HB 102-FOREIGN MEDICAL SCHOOL GRADUATES CHAIR ANDERSON announced that the first order of business would be HOUSE BILL NO. 102 "An Act relating to the licensure of foreign medical graduates; and providing for an effective date." REPRESENTATIVE BILL STOLTZE, Alaska State Legislature, sponsor, pointed out that his specialty was listening to people and that through listening, he has ascertained that a shortage of specialties in medicine exist here in Alaska. He then acknowledged that there are many qualified people here that can help solve this problem. CHAIR ANDERSON pointed out that one of the things we don't want is the insurgence of doctors into Alaska who come from countries that are not standards are lower. He then asked what the representative thought concerning this and whether changing the board rules would weed these kind out. REPRESENTATIVE BILL STOLTZE answered that a board with professionals will weed these people out and furthermore, they will be asking those who are qualified to practice outstanding medicine into the state. 3:24:02 PM REPRESENTATIVE LYNN asked if there was anything that will cover English speaking ability for those that practice medicine. REPRESENTATIVE BILL STOLTZE answered that he did not know. CHAIR ANDERSON stated that this question would be held and reexamined by one of the doctors that are here as witnesses. He then opened the floor up to the public. 3:25:23 PM RICK URION, Director, Division of Occupational Licensing, Department of Commerce, Community, & Economic Development (DCCED), standing in favor of the bill, stated that the biggest problem here is that in all of the Alaskan laws there are no discretionary powers within his grasp. He pointed out that there had been many instances when he could have solved many problems if he was given them. MR. URION further stated that the laws are written for the worst case scenario and that life was not black and white. He ends by stating that public safety could have been less jeopardized if he had been given some discretionary opinion. 3:26:15 PM REPRESENTATIVE GUTTENBERG mentioned that the question by Representative Lynn was an interesting one and that he wanted to revisit it. He postulated that in the event of a Chinese and Eastern European coming into take the test for competency, would there be a standard that the board would take to test competency and also, if they translate foreign documents to aid in licensing. MR. URION answered by stating that they are not going to allow people in that cannot speak English. He then said that most of the people are already licensed elsewhere in the United States. 3:27:20 PM REPRESENTATIVE LEDOUX mentioned that she was under the impression that doctors simply would not be practicing in this state unless they have been practicing in other states. MR. URION commented that people will not be practicing in this state unless they are highly skilled in their field. The problem that exists is that these very people cannot come into the state and practice due to constraints in the current law. CHAIR ANDERSON further stated that through the application process there would be enough background research to determine their abilities. 3:28:49 PM Dr. JAMES JORDAN, executive director of the Alaska State Medical Association, stated that he would be augmenting to previously submitted testament. In the written statement he stated that he referred to a 2002 study that showed that a shortage of 200 physicians in their market area. He then said that he has information that this is corroborated in a 2005 study. He then continues to say that in 2009 there will be a need for 261 more physicians. 3:31:01 PM DR. JORDAN continued by stating that one of the problems is delivering culturally competent care. He supported this statement by saying that in the school system alone there are instances of at least 80 languages being spoken by indigenous peoples. He ended by stating that foreign-born doctors could offer an excellent venue for culturally diverse treatment. DR. GEORGE STEWART, physician in Alaska, stated that it is very difficult to recruit specialists here. From his own personal experience, he stated that his own specialty suffers from a shortage. He asserted that the state of Alaska is getting to a critical point. The idea behind the bill is to not lower the bar to allow less qualified people in, but to allow highly qualified people in that do not fit the tight temporal guidelines that are found in the current law. He emphasized that Alaska has a critical shortage of physicians. By denying physicians the access to Alaska, he stated that you are also denying Alaskans healthcare. REPRESENTATIVE LYNN wanted to know if there is going to be an active effort to recruit these medical specialties. DR. STEWART indicated that he has been recruiting for eight years. He commented that these are not for people that are from areas far and remote but people that have been practicing in the United States for years. 3:38:29 PM REPRESENTATIVE GUTTENBERG pointed out that last year the state was not very supportive of the Naturopathic bill. He then asked if the two doctors were supportive of this practice. DR. JORDAN commented that his group is supportive of naturopathic physicians. CHAIR ANDERSON asked if there was anything else to be added. REPRESENTATIVE STOLTZEE pointed out that as a diabetic, he has a small conflict of interest in supporting the bill, but that others like him suffer the same lack of physicians. It takes six months to schedule an appointment with endocrinologists. He pointed out that his particular doctor is aging and that this trend is a growing one in Alaska. He advised that the specialists the state does have are going to be retiring and gone very soon. REPRESENTATIVE GUTTENBERG asked if anyone at the meeting was on the medical board, and he then followed this up with a question concerning the mechanics and procedures of the application process. CHAIR ANDERSON reiterated the question by asking how the application process works. 3:41:33 PM REPRESENTATIVE STOLTZE answered by stating that the state medical board sits down to look at and decide what alternative criteria is available, and then they go through the administrative process of adopting new regulations so they are outlined for everyone, and thus, the tests for competency are then made very apparent. These regulations will include three requirements. The first is licensure in another state and second, a board specialty. A new requirement would be passing a core comprehension test. The medical student is presented with a patient (an actor) who presents with various symptoms. The student doctor must properly diagnose the problem without failure. 3:43:46 PM REPRESENTATIVE LEDOUX points out that in section 3B, that these requirements are in the language. She then asked if it was the intent of this medical board to have the option of requiring licensure in another state for three years, but not being required to adopt the criteria. REPRESENTATIVE BILL STOLTZE answers that this is correct. It does give the board an alternate criteria to use in exceptional cases. He said that it removes the current rigidity. REPRESENTATIVE LEDOUX asked if it means 'either one of these requirements'. She further asked if this meant that someone who graduated from Oxford or Edinburgh would have the same ease in application as someone from the Universities of Washington and Oregon. REPRESENTATIVE BILL STOLTZE noted that it is not lowering standards- it provides alternatives for equitable standards for applicants. 3:45:51 PM DR. JORDAN interjected and reiterated that Representative Stoltze is correct in saying that what the bill is giving Alaska an alternative competency requirements that would equate to the three years required for American applicants. He further stated that the committee is not talking about new graduates; they are talking about graduates not in US medical programs that require the completion of a three-year residencies. REPRESENTATIVE KOTT pointed out that this would allow a physician who has practiced for 15 years, who then moved to Arizona and practiced for a year, eligibility to work in Alaska. As it stands now, he said that he would not be eligible since he missed the three-year rule. He then said that this language offers a competent professional the prospect of getting by this. CHAIR ANDERSON closed public testimony. REPRESENTATIVE KOTT moved HB 102 out of committee with individual recommendations and the accompanying fiscal notes. [No objection was stated, and therefore HB 102 was treated as moved out of the House Labor and Commerce Standing Committee.]