SB 89-PHYSICIAN ASSISTANT SCOPE OF PRACTICE  1:35:32 PM CHAIR BJORKMAN 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." 1:36:07 PM SENATOR LOKI TOBIN, District I, Alaska State Legislature, Juneau, Alaska, sponsor of SB 89. She presented a brief recap of SB 89 and stated that the legislation aims to modernize statutes governing physician assistants (PAs) by reducing administrative burdens and providing a pathway to independent licensure. While PAs are not doctors, they receive extensive education and clinical training comparable to nurse practitioners. SB 89 ensures PAs can practice fully within their scope, maintain competitiveness, and provide high-quality care. PA's require completion of accredited education, licensure exams, and at least 4,000 postgraduate clinical hours before independent practice. SB 89 also incorporates safeguards for specialty transitions, with oversight from the state medical board, and holds PAs to the same medical standards as MDs and DOs, ensuring patient safety and accountability. 1:40:29 PM CHAIR BJORKMAN asked how many hours a PA must work under a doctor's supervision before practicing independently. He also about the number of hours required by other states. 1:41:09 PM SENATOR TOBIN replied that at least seven states have created pathways for PAs to obtain independent licensure. She stated that the required number of supervised clinical hours varies widely across those states. Wyoming has no minimum hours, Iowa requires 4,000, South Dakota 6,000, Montana 8,000, and New Hampshire and Utah range from 8,000 to 10,000. She said rural states like Alaska, North Dakota, and Wyoming prioritize access to care and tend to have lower or no minimums. Given PAs similar scope of practice to nurse practitioners, stakeholders in Alaska agreed on a compromise of 4,000 supervised hours, acknowledging it is somewhat arbitrary. 1:42:37 PM CHAIR BJORKMAN asked whether the medical community has professional guidance on the optimal number of supervised hours needed to achieve the best patient outcomes. 1:42:55 PM MACKENZIE POPE, Staff, Senator Loki Tobin, Alaska State Legislature, Juneau, Alaska, answered questions for SB 89 and stated that as mentioned earlier other advanced practice providers (APP), like nurse practitioners, require zero supervised hours. She said research suggests zero hours is sufficient, and there is no consensus among stakeholders on an ideal number, resulting in a wide rangefrom zero to 10,000 hoursacross states. 1:43:40 PM CHAIR BJORKMAN stated that North Dakota's statute includes provisions requiring physician assistants to practice near their supervising physicians. He asked for the reasoning behind North Dakota's statute and what safeguards SB 89 includes to address the absence of a proximity requirement. 1:44:18 PM SENATOR TOBIN replied that current law does not require physician assistants to practice near their collaborating physicians. She said about 14 percent of those physicians live outside Alaska. SB 89 does not change this arrangement. While collaborating physicians must review PAs work and hold quarterly check-ins, compliance varies. Federally recognized health clinics already provide stronger oversight; however SB 89 does not change current practices regarding where PAs and collaborating physicians live or work. 1:45:36 PM CHAIR BJORKMAN requested more information on how Federally Qualified Health Centers (FQHCs) provide oversight. He asked whether the relationship between a supervising physician and a physician assistant (PA) includes requirements for case reviews or peer evaluations. He also asked how SB 89 addresses the oversight structure for this relationship. 1:46:09 PM MS. POPE replied that the policies and procedures of the Alaska State Medical Board define collaborative agreements in detail through regulation rather than statute, which SB 89 preserves. She said these agreements must be written, filed with the board, and outline how the collaborating physician and PA will communicate. Each plan is customized and must include regular, typically quarterly, check-ins and reviews, with minimum standards set by law. MS. POPE added that policies and procedures dictate a physician must have a method of quality assurance and at a minimum 2 days each quarter of direct personal contact for reviewing a PAs performance. 1:48:31 PM JENNY FAYETTE, Board Member, Alaska Academy of Physician Assistants (AKAPA), Anchorage, Alaska, testified by invitation on SB 89 and replied that regulations already authorize the State Medical Board to oversee collaborative agreements, requiring them in writing. The board is updating these rules to streamline the process, and SB 89 specifies that such regulations will also apply to PAs with fewer than 4,000 clinical hours. 1:49:21 PM CHAIR BJORKMAN asked if it would be beneficial to specify in regulation or statute the number of charts or cases a PA must review with their supervising physician as part of their collaborative agreement. 1:49:40 PM MS. FAYETTE stated her belief that overly restrictive collaborative plan requirements make it harder to employ PAs. SB 89 aims to safely expand employment opportunities, and there is no research indicating that specifying a set number of case reviews improves quality of care. 1:50:22 PM CHAIR BJORKMAN asked whether it would be appropriate for a PA to review the top 10 most complex or uncertain cases with their supervising physician as a baseline for collaboration. 