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

Cheryl Clark, for HealthLeaders Media, July 11, 2014

HLM: But we value foreign medical school education do we not?

Nasca: The assumption that medical school education is the same outside the United States as inside the United States has not been proven.

HLM: Why don't we have more U.S. residency slots?

Nasca: They're supported by and large by federal funding of residency positions, the number of which has been capped at 1998 levels.  The number of slots has gone up slightly because hospitals will fund those internally, but it hasn’t gone up dramatically.

The response from the state of Missouri, if it has an inadequate number of formally trained physicians, should be to create more graduate medical education programs. 

Missouri is just looking for a way out. A better example is Utah, which has the same shortage problem. But Utah has decided to fund residency programs independent of federal money. And they're now producing more doctors to serve their state.

I'm not minimizing the challenge of getting medical care to rural populations. But I think the state has responsibility to do things correctly.

Efforts to Bolster Rural Primary Care Residencies Fall Short

HLM: These assistant physicians would be supervised by a collaborative physician on site for 30 days. After that, the assistant physician could practice within 50 miles of his or her collaborating physician. What's wrong with that?

Nasca: Think about that, they're 50 miles away.  Who's supervising what they're doing? That level of supervision would not be permitted for any resident even up to seven years into a residency training program. Yet we would allow individuals with no training to have that degree of distant supervision? That's not just no oversight, it's inadequate in the extreme.

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

CJI (8/8/2014 at 1:04 PM)
How would the capabilities of these assistant physicians be different than that of general medical officers in the US military who are without specialty training, yet providing preventative and primary care to service men and women?

Lammy (7/16/2014 at 10:24 AM)
Finally people are starting to realize that there is an agenda being propagated by the NRMP, ERAS, AMA, and ACGME, which the CEO of the ACGME himself, has admitted too. That agenda being, to keep certain cohorts of medical school graduates (i.e. USFMG) from obtaining residencies. He should be ashamed of himself as he boldly makes admission to his agenda. These doctors have spent just as much time, effort, and energy as anyone else in studying medicine to help people. And not all graduates of Caribbean medical schools are the result of lack of admission into a US medical school. I never even tried to gain admission into a US medical school. My studies in medicine took me to the UK and eventually to the Caribbean. Incidentally, what difference does it make? Medicine is medicine is medicine irrespective of where you trained. Apparently so, because the US government financed my education. If my training is good enough to obtain US student loans for the training, then who is the CEO of ACGME to turn around and develop an agenda to block me, or anyone else indebted to the US government from completing a medical residency in the US? And to use the US citizen taxpaying dollar to do it? It's not like it's HIS MONEY. Talk about the MAN holding you down (LOL)!!! And for all the NP's and PA's getting on here boasting their 100 years of experience, etc...yeah right. It is unbelievable how as a group you can get on here and try to raise alarm to the opportunity for a PHYSICIAN to assume the duties and responsibilities for which they were trained. Your argument is as logical as a brown paper bag. It is very unprofessional to lament regarding the possibility of a PHYSICIAN entering the workforce and making a contribution to improving healthcare quality and access. Now...Step Aside!!!

Dave (7/14/2014 at 8:04 PM)
Not to stir the pot between MLPs and physicians, but some of the comments made seem based more on emotion and concern for territorial encroachment than for the improvement of access to healthcare for our patients. It may be surprising to some, but there might also be some physicians out there (recent medical school graduates) who would prefer this route versus completing a full residency program. They would do so knowing that they would be under the supervision of a board-certified physician, just as an NP or PA. Regarding the level of education required to practice in such an environment, it would seem to me that, statistically, a graduating medical student already has many more hours training in the pathophysiology of disease and it's management by the end of four years of medical school versus that required of an NP or PA (correct me if I'm wrong). The difference being that the expectation is they will continue on their education far beyond this during residency, continuing to rack up more hours. Experience beats nothing, but if an NP or PA can serve in the role described in the article, it is astounding to think that anyone would see this as potentially hazardous to patient care, unless they too want to apply this to how NPs and PAs practice medicine. This aside, maybe what we should be focusing on is how this could be beneficial to an already growing problem of access to care. PAs and NPs do a wonderful job of recognizing basic primacy care issues and making appropriate referrals when necessary. Increasing the pool of providers capable of performing the aforementioned task at a reduced cost to the system would decompress this issue some, as well as allowing medical students seeking an alternative career to a full residency to contribute to the cause. Beyond this, with an increasing number of medical student spots without an increased appropriation of residency positions, a bottleneck has been created. How do you think we can manage to afford these individuals who have incurred a ton of debt to utilize their degree in a compassionate way without having to find another job? I proposed this to mid-level provider recently, who promptly informed me that they would have to go back to school to become an NP or PA - wait, what? Seriously? This is an inherent issue with some of the commenter arguments made, and truly shows how much more motivated the counterarguments are by concern for this becoming more systemic and encroaching on their job market than it is for patient care and concern for those seeking out healthcare careers (all, of which, are tasking in their own right). What I would rather see is this concept becoming more systemic, allowing for alternative careers to graduating medical students as well as contributing to the problem facing the US regarding access to patient care. The military already does this with general medical officers and it has been successful. Most general medical officers are assigned to primary care billets after an internship and practice in the manner touched on by the article, often in austere environments, and do so hand in hand with their PA colleagues. For what it's worth, it seems to have worked well enough. If anything, maybe this is what the system has been waiting for - recognition of the amount of time and effort it takes to become a graduate medical student and the knowledge that comes along with it. If all they are asking for is an alternative career option, likely with similar pay, hours, compensation, and expectations in how one practices, this needs more attention and to come to fruition nationally.