for
collaborative work to share data, resources, and best
practices.
AHHA's mission is to advance the shared interests of
Alaska healthcare to build an innovative sustainable
system of care for all Alaskans.
MR. KOSIN said the association has been in Alaska for seven
years. He indicated that today's slideshow focuses on workforce
challenges. All the data in the presentation flows from
statistics and analyses in the Alaska Healthcare Workforce
Analysis report. The Department of Labor and Workforce
Development (DOLWD) provided the data for the report. The
presentation will follow this outline:
1. Industry footprint
2. Worker shortage
• Ecosystem growth / need
• The dominant position
• Shortages everywhere
3. The consequences
4. What should we do?
1:38:09 PM
MR. KOSIN reviewed slide 3, Industry Footprint: Healthcare. He
said Alaska pays out $3 billion in direct wages, more than any
sector in Alaska. The industry is responsible for 12 percent of
all earnings, outpacing the military and natural resource
sectors. It accounts for about 43,000 jobs, 11 percent of
Alaska's workforce. The industry is second only to the
retail/wholesale trade sector. Expanded to include the
multiplier effect, the total impact of Alaska's healthcare
sector was 75,060 jobs across the state's economy, with a total
Alaska income impact of $4.4 billion in 2021.
MR. KOSIN said the association would not argue against the
assertion that these statistics are a double-edged sword due to
the high cost of healthcare. He announced this presentation
focuses on workforce shortages, not healthcare costs. He said
the industry has a lot of jobs available because there is a lot
of need, emphasizing the jobs pay well. The positions are
essential to Alaska's economy and will provide young people with
challenging, well-paid career opportunities.
1:39:25 PM
MR. KOSIN reviewed slide 4, Ecosystem Growth / Need. Every
healthcare position in Alaska is projected to grow, and the
array of jobs is much broader than just doctors and nurses.
MR. KOSIN likened the healthcare workforce to an ecosystem,
stating hospitals employ doctors and nurses, as well as
maintenance workers, orderlies, food workers, delivery workers,
and clinical and non-clinical jobs. The whole operation suffers
if any position is understaffed. Patients and visitors will not
get food if the cafeteria is understaffed; it will shut the
hospital down. The same goes for staff that changes linens. If
rooms fail to be changed, patients will be stuck waiting for a
bed in the emergency room, creating a ripple effect until rooms
are ready. He said the healthcare industry has opportunities for
everybody, not just doctors and nurses. The workforce ecosystem
is critical to comprehend because the healthcare industry
expects to add 4,500 new jobs over the next ten years, more than
any other sector in Alaska. The industry experienced 28 percent
wage growth from 2016 to 2021. Alaska is ranked first or second
in the U.S. in 18 categories of healthcare positions; other job
categories typically rank third or fourth.
MR. KOSIN switched gears from the positive aspects of a growing
economic sector to exploring the downside. He said that the
healthcare industry needs 7,500 new workers every year. It is a
daunting prospect. Of that 7,500, the most dominant position
needed is registered nurse. Alaska will require more than 1,500
annually. He defined a recruit as someone outside the industry
instead of someone moving laterally or upwards within the
industry. He drew attention to the "Annual Healthcare Workforce
Development Needs" graphic, stating the chart creates the bulls-
eye effect; the bigger the bubble, the greater the need for that
particular position. The chart compares Alaska's workforce needs
and salary with the rest of the country. He emphasized the
extra-large bulls-eye in the center of the chart shows
registered nursing in the dominant position.
1:42:49 PM
MR. KOSIN reviewed slide 5, The Dominant Position. Hospitals are
the largest employer in the healthcare industry. They employ
about 34 percent of all healthcare workers and pay about 40
percent of healthcare wages. He reiterated that the most
dominant field in the healthcare industry is the registered
nurse. Registered nurses account for the highest number of total
workers and 18 percent of all healthcare wages.
MR. KOSIN directed attention to the Registered Nursing.org
chart, stating Alaska is expected to lead the United States in
nursing vacancies by 2030 with a 23 percent shortfall. He
interpreted these statistics, stating Alaska will be short by
about a quarter of the workforce by 2030. One in four positions
will remain open. He said that the labor situation is tight and
tough now, but Alaska is projected to be the worst in the
country in terms of state needs.