1:50:48 PM SENATOR TOBIN replied that PAs often seek input from various medical professionals, not just their collaborating physicians. With PAs consulting multiple experts on complex cases, a chart review by one physician may not provide the same quality of oversight, reflecting the collaborative nature of multidisciplinary medical practice. 1:51:29 PM CHAIR BJORKMAN asked who is permitted to use the title "doctor" or similar terms, and whether nurse practitioners with a PhD should use that title in clinical settings, given potential confusion for patients. 1:52:13 PM SENATOR TOBIN replied that SB 89, Section 17, page 9, lines 21- 26, clearly [AS 08.64.380(6)(B)] defines in statute how medical professionals may display their titles so patients can identify their credentials, requiring PAs to visibly identify themselves as physician assistants, similar to nurse practitioners. Second, individuals who earn a doctorate, such as in psychology or other fields, have the right to use the title "Doctor" to reflect their academic achievement. 1:53:39 PM CHAIR BJORKMAN opened public testimony on SB 89. 1:54:37 PM CANDACE HICKEL, representing self, Anchorage, Alaska, testified in support of SB 89 and advocated for addressing healthcare gaps in areas facing provider shortages. PAs and nurse practitioners perform similar clinical roles, but only nurse practitioners have independent licensure. She said current laws requiring collaborative agreements create barriers, as a PA cannot practice if their supervising MD moves, leaving communities without care. These agreements are seen as outdated administrative burdens, unnecessary for ensuring quality. SB 89 proposes independent licensure for PAs to improve access and allow them to practice fully within their training and capabilities. 1:56:47 PM KARI BERNARD, representing self, Anchorage, Alaska, testified in support of SB 89 and stated that as a PhD-trained PA, she does not use the title "Doctor" to avoid patient confusion and to comply with Alaska law. She said National research shows PA- delivered care is safe, effective, and sometimes superior, with lower complications, mortality, hospitalizations, and re- admissions, while also being cost-effective. PAs can help reduce healthcare costs through shorter hospital stays and fewer visits. SB 89 supports removing administrative burdens on PAs, enabling them to better serve rural, vulnerable, and well- resourced communities while filling provider gaps affordably. 1:58:59 PM DR. MOLLY SOUTHWORTH, M.D., representing self, Anchorage, Alaska, testified in opposition to SB 89 and acknowledged the value of supporting PAs but argued they are not trained for independent practice, and safety in such settings has not been demonstrated, as existing studies reflect supervised care. She proposed focusing on providing high-quality medical care through strategic planning rather than licensing professionals beyond their training. She said data from 2023 shows that only 43 percent of Alaskan PAs practice primary care, down from 47 percent in 2021, and independent licensure alone will not increase this. Improving primary care and making it more attractive requires addressing administrative burdens, inequitable compensation, poor support, and burnout. Physician leaders are developing a coordinated plan and invite collaboration from others. 2:01:40 PM JARED WALLACE, representing self, Kenai, Alaska, testified in support of SB 89 and stated that Odyssey Family Practice in Kenai serves over 6,000 patients, but care is constrained by the requirement of a collaborative plan. He said he has experienced collaborative physicians dying or losing licensure, making it increasingly difficult to secure collaborators. He said currently he pays $96,000 annually to maintain a collaborated plan. Over 15 years, he has built strong professional relationships with various specialists, which guide patient care regardless of formal collaborative agreements. He argued that professional relationships, not collaborative plans, are key to delivering quality care. Collaborative agreements, in their experience, act as barriers, risking patient access if disrupted, rather than improving outcomes. 2:04:16 PM KATHY TODD, Physician, Alaska Academy of Family Physicians, Valdez, Alaska, testified in opposition to SB 89 and explained that while PAs and nurse practitioners are capable, their training is less extensive than that of physicians or even advanced medical students. She said physicians undergo 1115 years of education, compared to six or seven for PAs, and the proposed 4,000 additional supervised hours would not equal the rigor of medical training. She argued that PAs are not prepared for independent practice. She recommended amendments requiring more supervised training and a team-based structure with physicians. She added that independent practice for PAs or nurse practitioners would reduce the quality of care, especially in Alaska's complex and remote healthcare environment. 2:06:48 PM MICHAEL MICHAUD, representing self, Mat-Su Valley, Alaska, testified in support of SB 89 and stated that as a PA he has practiced in both urban and rural Alaska, including the Alaska Native Medical Center and Southcentral Foundation. He said in rural and remote clinics, PAs often work independently without a physician present. He stated that SB 89 would modernize regulations to reflect the independent practice that already occurs throughout Alaska. 