Monday, February 16, 2015

“Assistant Physicians,” Solution to Physician Shortage, or Recipe for Disaster?

It is well known that there is a shortage of primary care physicians throughout the country, which will continue to worsen as more people are becoming insured under the Affordable Care Act. Missouri has passed a law that creates “Assistant Physicians” to help cure the shortage problem. This law will allow graduates of medical school who have passed USMLE Step 1 and 2 (but not Step 3), but who have not completed internship or residency, to practice medicine in rural or underserved areas of Missouri. They will be allowed to prescribe Schedule III, IV, and V drugs. These physicians will initially be supervised by a fully licensed physician for 30 days, and then will be free to practice medicine in those specified areas. The licensed physician will be responsible for the activities of the Assistant Physician under a collaborative practice arrangement. So far, no Assistant Physicians have been licensed. The Board still has to establish more specific rules with regards to the licensure. They anticipate the licensure to begin in the summer or fall of this year.

I have many concerns about this law.

 • Risk to Patients: people in these rural/underserved areas will be treated by physicians with minimal clinical training and will be doing so with no direct supervision.
 • Risk to Assistant Physician: This law seems to place the Assistant Physician at a huge liability risk. What standard of care will apply to them in malpractice law suits? Will they be able to obtain malpractice insurance?
• Risk to the Licensed Physician engaged in the collaborative practice arrangement: How can you hold the Licensed Physician responsible for all the activities of the Assistant Physician when they may not be supervising them face to face?
 • Confusion: will patients understand the difference between the Assistant Physician, Physician and Physician Assistant?
 • Standard of care
           o Are we creating different standards of care for those who live in rural/underserved areas, vs. everyone else?
           o Are we creating different standards of care for different states? These physicians will not be able to obtain a license in other states, so are we lowering the standard of care of underserved patients in Missouri?

 I am a licensed physician that completed at three year residency program in Emergency Medicine. Although residency was no doubt one of the most difficult times of my life, I could not imagine practicing medicine, unsupervised, without actually training in a residency program. I believe that residency training is crucial to becoming a licensed physician. I truly understand the need for more primary care physicians; however I feel there are safer ways to do this. How about create more residency spots so these same graduates can obtain the proper training to practice medicine?

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