1:44:09 PM
MR. KOSIN reviewed slide 6, Shortages Everywhere. He described
Alaska's career development pipeline, stating accredited nursing
programs in Alaska produce about 324 registered nurse graduates
per year. Boil that down, and Alaska's 324 registered nurses
fail to meet the demand of 1,500 needed yearly to provide
adequate services. He said there are seven priority positions in
Alaska, respiratory therapists, certified nursing assistants
(CNA), and nurses, to name a few. He said Alaska could only
train 13 percent of the workers needed. Alaska has a massive
labor deficit.
MR. KOSIN explored options to solve the labor deficit problem.
One option is to rely on nonresident healthcare workers. This is
an option many industries rely on in Alaska. Eleven percent of
the healthcare workforce were nonresidents in 2021, with about
5,000 workers. Interestingly, about 23 percent of these
nonresident workers remain in Alaska and attain residency. If
four people come to Alaska, whether they are traveling or are
temporary workers, there is a one out of four chance an
individual will stay. He said this is an important detail
considering the labor deficit mentioned above. This is
significant because healthcare has the highest nonresident-to-
resident conversion in the state compared to all other sectors.
This is an important detail from a recruiting standpoint. While
the state frowns on out-of-state recruiting, the good news is
Alaska may retain some of those people. He emphasized that there
are plenty of jobs to go around. There is no threat of taking an
Alaskan's job, reminding members that registered nurses will
graduate at a rate of 324 per year versus 1,500 in demand.
1:47:01 PM
SENATOR BISHOP asked how many nursing students the university
turned away.
MR. KOSIN prefaced his response, stating this is not to
disparage the University of Alaska with this answer. The
university has the largest nursing program. However, for every
student who sits in an incoming class, two applicants, who
qualified, and were accepted, are turned away due to a lack of
room in the program.
SENATOR BISHOP sought confirmation that the university could
potentially graduate 660 nurses if the university had the
capacity.
MR. KOSIN answered yes.
1:47:49 PM
SENATOR DUNBAR asked whether AHHA member organizations would
financially assist or consider moving towards an apprenticeship
model to help grow the number of nurses to 600 annually and to
increase the number of healthcare workers overall.
MR. KOSIN answered yes. He declared that AHHA would reply yes to
virtually any question about growing the number of nurses in
Alaska. He noted that if Alaska could produce 600 nurses, there
would still be a massive nurse deficit. AHHA is working with the
university and other programs. The association has not used
apprenticeships in healthcare as it should, meaning the industry
and state need to embrace a model change because the need is
great. The big bottleneck on the education side is a need for
more educators. Nurse educators make so much money in the field
now that finding a nurse to teach is impossible. There is no
incentive to teach. The nursing program waitlist is long; the
nurse faculty availability list is short. AHHA would consider
pulling resources and contributing to increasing pay to expand
the nurse program's capacity. Another limiting factor is space
to run students through their hospital clinicals, another piece
AHHA supports making work. AHHA is a yes to any ideas to help
this problem, especially a local solution.
1:49:53 PM
MR. KOSIN advanced to slide 8 to discuss the consequences of
workforce shortages. He offered these statistics to establish
the framework for his discussion:
- CNAs are the lifeblood of nursing homes and critical for
hospitals.
CNAs are running at a 22 percent vacancy rate.
It takes 108 days, on average, to fill a single position.
- In hospitals and nursing homes, nurse positions are running
at a 24 percent vacancy rate on average over the course of
the last year.
It took 161 days, on average, to fill a single position.
- He expressed his belief that respiratory therapists have a 38
percent shortfall.
- Sterile processing and cleaning instruments have a similar
shortfall range.
