HOUSE BILL NO. 102 An Act relating to the licensure of foreign medical graduates; and providing for an effective date. BEN MULLIGAN, STAFF, REPRESENTATIVE BILL STOLTZE, explained the legislation, noting that the purpose was to help alleviate the shortage of physicians in Alaska, which are more noticeable in the specialty fields. The legislation will allow, at the discretion of the Alaska State Medical Board, individuals graduating from foreign medical schools, the ability to practice medicine in Alaska. Currently, there is a 2-year United States graduate medical education residency program requirement. The proposed legislation would make it easier to practice medicine in Alaska. The requirements will remain as stringent as they currently are for persons graduating from medical school in the United States. Mr. Mulligan pointed out that the last section offers recommendations for the board; they may choose not to adopt those stipulations. 1:54:47 PM Representative Hawker questioned if this idea had been run by either Providence or Regional Hospital. Vice-Chair Stoltze advised that he had not "run it by" the actual hospitals, however, it has been looked at by the hospital representatives he met in the Capitol hall's and they offered "a thumbs up". Representative Weyhrauch asked the definition of an "active medical practice" as outlined in Section 3. Mr. Mulligan offered to check that out. He pointed out that Jim Jordan, the Executive Director of the Alaska State Medical Association was on line. Representative Weyhrauch referenced Section 3 and asked if the doctor was a general practioner, would they be carrying a board certified "specialty" license. Mr. Mulligan advised that would not fall under the American Board of Medical Specialties but thought that it would fall under the American Medical Board. He offered to provide further information on that concern. Representative Weyhrauch asked if the physician did not have a current board specialty but did have a long practice of general medicine, would they be excluded from being able to practice under the proposed bill. Mr. Mulligan advised that the stipulations are only guidelines and may or may not be decided to be worthy requirements. Representative Weyhrauch questioned why those two requirements had been set apart from all the other possible requirements. Mr. Mulligan explained that one of the specifics was the medical specialty and that the legislation attempts to fill vacancies for specific medical practices. Representative Weyhrauch asked why the listed two hospitals had been the only included. Mr. Mulligan offered to provide that information. Co-Chair Meyer noted that there are testifiers on-line that could address these concerns. 1:58:54 PM RICK URION, DIRECTOR, OCCUPATIONAL LICENSING, DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT, testified enthusiastically in support for the legislation. He claimed that licensing laws are written in such a way that they leave no discretion. HB 102 would solve some problems and would provide the Board with opportunities to make choices while protecting the public. He emphasized that it is important to pass the legislation. Representative Kelly questioned if background checks would be made on these applicants. Mr. Urion advised that most of these people are living in the United States and have been for many years. He did not foresee any problems. 2:01:19 PM JIM JORDAN, (TESTIFIED VIA TELECONFERENCE), EXECUTIVE DIRECTOR, ALASKA STATE MEDICAL ASSOCIATION, ANCHORAGE, noted he had submitted written testimony included in member's packets. (Copy on File). Mr. Jordan stated that the Alaska State Medical Association strongly supports HB 102. Mr. Jordan reiterated physician shortages that exist in the Anchorage hospitals. Providence Medical system did a study in 2002, which indicated at that time, they were short 200 physicians. He stressed the fact that there is a shortage and as the State moves forward toward 2009, the shortage will become bigger. The numbers will only grow without passage of the bill. He thought that HB 102 could help to address these alarming concerns. Mr. Jordan mentioned physicians currently in active practice. He acknowledged that it is important to guarantee that physicians have guidelines for applying for certain positions; they must be practicing and actively seeing patients. Mr. Jordan advised that general practice usually has a specialty area. For board certification, it is recognized that to qualify for core competency, there would be extensive peer review. Mr. Jordan addressed "accreditation counsel" for graduate medical education from the Royal College of Physicians in Canada. He commented that is the entity, which credits medical education programs in the United States and Canada. That college goes through extensive accreditation procedures for graduate medical education, primarily provided through hospitals. 2:05:43 PM Representative Croft asked the justification for the broad amount of discretion that the legislation would provide to the Board. Mr. Jordan stressed that it is a "very professional" State Medical Board, who would not want to "water" down any credentials. They would be determining other alternative measures of competency. 2:07:44 PM DR. GEORGE STEWART, (TESTIFIED VIA TELECONFERENCE), PHYSICIAN, ANCHORAGE, voiced his support for the proposed legislation. He noted that he has been practicing in Anchorage for over 30-years and is a specialist in the area of lung disease. At present time, there should be 10 physicians in that area of critical care medicine; however, there are only 8. He pointed out that he is now 68 years old and should have retired years ago but because of the shortage, he professionally has not been able to do so. Some of the other physicians with those specialties are also in their 60's. The purpose of the proposed legislation is not to lower the standard but rather provide the Board with the discretion to license physicians that are qualified, but do not meet the exact letter of three years of practice in the United States. He emphasized that there is consequently, a serious shortfall of physicians statewide, which will only become worse without passage of the legislation. Dr. Stewart voiced strong support for the proposed legislation. Vice-Chair Stoltze noted that his specialist had a 3 to 4 month waiting period and asked Dr. Stewart if that was typical. Dr. Stewart replied that is common and for some new patients, the wait time can be as long as 6 months. Representative Weyhrauch referenced Section 3, recommending a conceptual amendment be added that the practitioner is able to read and write English. Mr. Jordan explained that there are protections in place as the medical boards tests require fluency in English. Representative Weyhrauch addressed Section 3, Section C, suggesting to delete "means" and insert "includes". He thought that "means" would limit the two entities. Mr. Jordan advised that the correct word is "means", as the reference in that section goes back to the original body of the licensing law, which recognizes graduate medical programs in the United States. The only bodies recognized are the two listed. 2:16:52 PM Representative Croft asked why there was a limit to only those two in a bill promoting flexibility. He thought that the discretion in Section B was removed by the North American definition of "hospital". Mr. Jordan responded that the recognized hospital language relates to foreign medical graduates that have satisfied the 3-year medical graduation requirement in the United States. Latitude is still given, through the regulatory process, for an equivalency. However the State Medical Board would have the authority to bend regulations for that specific program. Representative Croft pointed out that Sections A & B could be either/or and were narrowly defining the type of hospital, which the person must have their 2-year additional postgraduate training at. He said that was odd; he suggested a regulation placed under "B" to address that. 2:20:00 PM Co-Chair Meyer agreed with the sponsor and Mr. Jordan. Representative Foster MOVED to report HB 102 out of Committee with individual recommendations and with the accompanying fiscal note. There being NO OBJECTION, it was so ordered. HB 102 was reported out of Committee with a "do pass" recommendation and with a zero note #1 by the Department of Community & Economic Development. 2:20:45 PM AT EASE: 2:20:52 PM CONVENE: 2:24:00 PM