Legislature(2009 - 2010)BELTZ 211

02/27/2009 08:00 AM Senate EDUCATION

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08:01:58 AM Start
08:02:16 AM SB18
08:48:54 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Bills Previously Heard/Scheduled
            SB  18-POSTSECONDARY MEDICAL EDUC. PROG.                                                                        
8:02:16 AM                                                                                                                    
CHAIR ELTON announced the consideration of SB 18.                                                                               
SENATOR  DAVIS moved  to  adopt  the CSSB  18  (  ), labeled  26-                                                               
LS0139/S,  as the  working document.  There  being no  objection,                                                               
version S was before the committee.                                                                                             
8:02:49 AM                                                                                                                    
SENATOR WIELECHOWSKI,  sponsor of SB  18, said this  bill follows                                                               
up on a  bill Senator Meyer introduced to increase  the number of                                                               
Washington,  Wyoming,  Alaska,  Montana,  Idaho  (WWAMI)  student                                                               
positions. One  of the primary  recommendations of the  2006 task                                                               
force suggestions was to increase  the number of positions to 30,                                                               
and the  initial bill  did that, but  the University  advised him                                                               
that  anything  over  24 students  would  result  in  significant                                                               
additional  costs  to  it  in terms  of  new  infrastructure  and                                                               
administration.  So he  changed the  number to  24, which  is the                                                               
maximum  number the  University  can  handle without  significant                                                               
incremental  cost  increases.  The  state is  about  350  doctors                                                               
short, and this will begin to address the problem.                                                                              
8:05:12 AM                                                                                                                    
SENATOR  STEVENS  questioned  whether  this  bill  is  necessary,                                                               
because  the   original  bill  says  "accommodate   at  least  20                                                               
8:05:57 AM                                                                                                                    
MICHELLE SYDEMAN,  staff to Senator Wielechowski,  explained that                                                               
the University  wanted them  to put this  in statute  although it                                                               
could have  been done through  a budget  appropriation increasing                                                               
the amount  going to  the WWAMI program.  Having the  fiscal note                                                               
with  the statutory  approach  is helpful  to  the University  of                                                               
Washington (UW) and  the University of Alaska  (UAA) for planning                                                               
their budgets. It was decided that  the words "at least 24" would                                                               
be acceptable to both universities.                                                                                             
8:07:04 AM                                                                                                                    
CHAIR ELTON assumed since the  fiscal note addresses the previous                                                               
version  of  the  bill,  it  would  probably  be  less  with  the                                                               
reduction from 30 to 24 in the CS.                                                                                              
8:07:39 AM                                                                                                                    
SENATOR HUGGINS joined the meeting.                                                                                             
MICHELLE SYDEMAN  said that is  true. An informal  revised fiscal                                                               
note  from the  UAA indicates  that as  the program  steps up  to                                                               
having  the full  suite of  24 students,  the cost  will increase                                                               
incrementally over the next five years to $550,000 in 2014.                                                                     
8:08:44 AM                                                                                                                    
CHAIR  ELTON asked  Ms. Sydeman  to  discuss the  history of  the                                                               
WWAMI program.                                                                                                                  
8:08:58 AM                                                                                                                    
MS. SYDEMAN explained that the program  began in 1971 or 1972 and                                                               
along the way got up to  10 students. It increased to 20 students                                                               
two years ago.                                                                                                                  
8:10:35 AM                                                                                                                    
PAT LUBY, Advocacy Director, AARP  Alaska, said anything that can                                                               
be done to  increase the number of physicians in  Alaska would be                                                               
8:11:23 AM                                                                                                                    
SENATOR HUGGINS  asked Mr. Luby if  he sees any rationale  in the                                                               
requirement for a  physician that took advantage  of this program                                                               
to  be required  to  participate  in some  level  of Medicare  or                                                               
MR. LUBY  replied if that  were legal,  he would support  it, and                                                               
that our  congressional delegation  is working  now to  find some                                                               
way  to  increase  the  number   of  physicians  seeing  Medicare                                                               
