SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE  3:32:05 PM CHAIR DUNBAR 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." 3:33:40 PM MARY SWAIN, Chief Executive Officer (CEO), Camai Community Health Center, Naknek, Alaska, testified by invitation on SB 89. She said Camai Community Health Center is a federally qualified facility serving the Bristol Bay Borough. She stated the center is critical for delivering primary, urgent, and emergency care, including receiving all EMS and 911 cases in the region. In the past year, the center handled over 2,000 patient visits, including more than 150 emergency cases. She emphasized long- standing recruitment challenges due to the remote location and increasing dependence on physician assistants (PAs) and nurse practitioners. She explained that the current state regulations requiring physician collaborative practice agreements place unsustainable financial and administrative burdens on facilities like Camai. She noted the center pays over $55,000 annually for physician collaboration, and delays in processing agreements negatively affect patient care and safety. MS. SWAIN expressed strong support for SB 89, stating it modernizes the practice framework for PAs in Alaska by authorizing a more autonomous model under State Medical Board oversight. She supported the bill's provision that allows PAs to practice independently after 4,000 hours of post-graduate clinical experience, noting that formal training includes approximately 2,000 hours. She called this a balanced approach that ensures proper oversight while providing a path to autonomy for experienced PAs. She cited examples from other states such as Iowa, Montana, New Hampshire, North Dakota, Utah, and Wyoming, which have eliminated statutory requirements for direct physician supervision, creating optimal practice environments. She added that Arizona also recently updated its laws to grant greater independence to experienced PAs, improving team-based healthcare delivery. 3:36:57 PM MS. SWAIN concluded that SB 89 will reduce wait times and improve healthcare accessibility without compromising quality. She underscored that while the legislation supports providers, it ultimately benefits patients. 3:37:32 PM JENNIFER FAYETTE, PA, Co-Chair, Alaska Academy of Physician Assistants, Anchorage, Alaska, testified by invitation on SB 89. said SB 89 is a crucial measure to modernize Alaska's physician assistant (PA) statutes and expand access to care. She noted that PAs have been essential to Alaska's healthcare system since the 1970s, serving both urban and underserved rural areas, yet outdated legal requirements continue to create unnecessary administrative hurdles for hiring and retaining PAs. She stated that SB 89 directly addresses these issues by updating collaborative practice language, allowing PAs to practice to the full extent of their training without compromising patient safety. She emphasized that the bill does not expand PA scope into areas like independent surgery or attempt to equate PAs with physicians but rather aligns regulations with current clinical practices in Alaska. She described the bill as the result of extensive discussions with physicians and a thoughtful response to prior legislative recommendations. MS. FAYETTE explained that removing outdated restrictions will enhance flexibility in the healthcare system and improve patient outcomes across the state. She stressed that modernization is necessary not just to reduce administrative burden, but also to sustain and grow Alaska's PA workforce, which faces significant recruitment and retention challenges. She cited data from the National Commission on Certification of Physician Assistants (NCCPA), noting Alaska had the lowest PA workforce growth nationally. She added that Alaska's healthcare licensing grew only 14 percent over two years, compared to higher rates for other provider types. Citing Department of Labor projections of several thousand unfilled healthcare positions by 2030, she concluded by urging support for SB 89 to ensure PAs can continue contributing meaningfully to Alaska's healthcare system and to meet the state's urgent care needs. 3:40:50 PM SENATOR HUGHES expressed strong support for SB 89 and shared that her husband, a retired PA, began his career in Bethel 40 years ago and was a member of the Alaska Academy of Physician Assistants. She acknowledged the work of the association. She sought clarification to address concerns and asked whether PAs still need to complete 100 CME credits biennially to maintain certification through the NCCPA, essentially doubling the requirement for physicians. MS. FAYETTE replied yes 3:42:03 PM SENATOR CLAMAN referred to Ms. Fayette's statement about the declining number of physician assistants (PAs) in Alaska and requested additional context. He asked for a comparison with trends in other states. He asked for national data to frame Alaska's situation. 