1:51:34 PM
MR. KOSIN said he spent considerable time outlining the nursing
shortage because this is the dominant group, but high vacancy
rates exist across the board. Vacancy rates and the amount of
time it takes to fill a position have become alarming. Vacancy
rates have risen due to recruitment delays and the time it takes
to obtain a license and process a background check. The industry
has vacancies across the board; they are getting worse
everywhere. Limited staff means limited hospital access,
community-based services, and pediatricians' offices alike. He
explained that all the open hospital beds and hospital rooms in
the world are unusable without staff to clean them and offer
services. Limited access means less revenue, especially in
nursing homes. Alaska is set up on a volume-based, fee-for-
service system. Less staff in nursing homes results in closed-
down units and less revenue, and yet, simultaneously, services
become more expensive due to overtime costs and incentive
payouts. Increased staff burnout means hiring replacements and
competing with other organizations for traveling workers. He
added that inflation is causing the cost of supplies to
increase. He wrapped up the discussion on consequences, stating
lower revenue, more expensive services, and increased supply
costs due to inflation led to the following headlines, which he
clipped from newspapers last month:
Juneau hospice and nursing home closures are the
latest symptom of the nation's nursing shortage.
1:54:07 PM
MR. KOSIN commented on the snippet, stating the state will start
to experience massive losses and see closures and
consolidations. A consolidation is effectively a closure that
looks a little different.
Local hospitals running near capacity as flu, RSV
cases rise.
Juneau's hospital is losing more than $1M a month.
Bartlett (Alaska) Regional Hospital, Wildflower Court
to merge.
Providence's operating loss grows to $1.1B for 2022.
This Sunday, we will have had a patient in house
waiting for long-term care for 1 year.
MR. KOSIN said these headlines represent visible cracks in the
system. He drew attention to the last snippet on the slide,
stating the patient should have been discharged to a post-acute
care facility but sat 365 days too long in a hospital because
there was nowhere for that person to go, no availability in a
post-acute care facility, and no staff to increase availability.
Other ancillary issues stem from a situation like this, such as
navigating the courts on supervision, custody, and other matters
of this nature. Challenges on the Medicaid side include
eligibility. All of this causes people to get stuck in
hospitals. He said hospitals get paid based on meeting the
criteria of care. A patient that no longer requires
hospitalization but is stuck in one fails to meet the criteria.
In this example, the hospital was not compensated for 365 days
of services, which included nursing rounds, meals, orderly
services, etc.
1:56:02 PM
SENATOR BISHOP directed attention to the Providence Hospital
news snippet, which indicated an operating loss of $1.1 billion
in 2022. He asked whether the operating cost would have been
zero with a plus sign if Providence was fully staffed.
MR. KOSIN speculated on the answer, stating this analysis is
difficult due to factors like inflation, supply cost increases,
traveler pay, and bonuses. Still, if the staffing piece were
solved, Providence's operating losses would be a different
story. He expressed his belief that it would be fair to say if
all systems were operating satisfactorily, meaning Providence
Hospital was fully staffed, and incoming patients cared for and
discharged appropriately and timely, the hospital would either
experience reduced loss or zero with a plus. This is how the
model of care works. He snipped the clip from a national news
story, and $1.1B was a cumulative number from a financial
disclosure.
SENATOR BISHOP remarked it is apples and oranges to compare the
healthcare labor shortage with food security, but they are
fundamentally parallel. He pointed out the severity of the
issue, stating if a mass casualty event occurred in Fairbanks or
Anchorage today, the injured would have nowhere to go.
MR. KOSIN echoed the same sentiment. The fix is more challenging
than changing a law. The issue requires a big-picture approach
to resolution, not only considering the problems occurring
within facilities but everything occurring outside facilities.
Community-based services are not robust enough to support
hospital discharges and placements, and those organizations
suffer from worker shortages too. The cascading effect pushes
everyone into hospitals, and hospitals are not compensated in
the end. This is one reason the cost of healthcare is high.
People are funneled into the most expensive environment of care.
The hospital is the last stop when there is nowhere else to go.
1:59:04 PM
SENATOR MERRICK asked what major factors attributed to the need
for 7,500 new healthcare workers every year.
MR. KOSIN answered it is a combination of increased demand for
services due to an aging population and worker turnover rates.
He said the number is derived by analyzing the number of
patients funneling through over four quarters and employee
turnover rates.
