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

Neeta (11/19/2015 at 12:05 PM)
Residency [INVALID]em is not a fair [INVALID]em in US.It depends on who you know and those contacts how much will they help you. The programs can take their contacts into the [INVALID]em but not the ones who are working hard,doing Research, obseverships and are US citizens.This country has made me an old graduate.I was an old graduate and was made another 7 years old. I have been trying for almost 7 years now in a row.I was not given a single chance not even for one year just because everyone was busy in giving Residencies to their near and dear ones and bringing them from their own countries rather than preferring us who are living here and are US citizens.I am on the verge of quitting now. Doing Research earing less but lost all hopes of getting a spot.I don't have anyone to recommend me. So inspite of that I strongly feel I can do it but I was not given a single chance in this country I am left and reduced to doing other petty jobs. Very shallow [INVALID]em here.Plus they demoralize us by saying that we cant do. If they wont let us do how can they know that we cant do.

Martin Masika (7/7/2015 at 12:10 PM)
This would be a timely intervention. I'm a medical doctor trained in Brooklyn courtesty of St. George's University which has produced hundreds of Medics in the USA. I was forced to pursue MBBS(British Bachelor of Medicine and Surgery after my MD degree because I couldn't find a residency spot. The Residency acceptance process is opaque and shrouded with conjecture. Many of the practicing doctors and residents will tell you that although some of us had a better transcript we were denied well deserved opportunities. They say its not based on your scores yet its a highly intellectual domain. With my new found ob/gyn and surgical skills the include c-sections, bone repair, chest-tube placement, bone biopsies, amputations, pelvic abcess drainage under anesthesia, etc etc your still regarded a less favorable candidate. Who you know really matters. But, with this opportunity we shall humbly avail our resumes and withstand scrutiny to prove we are well educated medics.

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.




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