2:08:37 PM MARGARET CARLSON, President, Alaska Academy of Family Physicians, Anchorage, Alaska, testified in opposition to SB 89 and stated that she is a physician who has collaborated with PAs for the past 10 years. She said she recognizes the value and limitations of PAs. She urged lawmakers to consider amendments that individual physicians have submitted, such as requiring more training hours like Utah's 10,000-hour model, to strengthen skills and confidence. She stressed the importance of maintaining team-based, collaborative care, warning that independence could erode that structure. She noted there is no data supporting PA independence and argued that physician oversight helps reduce costs and improve care quality. She cautioned that SB 89 could increase costs and worsen access, as independently practicing PAs may not choose primary care. 2:11:08 PM KATHERINE VAN ATTA, representing self, Wasilla, Alaska, testified in support of SB 89 and described extensive experience working as a PA in remote Alaska communities such as Adak and Naknek. She pointed out that SB 89 concerns independent licensure, not independent practice, and noted that most healthcare professionals already hold independent licenses. She explained that independent licensure allows continued collaboration with physicians while ensuring continuity of care despite physician shortages. Without it, frequent physician turnover could force her to stop working and reduce patient access. She concluded that SB 89 would expand hiring flexibility and improve access to healthcare, especially in rural areas. 2:13:28 PM JENNIFER PERKINS, representing self, Anchorage, Alaska, testified with concerns on SB 89 as written and praised the skill and dedication of PAs she has worked with in both rural and urban settings. She noted that medicine is increasingly complex and that physicians receive over 12,000 supervised clinical hours, giving them broader exposure and deeper training. While acknowledging that experienced PAs can be highly capable, she believes 4,000 hours of supervised training is insufficient for independent practice. She supports potential amendments but emphasized the need for more extensive preparation to meet Alaska's unique healthcare challenges. 2:15:17 PM NICHOLAS COSENTINO, representing self, Anchorage, Alaska, testified in opposition to SB 89 and acknowledged the passion on both sides of the SB 89 debate, noting that patient care is complex and often uncertain. He emphasized that physicians rely on years of intensive education and residency to make critical decisions, and 4,000 hours of PA training cannot match that depth. While recognizing PAs as valuable team members who often deliver excellent care, he noted that errors and missed details still occur. He stressed the importance of collaboration between physicians and PAs to maintain high-quality patient care. He urged lawmakers to vote against SB 89, arguing that teamwork, not independence, ensures the best outcomes for Alaskans. 2:18:20 PM CHAIR BJORKMAN closed public testimony on SB 89. 2:18:51 PM CHAIR BJORKMAN asked what role the Division of Corporations, Business and Professional Licensing (CBPL) play in overseeing this process of licensing PAs and transitioning them from practice under a physician to independent practice. 2:19:19 PM SYLVAN ROBB, Director, Division of Corporations, Business and Professional Licensing (CBPL), Department of Commerce, Community and Economic Development (DCCED), Anchorage, Alaska, answered questions on SB 89. She responded that the division's role is to ensure that all the necessary documentation and requirements have been met for licensure and that the role would continue under SB 89. 2:20:14 PM CHAIR BJORKMAN asked if the division has any concerns about any potential liability that might come from the concepts in SB 89. 2:20:41 PM MS. ROBB replied that she does not anticipate any great burden on the legislature. The division submitted a zero fiscal note for SB 89, noting it will not significantly impact their workload. She said as collaborative plan requirements phase out over time, the administrative burden will decrease. This change is expected to reduce the amount of paperwork the division must process and track. 2:21:32 PM SENATOR YUNDT asked if similar legislation has been passed in other states. 2:21:57 PM SENATOR TOBIN replied yes. She said several states, including North Dakota, Wyoming, Iowa, South Dakota, Montana, New Hampshire, and Utah, have created pathways for independent PA licensure. These states share similarities with Alaska, such as rural populations and challenges in attracting qualified medical providers. 2:22:35 PM SENATOR YUNDT asked how the number of required clinical hours in other states' legislation compares to each other and to Alaska. 2:22:52 PM SENATOR TOBIN replied that states requirements vary, from none in North Dakota to 10,000 in Utah. SB 89 does not change current PA education standards, which already include 2,000 clinical hours during a 27-month program. It adds 4,000 additional hours before a PA can seek independent licensure, totaling 6,000 clinical hours overall. 2:24:04 PM CHAIR BJORKMAN held SB 89 in committee.