ACGME Chief Sees 'Huge' Risk of Error in Proposed Assistant Physician Licensure

Cheryl Clark, for HealthLeaders Media , July 11, 2014

HLM: Will patients be harmed if this is implemented? What could go wrong?

Nasca: What couldn't go wrong?
These graduates' [who would be eligible for the assistant physician license] experience in general medicine is measured in months. During this time they never had authority or responsibility to care for patients on their own, and yet in Missouri, we would turn them loose in a place where there is no one available to them to tell them what's the right thing to do.

These are physicians with rudimentary experience. But in Missouri, they'd be turned loose to manage patients with complex diabetes, congestive heart failure, arrhythmias, [and] malignancies? This is nuts.

The risk of an error is huge. Even seemingly simple things can produce dramatically adverse outcomes in patients.  Drug interactions would be a primary example. They presumably would be practicing general medicine in pediatrics.
And to care for children and adults with chronic illness? Each of those is a unique specialty, and to expect someone to do that with no training at all, I think, [presents] safety issues to the public.

And there's another important issue. We in medicine and in society are trying to eradicate disparities in care. But this will serve to systematize disparities. These people will be practicing in these communities for generations. In reality, what we will have done is create a system that provides poorer quality care than we do for other areas.

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16 comments on "ACGME Chief Sees 'Huge' Risk of Error in Proposed Assistant Physician Licensure"

Tim Fontaine (12/3/2015 at 5:17 PM)
It is so obvious that the CEO is fear-mongering by stating that one of his concerns would be that Assistant Physicians/MD may make drug interaction mistakes...REALLY? What the general public does not know is that all doctors either use medication interaction apps on their laptop or phones, or consult a hard text reference source in order to not make these mistakes. Trained pharmacists are the only professionals I have ever spoken with that know most of the drug interactions per rote memory. Moreover, most hospitals/clinics are on or will be going to EMR/EHR [INVALID]ems - they have built-in drug interaction settings which automatically alert you if a dangerous interaction could occur. The CEO is creating a paper tiger. If you look at what the CEO and the ACGME has to lose when MO starts licensing APs and other states start following suite, then you will see why he states what he does. Thanks, Tim F.,MD,MPH,CT(ASCP)

dana (12/9/2014 at 7:09 PM)
I live in USA from 10 years,I'm an US citizen,,,I have passed all USMLE steps but couldn't get a residency spot. I don't have a job ,I'm a saty at home mom.I was a reputable physician in Europe but I cannot use my knowledge to help American people,Very sad!!!!!

Andrews C Ninan, MD, MS, FRCS (12/7/2014 at 2:12 PM)
There is yet another side of this equation. There are legal citizens in this country, people who have been qualified and worked abroad (U.K. and India) after doing their residency abroad in specialities (for over 20 years in both countries) but not had the chance to be included into any residency programs in this country due to being "overqualified". These people, like myself, are wasting their time when their knowledge could be utilised without any fear of not having had any supervised training in this country.




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