2:00:04 PM
MR. KOSIN advanced to slide 9, stating this is a long-term
problem and requires a long-term solution. The process will take
10 to 15 years to yield results. He reviewed slide 9 to summate
solutions to grow the healthcare workforce:
Healthcare Workforce Strategy
2022-2025
Pipeline
Forge strong partnerships between the healthcare
industry, schools, and students to recruit, train, and
graduate healthcare professionals to build a
sustainable workforce pipeline in Alaska.
MR. KOSIN said a huge piece in solving the workforce shortage is
increasing faculty pay, classroom size, and the number of
faculty in universities. He suggested educational classroom
planning to expand the idea among 1st and 2nd graders that
healthcare career opportunities are not limited to doctors and
nurses.
Pathways
Develop healthcare career pathways and professional
development opportunities to provide training and
advance skills that will improve patient care and
employee retention.
MR. KOSIN recommended skilled professionals train up new
recruits and inexperienced staff in an apprenticeship model for
professional and specialty training.
Protection
Develop and implement strategies that support
wellness, increase resiliency, and address burnout,
violence, and other threats to retention. Remove
barriers that overburden the industry and workers.
MR. KOSIN said protecting the current workforce is perhaps the
most essential factor. Prioritizing their wellness, preventing
burnout, and keeping the workforce resilient.
2:01:23 PM
SENATOR DUNBAR commented that Senator Bjorkman pointed out that
K-12 education is flat-funded; as a result, the state reduced
the number of programs offered to students. Some of those
programs were vocational and job readiness, which feeds into Mr.
Kosin's ideas. He asked what AHHA's opinion is of increasing K-
12 funding in Alaska.
MR. KOSIN replied that the answer to that question would require
an AHHA group discussion. He said that AHHA supports robust
education and creating a workforce in-house. It is a sustainable
way to offset Alaska's labor shortages.
2:02:38 PM
SENATOR BISHOP provided a historical perspective to underscore
the need. During his tenure as the Department of Labor and
Workforce Development (DOLWD) commissioner, the department's
2010 ten-year forecast showed a 4,000-person gap. The gap last
year was 6,500. One year later, the healthcare labor shortage is
more than a 7,000-person gap.
2:03:13 PM
SENATOR BJORKMAN asked whether there have ever been any programs
in Alaska that incorporated vocational education at the high
school level for CNA or other healthcare worker training.
MR. KOSIN replied that to do this question justice, he will
collect the information and get back to the committee. A lot of
work is happening on this subject. Many facilities are
progressively moving on this, and AHHA has invested a lot of
energy in this subject.
2:03:57 PM
MR. KOSIN advanced to slide 10 to discuss the nurse licensure
compact. He said legislators always ask AHHA what the
legislature can do to help the problem now. He emphasized if
legislators want to do something now, it is reciprocity. One
deterrent for working in Alaska is that getting a nurse license
in Alaska takes three months. He shared the story of a young
person who wanted to accept a neonatal intensive care unit
(NICU) nursing position in Alaska. She had the job, the car, and
the place to stay but did not want to wait three months for a
license. He said that no one could wait three months. She turned
down the assignment. NICU nurses are in incredibly high demand,
especially in the Anchorage area. This is a case in point. It
takes three months to get licensed, and it is a deterrent. He
said the state needs to get people here faster to reduce the
vacancy rate. Reducing the vacancy rate will increase capacity.
Increase capacity, and the system will start to flow. He
reviewed slide 10 to explain that 39 states and jurisdictions
have passed reciprocity acts to alleviate their licensing
logjams:
Nurse Licensure Compact
How it works
• 39 states and jurisdictions
• Reciprocity ? Single RN license across state lines
2:06:15 PM
MR. KOSIN said states that enact the nurse licensure compact
recognize a single license between all the compact states. Any
nurse from a compact state can get one license and practice
across state lines.
• Uniform standards, including background checks
MR. KOSIN said the compact changes the standards to get a
license. They have uniform standards to be processed and
approved for a license, but the practice of being a nurse is
left up to individual states.
• Local jurisdiction for oversight / enforcement
MR. KOSIN said the enforcement of rules and the scope of
practice remains with the individual state. However, the
standards for licensing and allowing someone to practice becomes
uniform and reciprocal. The compact would knock a 3-month
processing time down to a week or two, including a background
check. The compact licensing standards and background checks are
more stringent than Alaska requires, making them safer.