3:42:31 PM MS. FAYETTE clarified that Alaska has seen a 14 percent increase in PAs, but this growth is significantly lower than the 35 percent increase among advanced practice registered nurses (APRNs). She added that nationally, PA numbers have increased by approximately 11 percent, though many states are experiencing much higher growth. She noted that the national median growth is in the 20 percent range, with some states seeing up to a 50 percent increase in PA licenses. She stated she would submit the relevant data from the NCCPA and emphasized that Alaska ranks at the bottom in terms of PA workforce growth. 3:43:22 PM CHAIR DUNBAR acknowledged that SB 89 does not aim to expand the scope of surgery for PAs and explicitly stated that PAs cannot perform surgery independently. He pointed out that certain procedures, such as suturing, can be technically classified as surgery. He noted that some in the medical community have raised questions about how SB 89 addresses or defines surgical activities. He asked for the sponsor or another testifier to address this concern. 3:43:58 PM MACKENZIE POPE, Staff, Senator Löki Tobin, Alaska State Legislature, Juneau, Alaska, answered questions on SB 89. She explained that the bill's language regarding surgery was carefully placed under the authority of the State Medical Board, which is tasked with developing regulations. She stated this approach allows subject matter experts, such as physicians, PAs, and other medical professionals, to define "surgery" in a way that accurately reflects clinical practice. She emphasized that the regulations and definition of surgery must not restrict physician assistants from performing routine procedures already within their established scope, such as suturing and stitching. She clarified that the bill ensures the State Medical Board cannot use its regulatory authority to impede PAs from continuing to perform these common tasks. SENATOR TOBIN stated the language if found in SB 89, page 2, lines 6-7. 3:45:32 PM MS. SWAIN provided a clinical perspective on the definition of surgery within her facility, noting that in the absence of a physician, surgical procedures are limited to those performed with local anesthetic. She stated that procedures like suturing using localized anesthetic are considered minor surgeries and are allowed. However, any procedure requiring regional or blocking anesthesia would fall outside the clinic's capabilities and would require a physician. 3:46:22 PM CHAIR DUNBAR opened public testimony on SB 89. 3:47:18 PM BARTHOLOMEW GRABMAN, MD, representing self, Anchorage, Alaska, testified in opposition to SB 89 stating that 4,000 hours of clinical experience is insufficient for safe, independent medical practice. He compared this to his own training as a physician, which included roughly 18,000 clinical hours, and emphasized that even with that background, he still consults a supervising physician for every patient. He shared the perspective of a colleague and former physician assistant (PA) who stated her competence as a PA was significantly lower than her current competence as a physician in training, highlighting the difference in education and training. He argued that current PA regulations under 12 AAC 40.410450 are not burdensome, citing requirements such as monthly check-ins and quarterly evaluations. He also stated that SB 89 does not improve rural healthcare access, suggesting financial incentives would be a more effective approach. He concluded by urging the committee to reject SB 89 as written and recommended increasing the clinical hour requirement to at least 6,000 or 8,000 hours, citing Arizona as an example. 3:50:49 PM DANIEL REYNOLDS, DO, representing self, Naknek, Alaska, testified in support of SB 89 stating he has worked with PAs for 22 years across military, Indian Health Service, and private practice settings, including in Naknek. He questioned a prior speaker's claim of working in Naknek, noting he had not encountered that individual during his eight years there. He affirmed that PAs receive strong training, especially in family medicine, and have also performed well in emergency department settings. He described PA training as extensive and appropriate for increased autonomy. He emphasized that PAs deliver high- quality care and, like physicians, consult when needed. He stated their training supports the level of independence proposed in SB 89. 3:52:47 PM SENATOR GIESSEL asked for confirmation that Dr. Reynolds was amenable to entering into a collaborative agreement with a physician assistant (PA) to support them during the transition to independent practice. DR. REYNOLDS responded, correct. 