JUNEAU — The Alaska Senate has passed a bill that would allow physician assistants with sufficient training to practice under an independent license, removing the state’s current requirement that they work under a formal collaborative agreement with physicians.

Supporters say the change would reduce administrative burdens that can delay and increase the cost of care. But physicians who opposed the bill argue it lowers the bar for training and could affect patient care.

Senate Bill 89, sponsored by Anchorage Democratic Sen. Löki Tobin, passed by a unanimous vote in the Senate on Wednesday, with 18 votes in favor and two members absent. The bill would allow physician assistants to apply for an independent license after completing 4,000 hours of postgraduate supervised clinical practice.

Under current law, physician assistants in Alaska must operate under a collaborative plan with physicians. These plans outline the medical services a physician assistant can provide and require oversight from doctors.

The Alaska State Medical Board regulates physician assistants and authorizes them to provide care only within the scope of their training. Most physician assistants in Alaska work in family practice, though some are specially trained in particular fields. All care must be provided under a physician’s license through a collaborative agreement that also requires a second, alternate physician to sign off.

For some clinics, particularly in more remote areas, finding those physicians can be difficult.

Mary Swain, CEO of Cama’i Community Health Center in Bristol Bay, testified in support of the bill before the Senate Labor and Commerce Committee in March 2025. Her practice employs two physicians to maintain collaborative plans for its physician assistants. She said neither of them lived in the community, and the primary physician lived out of state.

Roughly 15% of physicians who hold collaborative agreements with Alaska-based physician assistants do not live in the state, according to Tobin. At the same time, Alaskans face some of the highest health care costs in the nation.

Jared Wallace, a physician assistant in Kenai and owner of Odyssey Family Practice, testified in support of the bill at a committee meeting in April.

Wallace said maintaining collaborative agreements is one of the most difficult parts of running his clinic. He said he pays a collaborative physician about $2,000 per physician assistant per month, roughly $96,000 a year, simply to maintain the required agreement.

“In my experience, a collaborative plan does not improve nor ensure good patient care,” Wallace said. “Instead, it is a barrier in providing good health care in a rural community where access is limited, is a threat that delicately suspends my practice in place, and if severed, the 6,000 patients that I care for would lose access to (their) primary provider and become displaced.”

Opposition to the bill largely came from physicians, who testified that physician assistants do not receive the same depth of training as doctors.

Dr. Nicholas Cosentino, an internal medicine physician, testified in opposition to the bill last April. He said that medical school training provides crucial experience in diagnosing complex cases.

“It’s not infrequent that you get a patient that you’re not exactly sure you know what’s going on, and you have to fall back on your scientific background, the four years of medical school training, the countless hours of residency to come up with that differential, to think critically and come up with a plan for that patient,” Cosentino said. “I think the bill as stated, 4,000 hours, does not equate to that level of training.”

The Alaska Primary Care Association said it supports the intent of the bill but argued that physician assistants should complete 10,000 hours in a collaborative practice model with a physician before practicing independently.

Other states that have moved to allow independent licensure for physician assistants have adopted a range of thresholds. North Dakota requires 4,000 hours, while Montana requires 8,000 hours. Utah requires 10,000 hours of postgraduate supervised work, while Wyoming does not set a specific statewide minimum hour requirement.

Tobin said the hour requirement chosen in the bill came from conversations with experts during the bill’s drafting.

“When we were working with stakeholders on this piece of legislation, we came to a compromise of 4,000 hours, recognizing and understanding that there was concerns, but also … understanding that it is a bit of an arbitrary choice,” she said.

The bill now heads to House committees before a potential vote on the House floor.

Fairbanks, Alaska (KTUU/KTVF) – On Wednesday, Gov. Mike Dunleavy, Alaska Attorney General Stephen Cox and Lee Zeldin, the administrator for the Environmental Protection Agency (EPA), spoke to press at the University of Alaska Fairbanks power plant.

During their time at the university, the federal and state leaders spoke about developing resources such as coal, oil, gas and critical minerals in the 49th state.

During his 24-hour trip to Fairbanks, Zeldin said he has spoke to business and state leaders about environmental regulations impacting operations in Alaska, saying the EPA needs to consider whether regulations are solving problems or are solutions in search of a problem.

He also discussed the concept of “cooperative federalism,” where the EPA takes its cues from state leaders to determine where regulations and help are needed.

“We’re here at the University of Alaska’s coal plant, and the most modern coal plant in the United States of America,” Dunleavy said.

Zeldin said visiting Fairbanks in winter helps inform decisions the agency is considering.

“There are a lot of decisions right now in front of this agency that the first-hand perspective of being here on the ground helps inform our agency to make the right decision,” he said.

Zeldin also said the agency is hearing concerns from Alaska truckers about diesel exhaust rules in extreme cold.

“We then met with truckers who have been dealing with unique cold weather concerns with the implementation of EPA regulations related to diesel exhaust fluid system,” he said.

When asked about PFAS in drinking water, Zeldin said the EPA is not rolling back the standards.

“So the PFAS standards are not being rolled back at all,” he said.

On Fairbanks air quality and PM2.5 regulations, Zeldin said the agency wants to work with the state.