The Coalition
• 75+ orgs (every facet of healthcare) say this will
help!
o Medical, tribal, nursing schools, aging
population, behavioral health, chambers of
commerce, local governments, public health,
military, post acute providers . . .
MR. KOSIN expressed his belief that if the state joins the
compact, it will get nurses into positions faster, especially in
rural communities. It will draw down on vacancies, which will
help. It is not a cure-all but an excellent tool that will make
a big difference. Over 75 organizations would tell the
legislature this would help. The organizations listed above
agree; it has widespread buy-in. He said this discussion offered
doom and gloom and dire statistics, but there is something the
legislature can do to make a difference. Adopt the nurse
licensure compact.
2:08:17 PM
SENATOR MERRICK asked whether nurses would be more inclined to
leave Alaska for part of the year, especially during less
desirable seasons, if the nurse licensure compact were enacted.
MR. KOSIN prefaced his answer, stating the other 39 states that
joined must not be as concerned. He added that a lot of movement
already occurs amongst traveling nurses. He expressed his belief
that joining the compact would not create mass out-migration. He
suggested putting it in place with a sunset after two years to
see if it worked. He proposed repealing it after a year if there
is out-migration. AHHA does not think out-migration is an
overarching concern, but should it become a reality, the state
could exit anytime.
2:09:48 PM
SENATOR DUNBAR commented that this is an interesting topic. He
assumes there will be a bill, and should one come forward, he
would like a much longer conversation about this subject. He
will hold his questions to that time as other items are on the
agenda today.
MR. KOSIN responded that AHHA hopes there is a bill. The
association is available to offer ideas and policy. He receives
many calls about workforce, licensing, and background checks
from AHHA members. The association would like to see a bill on
this.
2:10:34 PM
SENATOR BJORKMAN asked what other ideas the Board of Nursing has
to speed up licensing in the state if the compact fails to move
forward.
MR. KOSIN replied AHHA spent over a year asking the same
question, consulting nurses, the board, and the state. They
answered nothing that would speed up licensure, be as cost-
effective, or be implemented as fast. He said that AHHA had yet
to find an alternative idea that could perform in equal measure
to the compact. AHHA has settled on the compact.
2:12:03 PM
At ease.
^PRESENTATION: SOUTH CENTRAL FOUNDATION WORKFORCE OVERVIEW
SOUTH CENTRAL FOUNDATION WORKFORCE OVERVIEW
2:17:33 PM
CHAIR BJORKMAN reconvened the meeting and announced the South
Central Foundation workforce overview. He asked Ms. McIntire to
state her name and affiliation for the record.
2:17:36 PM
KAREN MCINTIRE, Vice President of Workforce, Southcentral
Foundation, Anchorage, Alaska, introduced herself.
2:17:45 PM
CHAIR BJORKMAN provided a brief overview of the Southcentral
Foundation (SCF). He said SCF's vision is a native community
that enjoys physical, mental, emotional, and spiritual wellness.
Its mission is to work together with the Native community to
achieve wellness through health and related services. SFC was
administering nearly half the primary care services for Alaska
Native people by 1994. The Alaska Medical Center opened its
doors in May of 1997. Public Law 105-83 enabled Alaska Native
people to obtain ownership and management of all Alaska Native
healthcare services. SCF completed the assumption of ownership
and management of primary care and other programs located in the
Anchorage Native Primary Care Center in 1997. SFC instituted
significant philosophical changes and other changes in the
design and administration of these programs from the beginning.
He invited Ms. McIntire to begin the Southcentral Foundation
presentation.
2:20:19 PM
MS. MCINTIRE said Southcentral Foundation is a tribally owned,
Native nonprofit located primarily in the Anchorage area. She
gave a brief overview of her work experience and of SCF. She is
a customer-owner of the system; she comes from the community
that helps manage and own healthcare services. SCF provides
services to over 65,000 Alaskan Native American Indian people
and works with over 55 villages and community health centers.