3:53:34 PM KATHERINE VAN ATTA, PA, representing self, Naknek, Alaska, testified in support of SB 89, stating she has been a PA for 20 years and a nurse midwife for seven, holding independent licensure as an APRN and dependent licensure as a PA. She works in both Wasilla and Naknek, where the nearest physician is typically over 100 miles away. She also precepts medical students in rural rotations. She argued that state-mandated collaborative plans are unnecessary for experienced providers to practice safely, citing her ability to consult and transfer care as an independently licensed APRN. She emphasized that internal facility-level oversight ensures competence and appropriate scope of practice without requiring state-imposed collaboration. She stated that SB 89 would help address healthcare shortages in rural areas by reducing administrative burdens that limit the ability of facilities to hire PAs. She concluded that the bill would give rural clinics more flexibility to hire the most qualified provider for their needs. 3:56:09 PM MICHAEL MICHADU, PA, representing self, Mat-Su, Alaska, testified in support of SB 89, sharing that he practiced as a PA for three years in emergency departments across Virginia, ranging from large teaching hospitals to small rural facilities. He described receiving extensive hands-on training under physician supervision, which prepared him well for independent decision-making. He stated that after moving to Alaska to work with Southcentral Foundation in both the Mat-Su Valley and rural clinics like McGrath and Iliamna, he immediately experienced the challenge of providing care without the team-based support he was accustomed to. He expressed deep respect for the skill and professionalism of the PAs he has worked with in Alaska. He urged the legislature to align Alaska's PA practice laws with the high standards already being demonstrated across the state. 3:58:48 PM MOLLY SOUTHWORTH, MD, representing self, Anchorage, Alaska, testified in opposition to SB 89, stating she has been a physician in Alaska since 1985, with extensive experience in the tribal system, private sector, and medical education through the WWAMI program. She emphasized that while PAs strengthen the healthcare system, SB 89 undermines physician-led teams, which she believes would reduce care quality and hinder access to specialists. She warned that passing SB 89 as written could result in decreased access to quality care for patients. She urged the legislature to instead focus on strengthening team- based care and offered to share specific alternative recommendations. MS. SOUTHWORTH also shared a written message from Dr. Kamila Sulak, president-elect of the Alaska College of Emergency Physicians, who stated, "the physician voice is important, and the physician groups we represent account for most of the physicians in the state of Alaska, it is important that we stand up strong for the highest quality care possible for our patients and ourselves." 4:01:33 PM MARGARET CARLSON CONSENTINO, MD, President, Alaska Academy of Family Physicians, Anchorage, Alaska, testified in opposition to SB 89. She said the Alaska Academy of Family Physicians, representing 340 family doctors, and the organization opposes SB 89 in its current form. She noted that while they value their work with PAs and have collaborated on alternative frameworks, SB 89 does not reflect a mutually agreed-upon solution. She acknowledged concerns with current collaborative plan requirements and confirmed that the State Medical Board is already working to revise them significantly. She emphasized the importance of maintaining team-based care models, which she believes have contributed to successful partnerships between physicians and PAs. She recommended considering the North Dakota model, which retains physician-led care teams without granting full independence to PAs. She urged continued work on SB 89 to ensure any changes preserve care quality and respect both physician and PA roles. 4:04:07 PM MEGHAN HALL, PA, President, Alaska Academy of Physician Assistants, Anchorage, Alaska, testified in support of SB 89 as the current president of the Alaska Academy of Physician Assistants. She explained that the PA profession was originally created to relieve overburdened physicians and improve access to care, operating under collaborative agreements for supervision and liability. She emphasized that the profession has evolved, with PAs now holding master's degrees, national certifications, individual licensure, and Drug Enforcement Administration registration. She stated that while collaboration remains essential in practice, formal collaborative agreements have become outdated and now pose barriers to hiring. She noted Alaska's critical healthcare shortage and warned that outdated laws are pushing PAs to relocate to states with modernized practice statutes. She urged support for SB 89 to help retain the PA workforce and expand access to care across the state. 4:05:59 PM CHAIR DUNBAR closed public testimony on SB 89. 4:06:38 PM CHAIR DUNBAR held SB 89 in committee.