SENATOR HUGGINS remarked that we  obviously need more physicians,                                                               
and we don't  need to require onerous things of  them, but on the                                                               
other hand,  if the state is  paying their way, they  could think                                                               
about  being more  open minded  about Medicare  and Medicaid  for                                                               
some period of time.                                                                                                            
MR. LUBY  said he would  check on the  status of that  issue with                                                               
the WWAMI staff.                                                                                                                
CHAIR ELTON said part of  that analysis should include whether it                                                               
would also  discourage physicians from  coming back the  state to                                                               
8:12:57 AM                                                                                                                    
SENATOR  OLSON   said  that  the  first   graduates  won't  start                                                               
practicing until 2019, and many people  now in need won't even be                                                               
around then.  He asked  how he thought  the number  of physicians                                                               
could be increased now.                                                                                                         
MR. LUBY answered that many  of their members are using community                                                               
health centers throughout  Alaska where they will see  you if you                                                               
simply  walk in  their  door.  Another idea  is  to  use a  nurse                                                               
practitioner  for  primary  care  and refer  to  a  physician  as                                                               
8:15:24 AM                                                                                                                    
SUZANNE  TRYCK,  Director  of Regional  Programs,  University  of                                                               
Washington-side  of the  Alaska-WWAMI  Partnership Program,  said                                                               
she doesn't  have a  definitive answer to  that question  now but                                                               
felt it  would be a disincentive  to physicians to return  to the                                                               
state. She could respond by the beginning of next week.                                                                         
8:16:32 AM                                                                                                                    
MS.   TRYCK  wanted   to  speak   to  the   issue  of   mid-level                                                               
practitioners   and    other   methods   available    to   expand                                                               
practitioners in the  state. Under the WWAMI  umbrella, she said,                                                               
both  universities  are  expanding their  physician's  assistants                                                               
program and  making it  more Alaskan by  doubling the  number. In                                                               
addition,  they   are  working  on  graduate   medical  education                                                               
residency  programs in  psychiatry and  pediatrics. All  of those                                                               
things will be necessary to resolve this problem.                                                                               
SENATOR  OLSON  asked how  many  members  are on  the  Admissions                                                               
Committee and where they are from.                                                                                              
8:18:20 AM                                                                                                                    
DENNIS  VALAENZENO,  faculty  member, UAA,  and  Director,  WWAMI                                                               
Biomedical program  at UAA,  said he is  also Associate  Dean for                                                               
Medical  and   Pre-Medical  programs.  He  said   the  Admissions                                                               
Committee  in  Alaska works  with  the  UW Admissions  Committee.                                                               
The committee  has four members  from the  different geographical                                                               
areas of Juneau,  Anchorage, and North Pole. Next  year they hope                                                               
to go  to five  members. Alaskan  applicants interview  either in                                                               
Anchorage or  Seattle, and  typically two  or three  students are                                                               
interviewed for each one admitted.                                                                                              
SENATOR OLSON asked the reasons  for adding another member to the                                                               
MR. VALAENZENO  explained that they started  having interviews at                                                               
UAA at the request of a  lot of residents. Anchorage doesn't have                                                               
a large  pool of interviewers  like Seattle does, so  having only                                                               
three  members  limited the  number  of  students that  could  be                                                               
interviewed in  Anchorage. That is  the reason for  expanding the                                                               
committee. They  also tend to  use an Alaska medical  student who                                                               
is rotating in their third or  fourth year in the Anchorage area,                                                               
and that practice is also followed for interviews in Seattle.                                                                   
SENATOR OLSON  assumed all  of the  committee members  are Alaska                                                               
MR. VALAENZENO answered yes.                                                                                                    
SENATOR  OLSON   asked  the  reason  for   holding  pre-admission                                                               
interviews in Seattle.                                                                                                          
MR. VALAENZENO replied that historically,  until they finally got                                                               
one of the two sessions held  in Anchorage, no interviews for any                                                               
of the  WWAMI participants  from any state  were held  outside of                                                               