They co-manage the Alaska Native Medical Center (ANMC) with the
Alaska Native Tribal Health Consortium (ANTHC) in Anchorage. SCF
is one of Alaska's top ten largest private sector employers,
with 2,700 employees. She said everybody is having challenges
with workforce shortages in Alaska. Recruiting is an ongoing
issue. It is not for lack of trying or partnering with community
hospitals.
MS. MCINTIRE read slide 2:
Vision
A Native Community that enjoys physical, mental,
emotional and spiritual wellness
Mission
Working together with the Native Community to achieve
wellness through health and related services
MS. MCINTIRE reviewed slide 3, Learning Objectives:
Share how SCF faces challenges of recruiting and
retaining health care professionals.
Share opportunities that the State can implement to
positively impact health care workforce.
Share and answer questions regarding Tribal Health
workforce from SCF perspective.
2:23:19 PM
MS. MCINTIRE reviewed slide 4, SCF Workforce Snapshot. She said
SCF is one of the top ten employers in the state, with 2,700
employees. They currently have 510 vacancies. Some vacancies are
due to turnover, and some are due to growth. Many individuals
decided they did not want to work in healthcare after COVID;
they wanted to be closer to family, leave Alaska, etc.
Historically, SCF had a great retention rate; they had a better
retention rate than local healthcare organizations. However, the
turnover is 20 percent now. She said this is her first
experience with a high turnover rate, stating employees are
excited to work with SCF because of the foundation's work with
the community to achieve wellness. SCF had 500 vacancies as of
January 17, and the vacancies are affecting service.
2:24:39 PM
SENATOR DUNBAR drew attention to the number of employees working
at SCF, which is 2,700. He asked whether the 2,700 includes the
employees at ANMC.
MS. MCINTIRE answered that 2,700 does not include ANMC staff;
the number specific to SCF totals close to 6,000, including
ANTHC employees.
MS. MCINTIRE summarized slides 5 and 6, Recruit and Retain
Licensing Professionals. SCF regularly collaborates with ANTHC,
Providence, Alaska Regional Hospital, and AHHA to think about
ways to improve retention rates and recruitment. The most
challenging position to fill is nurse, and it is an ongoing
issue. SCF's nursing workforce is maturing and retiring. SCF is
not meeting the demand for good quality care at ANMC and
community health centers. SCF's other most significant needs are
behavioral health, master-level therapists, and dental
hygienists. She thanked the legislature for passing HB 265,
telehealth pharmacy, last year. It was beneficial to the
community that provides services to 55 villages.
2:26:43 PM
MS. MCINTIRE said SCF coordinates with organizations within the
community to figure out how to attract and train qualified
people to provide good quality care. Alaska is a state of
collaboration, so even though organizations offer similar
services, they work together to meet the community's needs. It
is increasingly difficult to recruit specialists to the state;
as a result, providers often work with all hospitals in
Anchorage to meet customer's needs.
MS. MCINTIRE said a concern is the licensing backlog at the
Division of Licensing. The backlogs continue to increase. It can
take anywhere from three to nine months to get an individual
licensed. Often it takes longer for dentists. She suggested
looking at alternative options to speed up licensing. Consider
expedited background checks and licensing for healthcare
professionals from the Lower 48. Mounting backlogs mean SCF
customers wait increasingly longer to receive primary health
care and dental services.
2:29:04 PM
MS. MCINTIRE summarized slide 7, which pictured these SCF
community health centers: Benteh Nuutah Valley Native Primary
Care Center, Anchorage Native Primary Care Center, Nilavena
Subregional Clinic Iliamna, McGrath Health Center, and St. Paul
Health Center.
MS. MCINTIRE advanced to slide 8 to discuss opportunities for
the legislature to help the industry with rural housing for
healthcare professionals. She thanked the governor for
introducing the Alaska Housing Finance Rural Professional
Housing Program and the legislature for supporting it. SCF
supports community health centers and locations that need
housing. She offered personal testimony about the need for more
rural housing. After graduating from college, she wanted to work
in St. Paul; her dad was from there. She was offered a job but
could not accept it due to housing unavailability. The slide
pictured the St. Paul Health Center and surrounding community.