“We want, at the EPA, to help the Fairbanks community be able to be in attainment on PM 2.5. We want to make it work,” he said.

Dunleavy said energy costs and heating needs remain a major factor in Interior air quality discussions.

“People have to be able to live. They’ve got to be able to afford to live,” he said.

Zeldin said EPA is considering further changes to diesel regulations and urged Alaskans to participate in the rulemaking process.

“We need Alaskans to participate in that public comment period,” he said.

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This is the beginning of the Iditarod spring, signaled by the burst of sun and what used to be the long wait for dog teams to pass under the arch in Nome, the finish line a thousand miles away from Anchorage. For old-timers, it’s the story of the way Alaska used to be. What once was a 30-day wait has become about 10 days for winners to celebrate and the rest of us to shout, “Well done.”

My story is about family that welcomed immigrants from all over the world to be among the last groups of Indigenous people in the country, a life of taking good care of dog teams, and of parents who taught their children how to live in a wild, rugged frontier.

I came to be in a different age, a time of dog teams that ruled the trails to mining camps and where the salmon ran strongest — before the introduction of the snowmachine that revolutionized rural and Native Alaska.

For the Blatchford family, it is a recognition that some things will always stay the same and everything else changes. All four of my grandparents were noncitizens. My mother Lena’s parents of Elim were Alaska Natives, as was my dad Ernie’s mother, Mae, of Shishmaref. The name Blatchford comes from his father, the Englishman who was born in Cornwall and arrived in Nome during the gold rush. His brother, William, was one of the early immigrants, and by 1899 there was a creek just outside Nome named after him. He discovered gold. My grandfather, Percy, found gold, too, but it was a different kind of wealth, a finding that he had found home and never left.

I was born in Nome, delivered by an Iñupiaq Eskimo midwife in a one-room cabin where the frozen Bering Sea met the treeless tundra’s permafrost. Dad had a dog team. I like to think that the dogs were anxious for me to be born because it was hunting time for Dad to hitch them up and mush out to where the sea mammals, snowshoe hares, ptarmigan and other game thrived in the winter. My earliest memories are of dogs; all of them working as a team to bring home the game so we could have a fine meal cooked by Lena. In the Arctic, dogs were essential for family survival. If you didn’t hunt, you didn’t eat.

There are several memories that remain strong. I suppose I can call them lessons of the Arctic.

The first is to take care of the dogs and treat them well. Dog lovers all over the world know very well that a dog, whatever the breed, is loyal and will die to protect the one who feeds and pets it. If you don’t feed a husky, it won’t pull, and it could mean a long time before the family eats. When a dog team is hungry, it will race back home to be fed a healthy meal. Mother Lena must have been a great cook because Dad said the dog team always raced back to the edge of Nome, where Lena was waiting beside the propane stove. For Mike, Tom and me, our job was to take the rifle, shotgun and .22 into the cabin to be cleaned and oiled. Once that was quickly done, we unhitched the dogs and then fed the team.

All three of us boys had special responsibilities to Tim, Buttons and Girlie. Tim, the lead dog, was brother Mike’s pet; Tom had Buttons, and I had Girlie. We made sure they were healthy and well cared for. Dad would often comment that “Papa,” our grandfather Percy, the Englishman, took good care of his dog teams, being kind to the dogs and feeding them. Dad was the oldest of a large family that lived in Teller and later Nome.

“Papa” Percy was a prospector, fox farmer and a contestant in the All-Alaska Sweepstakes, the dog team race from Nome to the mining camp of Candle, a 400-mile race. He didn’t win, but he finished well, very well. The stories of the Sweepstakes have remained with the family for over a century. At a memorial service in Palmer for “Doc” Blatchford, Aunt Marge, without a question or a prompt, said that Papa took good care of his dogs.

Percy Blatchford was a legend in the Alaska Territory. As a teacher of Alaska newspapers, I would find headlines similar to one in the Fairbanks Daily News-Miner that blazed on the front page: “Blatchford Wins Solomon Derby.” There was even a story in The New York Times.

There’s probably no other sport in Alaska that brought Alaskans together like dog mushing. When old-timers would visit over strong coffee, dogs and dog team racing would come up. In the territory, there were few high schools and fewer gymnasiums, so the only team sport was dog mushing. It was something to talk about that was unique to Alaskans.

I used to travel in rural Alaska quite a bit. In the smaller communities, I would see the teams and would wonder how long they would power the engines that brought the mail and the foodstuffs down and up the trails. When I think of dog teaming, I think of the Iditarod and wonder, and then come to know, what the strength of the story would mean for bringing generations together from Papa Blatchford to his eldest son Ernie and to the fourth generation of Blatchfords in Alaska.

There are times when I think that old-time Alaska is gone. But then my faith and confidence in the old-time spirit are ignited when I see what others in the Lower 48 see. When I was walking in downtown Philadelphia, I looked up and saw on an ancient federal building a stamped concrete sculpture of a dog musher leaning into a blizzard. Such is the way I think of the Iditarod and the lessons I learned growing up with the dog team, preserved in my memories.

Edgar Blatchford is former mayor of Seward, Mile 0 of the Iditarod Trail.

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