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Doctor Shortage 'Fix' Is a Disaster Waiting to Happen

Cheryl Clark, for HealthLeaders Media, July 10, 2014

New legislation in Missouri will create a new class of medical license, the "assistant physician." Critics say it will establish a reprehensible dual standard of care, one for the rural and underserved and another for everyone else.

Update: The bill was signed into law on July 10.

From Missouri's Ozark Mountains to its northern plains, a healthcare drama is quietly underway. And it is sure to be the House of Medicine's ruin.

Or its salvation.


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


It depends who's talking, but I think it's going to be a national disaster because of the dangerous precedent it sets.

Legislation sitting on Missouri Gov. Jay Nixon's desk will, if he signs it by July 14, empower Missouri's medical board to create a new category of doctor's license, "the assistant physician."

This new type of certificate would be handed out to medical school graduates who didn't get into a residency program and who passed Step 1 and 2 exams, but not the most important one, Step 3.

With minimal prior exposure to patients, these young doctors would be licensed to practice just like regular doctors, as long as they only treated patients in the most physician-starved poor and rural areas throughout the state.

This licensing lunacy would allow unqualified clinicians to misdiagnose, misprescribe, and bungle treatments inevitably leading to patient harms too numerous to detail.

The bill's antagonists, and there are many including the American Medical Association's House of Delegates, fear the "Show Me" state will have a reprehensible dual standard of medical care, one for the rural poor and one for everyone else.

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25 comments on "Doc Shortage 'Fix' Is a Disaster Waiting to Happen"


Mike (7/30/2014 at 2:49 AM)
Anne Walsh's "There is a reason your "assistant physicians" can't pass their boards (Step 3) or get into a residency program (many spots in primary care go unfilled each year, and still, programs would leave them unfilled and lose federal money rather than accept these marginal applicants???)" comment is completely false. Medical graduates are not required to take step 3 of their boards until after their first year of residency training. Many medical school graduates HAVE passed step 3 of the U.S. licensing exam are still unable to obtain a residency position. There were 40,000+ applicants last year for 29,000 first AND second year residency positions. These applicants passed all required exams. A limited number of residency positions go unfilled because many positions can go to different departments. For example many preliminary surgery positions go unfilled each year and are converted to obstetrics or internal medicine residencies. Currently, Physician Assistants are not required to attend any type of residency training. If Physician Assistant's were required to complete a mandatory residency with 20,000 qualified applicants and 15,000 applicants each year, I think nurse Walsh would rethink her negative comments regarding graduate doctors. Implying that any 4-6 year medical school graduate who has passed all 3 required exams to attend residency training (USMLE step 1, step 2 clinical knowledge, and step 2 clinical skills) is substandard to a Physician Assistant who receives 2 years total of training and passed only 1 exam is just silly.

Amy (7/29/2014 at 3:36 PM)
I think it is a great idea as there are competant,intelligent doctors who miss out getting into residency.Off course some are not[INVALID]-but in the residency program too some are not to the par and get in. I think medical students are very smart and study hard and it is un fortunate dont get into Residenct

Anne Walsh, MMSc, PA-C, DFAAPA (7/27/2014 at 5:40 PM)
To Eugene, who knows "for a fact that they can diagnose way better than a PA or a NP" - you apparently don't read enough healthcare research (or even just browse any of the dozens of daily-weekly-monthly [INVALID]s from a variety of professional medical organizations) to know that your anecdotal statement has no basis in fact, MOST ESPECIALLY in primary care and in chronic disease mgt. PAs and NPs, state licensed and nationally certified, have long provided high quality medical care that is at minimum equivalent to, and often, superior to, that of physicians, usually at lower cost; this statement is backed by extensive research over the 50+ years of our professions' existence. There is a reason your "assistant physicians" can't pass their boards (Step 3) or get into a residency program (many spots in primary care go unfilled each year, and still, programs would leave them unfilled and lose federal money rather than accept these marginal applicants???). Shame on you for supporting any legislation that perpetuates healthcare disparities, only serving to KEEP the medically disadvantaged, disadvantaged! The solution to Missouri's problem is simple: adopt the same practice laws for PAs and NPs found in other states, where we are able to actually do the job for which we are trained. The PA profession was created BY PHYSICIANS in the late 1960's specifically to address the primary care physician shortage by teaming us up WITH a physician. We actually do a great job when allowed to do so; the vast majority of my patients (in 15 years of practice) prefer to see me for their visits, rather than my excellent supervising MDs, even when I insist they schedule with the MD because of complicated issues. Why? My superb medical training and clinical experience (which by the way tells me there is a whole lot more to quality medical care than "diagnosis"). In fact, the "diagnosis" can often be made by the patient herself searching the internet; oh, that medicine, particularly primary care, were as simple as "diagnosis." I am a Family Medicine PA and a medical school faculty member in California, a state that well-knows how to effectively use PAs and NPs in their abundant healthcare shortage areas. I was born, raised, and college-educated in Missouri, and my entire family still lives there - some in rural areas. This new law makes me embarrassed for and ashamed of my home state, and scared to see what the healthcare future holds for disadvantaged Missourians...God help them all.