The Alaska Medical Board has tabled a controversial set of regulations that critics say would have endangered health care in rural Alaska.
The regulations would have proposed steep barriers for physician assistants to work in rural communities, significantly increasing the additional training required and limiting the scope of their work. PAs are health care providers who can treat and diagnose a wide range of issues based on their training under a doctor’s or doctors’ direction.
PAs are particularly important in Alaska because they can work remotely, frequently making them the only health care provider in a rural community.
While PA groups had called for updated regulations, what was produced by the Alaska Medical Board came as a major surprise. Rather than streamlining and modernizing the regulations, they saw an effort to undercut the profession entirely. The proposed regulations were met with a backlash from the Alaska health care industry, which warned it would greatly undermine health care in rural communities.
Alaska Medical Board member Sarah Bigelow-Hood was the first member of the board to speak out against the regulations at Friday’s hearing. She recognized that some people on the board might not be familiar with PAs, but said the proposed regulations were disrespectful to the profession.
“The submitted comments clearly demonstrated that portions of the proposed changes belittled the value of PAs in Alaska. They will discourage PAs from applying for licensure and physicians from either entering into or even continuing with collaborative plans, reducing access to care,” she said. “These would set the PA profession back years without valid justification or need.”
Several other board members spoke out against the regulations, citing the pushback heard during public testimony. Most supported revisiting the regulations for further work.
“The public commentary was a nice gut-check on how impactful these proposed changes would be,” board member Dr. Matt Heilala said. “In spite of the deliberation we had undertaken prior, I think that public comment was a huge eye-opener.”
The major supporter of the regulations was Alaska Medical Board Chair Dr. Richard Wein. Wein argued that it seemed like PAs were pushing to be able to offer care without a doctor’s oversight and suggested that if that’s what they really want, then they should move in that direction. He suggested splitting off a board strictly to oversee physician assistants.
Wein pointed several times to pending legislation that would expand the powers of physician assistants, but that legislation has not yet cleared either legislative chamber. Such expansions have regularly been met with opposition from doctors.
Only Board Member Dr. David Wilson voiced support for the plan, with others calling the proposal to split off physician assistants into their own board a “nuclear option” that would require needless extra time and costs.
At one point, Wein argued that the health care industry is rapidly shifting and outside forces are already hampering people’s ability to make a living, citing online pharmacies hurting local pharmacists.
“How do you earn your living if all of these other sources are taking your basic ability to earn a living away from you?” he said. “You have the pharmacy benefit managers, who are killing the pharmacists. I think it’s relevant. I think there are a lot of issues that have to be addressed.”
That struck a nerve with Bigelow-Hood, who said she didn’t appreciate the PA profession being likened to outside competition online pharmacies or the suggestion that they are undermining doctors.
“Just so you understand, PAs are not here to take business away from MDs,” she said. “That’s why we work in collaboration. I’m sorry you feel that way, but that’s not our role.”
He said that’s not what he was trying to say, pivoting back to the threat from online pharmacies. Bigelow-Hood said it was irrelevant to the discussion at hand.
The discussion ended shortly after that, with Bigelow-Hood promptly making a motion to send the regulations back to the drawing table with a new working group to involve PAs in their drafting more closely.
The motion passed unanimously.
Matt Acuña Buxton is a long-time political reporter who has written for the Fairbanks Daily News-Miner and The Midnight Sun political blog. He also authors the daily politics newsletter, The Alaska Memo, and can frequently be found live-tweeting public meetings on Twitter.
