Senate committee hears competing views on pathway to independent licensure for physician assistants

Senate Labor and Commerce Committee members on April 16 heard testimony for and against Senate Bill 89, a measure that would establish a formal pathway to independent licensure for physician assistants in Alaska.

Sponsor Lukey Gail Tobin, senator for Senate District I, summarized the bill and said it is intended to “reduce administrative burdens and modernize our statutes pertaining to the physician assistant medical practice.” Tobin told the committee the proposal would require education, licensure, exams and an attestation of at least 4,000 postgraduate clinical hours before a PA could pursue independent licensure; combined with standard educational clinical rotations, the sponsor said that would total about 6,000 clinical hours before seeking independent licensure.

The measure, Tobin said, preserves oversight by the Alaska State Medical Board: the bill delegates detailed requirements for collaborative plans, specialty transitions and quality assurance to board regulation rather than statute. “The state medical board has significant expertise and also a very robust regulatory process that we want to ensure is where some of this more prescriptive detail sits,” Tobin said.

Nut graf: Backers argue SB 89 is a practical response to persistent provider shortages in rural and remote communities, while physician groups and some doctors say the proposal shortchanges training and patient safety. Committee members heard dozens of personal accounts from PAs, physicians and professional organizations during a two-hour public testimony period.

Several PAs and employers described operational problems under Alaska’s current collaborative agreement model. Candace Hickle, a PA with 17 years of experience, said collaborative agreements can leave communities without care when a collaborating physician departs. “Collaborative agreements with the state are unnecessary and antiquated administrative burden,” Hickle told the committee, arguing independent licensure would reduce service interruptions in remote areas. Darren Wallace, a PA who owns Odyssey Family Practice on the Kenai Peninsula, said recruiting collaborating physicians has become harder and noted an example fee: he described paying about $96,000 over a year to maintain a collaborative arrangement for multiple PAs.

Supporters also pointed to national research summarized by testifiers showing comparable patient outcomes and cost measures for PA-delivered care. Carrie Bernard, a doctoral-trained PA who has practiced in Alaska for 21 years, told the committee that published studies find PA outcomes similar to or better than physicians in certain measures and said independent licensure would expand access without increasing cost.

Opponents said the bill’s 4,000‑hour postgraduate requirement is insufficient compared with physician training and with some other states’ approaches. Dr. Molly Southworth, a physician and medical educator of 40 years, testified in opposition and urged a more coordinated plan to make primary care an attractive career rather than quickening independent licensure. “They have not been trained for independent practice, nor has the safety of independent practice been demonstrated,” Southworth said. Other physician witnesses, including representatives of the Alaska Academy of Family Physicians, recommended higher supervised‑practice thresholds and structured team‑based requirements if any path to independence is adopted.

Committee members questioned specifics of oversight and the practical effect of proposed regulatory delegations. Staff and witnesses described existing regulatory details: a collaborative plan must be in writing and on file with the medical board, and current board policies require methods for communication and at least two days of direct personal contact per quarter for review and quality assurance in collaborative arrangements. Mackenzie Pope, staff to Senator Tobin, said many detailed standards are in regulation and that the bill intentionally keeps those technical requirements with the medical board so they can be updated as practice evolves.

Sullivan Raab, director of the Division of Corporations, Business and Professional Licensing (CBPL), told the committee the division screens license applications and forwards completed files to the board; the division submitted a zero fiscal note for the bill and does not anticipate a large change in workload. Raab said, however, that removal of some collaborative paperwork could reduce the division’s administrative follow-up over time.

The committee did not take a vote. Sponsor Tobin said the bill has been amended through stakeholder input and caucused language reflects compromise; the committee ultimately set SB 89 aside for further consideration at an upcoming meeting.

Ending: The committee will hold further work sessions and invited testimony on SB 89; no date for action was set on April 16.