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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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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