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.