SENATOR OLSON asked  if he would oppose having one  member of the                                                               
committee appointed by the Legislature.                                                                                         
8:21:34 AM                                                                                                                    
MR. VALAENZENO  answered that could be  an accreditation problem.                                                               
Medical  schools are  accredited  by a  national  agency and  the                                                               
members  of the  committee  have  to be  faculty  members at  the                                                               
SENATOR OLSON  recalled that other medical  schools have at-large                                                               
admission's members  that aren't even  in the health  care field,                                                               
let alone part of a faculty.                                                                                                    
MR. VALAENZENO  replied that they  could interview  students, but                                                               
can't vote as to who is admitted.                                                                                               
SENATOR OLSON  asked how many  members last year came  from rural                                                               
Alaska - cities of less than 10,000.                                                                                            
MR. VALAENZENO  said he didn't  have that  data in front  of him;                                                               
historically  they   tend  to   represent  the   distribution  of                                                               
population pretty well.                                                                                                         
SENATOR  OLSON  said when  he  looked  at last  year's  admission                                                               
numbers he did not see a good statewide distribution.                                                                           
MR. VALAENZENO  replied that  it varies from  year to  year. They                                                               
look over the historical admissions.                                                                                            
SENATOR OLSON asked how many residency graduates are in Alaska.                                                                 
MR. VALAENZENO  replied that the  residency program  places about                                                               
75 percent of its graduates in Alaska.                                                                                          
SENATOR OLSON said he was thinking about last year.                                                                             
MS. TRYCK answered that the  overall numbers went from 78 percent                                                               
to 81 percent, and she can  tell him where they are practicing by                                                               
location,  but  she  couldn't tell  him  the  difference  between                                                               
SENATOR OLSON asked how many of those went out to rural Alaska.                                                                 
8:24:40 AM                                                                                                                    
MS. TRYCK  replied that six  are in Bethel, three  in Dillingham,                                                               
one in Kotzebue,  one in Haines, one in Kodiak,  seven in Seward,                                                               
one in  Sitka, two in  Unalaska, one  in Wrangell, and  three are                                                               
travelling physicians.                                                                                                          
CHAIR  ELTON  thanked  them  for  their  testimony  and  restated                                                               
Senator Olson's  question about having  someone appointed  by the                                                               
Legislature and  about how many  interviewees were  accepted from                                                               
rural Alaska.                                                                                                                   
CHAIR ELTON  said they interview  two or three students  for each                                                               
one accepted  and asked if  that ratio  is because there  are not                                                               
enough  slots or  is  it  because of  the  qualifications of  the                                                               
people they are interviewing.                                                                                                   
MR. VALAENZENO replied  this is fairly typical  of medical school                                                               
admissions. In  order to  get the best  applicants, you  look for                                                               
people who  are not only  excellent as  far as grades,  but other                                                               
qualities that are  often revealed by the  interview. It's fairly                                                               
typical to  interview two  or three  per slot.  If they  had more                                                               
slots, more could be admitted.                                                                                                  
SENATOR  OLSON asked  Ms.  Purdue  if she  is  familiar with  the                                                               
Western  Interstate  Commission   for  Higher  Education  (WICHE)                                                               
8:27:55 AM                                                                                                                    
KAREN  PURDUE, Associate  Vice  President,  University of  Alaska                                                               
(UAA), answered yes, but Diane Barrans knows more about it.                                                                     
SENATOR OLSON asked if there  is anything going on to reinstitute                                                               
the WICHE program,  which he understands would  be less expensive                                                               
for a resident  of Alaska than for the state  to put more numbers                                                               
into the WWAMI program.                                                                                                         
MS. PURDUE replied that WICHE  is a professional student exchange                                                               
program, and  when the price  of oil  was down the  state stopped                                                               
paying to be a part of it. It's  a good program, but would cost a                                                               
lot of  money to get back  in. Their strategy is  to expand WWAMI                                                               