Housing is needed to attract and retain healthcare professionals
in rural SCF-served communities; it is an ongoing challenge.
MS. MCINTIRE advanced to slide 9, Reducing Administrative
Burden. Healthcare is complicated. It is technical, with a lot
of hoops. Organizations must jump through paperwork hoops,
background checks, billing, and licensing forms. It is important
to remember that new requirements often affect access to care
and the ability to provide care. People want to return home to
work in their community, but often, it is easier to avoid the
hoops, like the licensing hoops. The workload is an ongoing
issue for the state background check unit. Workers do not have
enough hours in the day to process the amount of background
check requests.
2:31:53 PM
MS. MCINTIRE advanced to slide 10 to talk about creating an
apprenticeship pipeline. She said it is vital to build pipelines
in the workplace. SCF's Raise Program gets young people
interested in healthcare work. The program starts at age 14 and
goes to age 18. 744 youth have participated in the program; some
have become SCF nurses and healthcare support staff. She
revealed that she began her career with SCF as administrative
support and is now the vice president of Workforce. The Raise
Program provides opportunities for SCF to grow its own staff.
2:32:57 PM
She detailed SFC's entry points, apprenticeships, and vacancies
on slide 10:
Creating Apprenticeship Pipeline
Entry Point
• Raise
• Administrative Support Training Program
• Dental Assistant Training Program
• Clinical Degree Program Initiatives
MS. MCINTIRE said the SCF Board of Directors support Alaska
Natives and American Natives in clinical training, paying
their way through school to graduation. There is so much
need SCF cannot afford not to pay.
Apprenticeships
• Universities
• Trade Schools
• Community Partnerships
• State Programs
• Training Programs
• Internships
Vacancies
Tribal Doctor
Community Health Aide
Dental Health Aide
Behavioral Health Aide
Certified Medical Assistant
Chemical Dependency Counselor
Manager or Supervisor
MS. MCINTIRE said SCF has a training program for all these
vacancies. SCF has career pathways to learn and try new
things, gain competency, and go to school; SFC helps fund
these individuals to help meet the community's needs.
2:36:33 PM
SENATOR DUNBAR asked whether low-level barrier crimes prevent
individuals from working in the healthcare industry,
particularly within the health aide and dental aide path. He
offered the example of a low-level drug conviction committed by
a teen.
MS. MCINTIRE answered yes, that is an ongoing issue. She
expressed her belief that SCF has the opportunity to apply for
variances with the state background check unit, but the process
is lengthy and has a long application. Youth who had trouble at
18 and want to get into healthcare can apply for variances, and
SCF can support their variance application. However, the process
can take three months, and often applicants cannot wait that
long for a job. Additionally, the Indian Child Protection Act
prevents variances when working with Indian children. Often SCF
would like to hire people with life skills but cannot due to
those burdens or things that happened twenty years ago.
SENATOR DUNBAR sought confirmation that the Child Protection Act
is a federal law, commenting that the state legislature would
not have jurisdiction. He asked whether that is the case with
most barrier crimes or if there are opportunities for changing
the variance process or the underlying law, such as crimes of
moral turpitude, at the state level.
MS. MCINTIRE confirmed that the Indian Child Protection Act is a
federal law. She answered the second question, stating that an
applicant who gave up a child through the Office of Children's
Services (OCS) is another barrier to employment. The state
prevents an applicant who gave up a child to OCS from working in
healthcare; this includes individuals who may have done
something when they were young and OCS was involved.
2:39:34 PM
SENATOR BJORKMAN asked whether SCF was involved in the childcare
industry.
MS. MCINTIRE answered SCF is not involved in childcare; however,
it does have a residential treatment center for youth.
2:40:27 PM
There being no further business to come before the committee,
Chair Bjorkman adjourned the Senate Labor and Commerce Standing
Committee meeting at 2:40 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 01.25.23 AK Hospital and Healthcare Assoc Presentation.pdf |
SL&C 1/25/2023 1:30:00 PM |
AHHA Presentation to SL&C |
| 01.25.23 SCF Workforce Overview Presentation.pdf |
SL&C 1/25/2023 1:30:00 PM |
SCF Presentation to SL&C |