with  loan  repayment  incentives and  more  residency  programs.                                                               
They've done  only one thing so  far mentioned in the  task force                                                               
report and that is to double the WWAMI program.                                                                                 
SENATOR  OLSON asked  how she  thinks the  extra expense  for the                                                               
WWAMI program would  be affected by the lower price  of oil since                                                               
the WICHE program was deleted because of the low price of oil.                                                                  
8:31:55 AM                                                                                                                    
MS.  TRYCK replied  when the  oil prices  dropped last  time, the                                                               
idea they  had was to  start cutting seats, because  the contract                                                               
UW  has with  each state  under WICHE  is fairly  inelastic. Each                                                               
contract pays  the same  amount per student  leaving no  room for                                                               
negotiation except to add or cut seats.                                                                                         
MS.   PURDUE  added   that  UW   is  going   through  significant                                                               
downsizing,  but one  area  they are  not  downsizing is  medical                                                               
school  investment.  They  continue  to  take  a  lot  of  Alaska                                                               
students, but they also get pressure from every state to do so.                                                                 
MR.  VALAENZENO mentioned  that the  Physician Supply  Task Force                                                               
did look  at the  cost effectiveness  of the  WICHE vs  the WWAMI                                                               
programs. The  state participated  in WICHE  for 40-50  years and                                                               
ended in about  1995. The issue became that WICHE  had only an 18                                                               
percent return  rate. So while  the state  paid half as  much per                                                               
student for WICHE,  because so few of them came  back to practice                                                               
in the state, the WWAMI program was more effective.                                                                             
8:34:21 AM                                                                                                                    
SENATOR  OLSON asked  how his  clinical  staff would  be able  to                                                               
handle  the  increased  number  of  clerkships  giving  them  the                                                               
exposure that they need.                                                                                                        
MR.  VALAENZENO said  that  is  one of  the  major challenges  in                                                               
expanding the  class. They currently  offer about  130 clerkships                                                               
in Alaska  and that still needs  to be increased. And  while they                                                               
have  adequate  capacity now,  they  are  working with  hospitals                                                               
around  the  state and  physicians'  associations  to expand  the                                                               
opportunities  in  the future.  For  instance,  they have  a  new                                                               
family medicine  clerkship in Nome  and have started a  new rural                                                               
training experience in Juneau.                                                                                                  
SENATOR OLSON  said he  thinks the medical  staff with  the WWAMI                                                               
program has  done "an  exceptional job"  of using  the physicians                                                               
out there and recruiting.                                                                                                       
CHAIR  ELTON said  he would  hold this  bill since  this was  its                                                               
first  hearing, but  he would  reschedule it  in the  near future                                                               
when they  have an answer  to the Medicaid/Medicare  question. He                                                               
sees two big  issues: the number of doctors they  can get back to                                                               
practice   in  the   state  and   physician  access   surrounding                                                               
8:38:15 AM                                                                                                                    
MS. TRYCK commented that on  the issue of getting physicians back                                                               
to the state,  WWAMI is always trying to balance  how to keep the                                                               
physician  pipeline flowing  back  into  Alaska. UW/WWAMI  rarely                                                               
takes a  position on Alaskan  policy issues. However, there  is a                                                               
nationwide  and worldwide  physician shortage,  so anything  they                                                               
can do  to get  physicians will  be beneficial.  Currently Alaska                                                               
WWAMI  graduates graduate  with $117,000  - $138,000  of debt  in                                                               
addition to whatever  payback obligations they may  have. She has                                                               
heard  anecdotally  that  is  having  an  effect  on  the  people                                                               
applying to the  program. So, any requirement that  makes it less                                                               
attractive to come back to Alaska makes them concerned.                                                                         
8:40:15 AM                                                                                                                    
SENATOR  DAVIS followed  up saying  maybe they  should look  into                                                               
giving incentives  to those  who take  Medicare/Medicaid patients                                                               
rather than penalizing those that might  want to come back to the                                                               
state and  not take  on those  patients. She  asked, if  we bring                                                               
these additional slots on, how soon they would be filled.                                                                       
MS. TRYCK replied  that the effective date of SB  18 is July 2010                                                               
and the fall  of 2010 is probably the soonest  new students could                                                               
be taken.                                                                                                                       
SENATOR  OLSON remarked  that  the fiscal  note  says it  doesn't                                                               
start until FY 2012, which would mean July 1, 2011.                                                                             
DIANE   BARRANS,  Executive   Director,   Alaska  Commission   on                                                               
Postsecondary  Education,  Department   of  Education  and  Early                                                               
Development  (DEED),  replied the  reason  it  doesn't appear  in                                                               
their fiscal note  is because the state doesn't begin  to pay the                                                               
fee to UW School of Medicine until the second year.                                                                             
SENATOR OLSON asked who paid for the first year.                                                                                
MS. BARRANS replied  that they are embedded in the  first year of                                                               
the UAA programs and are covered within the UAA budget.                                                                         
SENATOR  OLSON  asked  if she  could  validate  Mr.  Valaenzeno's                                                               
numbers  that 18  percent of  the  WICHE graduates  come back  to                                                               
MS.  BARRANS confirmed  Mr. Valaenzeno's  numbers,  but she  said                                                               
there  was  no obligation  for  them  to return.  The  relatively                                                               
higher return  rate for  the WWAMI program  is attributed  to the                                                               
fact that  it is so  embedded in  Alaska. It is  Alaska's medical                                                               
school; training was  always done in Alaska as part  of the four-                                                               
year program. That has only  increased over time. But in addition                                                               
now they  require that individuals  who participate to  come back                                                               
or be  responsible for a substantial  portion of the cost  to the                                                               
SENATOR OLSON speculated that the  medical atmosphere has changed                                                               
from what it was 30 years ago, as well.                                                                                         
MS. BARRANS said she couldn't speak to that.                                                                                    
SENATOR  OLSON remarked  that from  a  practical standpoint  when                                                               
Barrow had two  doctors, they knew they were going  to be on call                                                               
every  other night,  and that  doesn't  look very  inviting to  a                                                               
person fresh out of medical school.  He asked how many states are                                                               
involved in the WICHE program.                                                                                                  
8:44:32 AM                                                                                                                    
MS. BARRANS replied that it is  a 14-state compact, and Alaska is                                                               
one  of the  states.  She  added in  reference  to the  incentive                                                               
Senator  Davis suggested  for individuals  who  are in  practices                                                               
with high  levels of service to  Medicaid/Medicare, one incentive                                                               
that  is  available  within  statute  would  be  to  shorten  the                                                               
required period of service similar  to the enhanced incentive for                                                               
rural practice as opposed to practice in urban communities.                                                                     
SENATOR  HUGGINS  said  he  was   interested  in  expanding  this                                                               
conversation to physician assistants  and nurse practitioners and                                                               
other  programs   that  may  help  solve   the  medical  practice                                                               
CHAIR ELTON  said he  appreciated the  wide discussion,  but when                                                               
the bill  is back  before the committee  the discussion  would be                                                               
narrowed to the issues directly affecting it.                                                                                   
MS. PURDUE  clarified that the  UA fiscal note  on SB 18  is zero                                                               
and  that they  could  accommodate the  four additional  students                                                               
without additional cost.                                                                                                        
SENATOR  OLSON  asked Senator  Wielechowski  if  he's gotten  any                                                               
feedback from physicians' organizations in the state.                                                                           
8:47:50 AM                                                                                                                    
MS. SYDEMAN replied that they have  had some response in terms of                                                               
conversations  with Alaska  State Medical  Association indicating                                                               
CHAIR ELTON held SB 18 in committee.                                                                                            

Document Name Date/Time Subjects
AARP lttr 2-26-09.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
ADN editorials.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
SB 18 Sponsor Statement.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
SB 18 supporting documents.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
SB018-UA-Anch-2-23-09 (2).pdf SEDC 2/27/2009 8:00:00 AM
SB 18
SB018-EED-ACPE-02-23-09.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
CSSB 18 version S.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
comparison SB 18 to work draft.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
WWAMI response 3-2-09.pdf SEDC 2/27/2009 8:00:00 AM
SB 18
AK Com. on Aging re SB 18.pdf SEDC 2/27/2009 8:00:00 AM
SB 18