A Concise Guide to Mastering the Medical School Interview

If you or someone you know is applying to medical school, please check out "A Concise Guide to Mastering the Medical School Interview," written by myself. It is a book with many tips for the interview process as well as practice interview questions. The book is available at Amazon.com. http://www.amazon.com/Concise-Mastering-Medical-School-Interview-ebook/dp/B00X1YKDXQ/ref=dp_kinw_strp_1

Protecting Good Physicians

http://journals.lww.com/em-news/Fulltext/2015/09000/Viewpoint__Protecting_Good_Physicians.18.aspx

“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?

SB 716, Modifies Provisions Relating to Public Health http://www.senate.mo.gov/14info/BTS_Web/Bill.aspx?SessionType=R&BillID=28296866

Defying the AMA, Some Politicians Lower Standards for Practicing Medicine http://www.forbes.com/sites/leahbinder/2014/07/22/defying-the-ama-some-politicians-lower-standards-for-practicing-medicine/

Doctor Shortage Fix is a Disaster Waiting to Happen

http://www.healthleadersmedia.com/page-1/QUA-306258/Doctor-Shortage-Fix-Is-a-Disaster-Waiting-to-Happen

Top Health Law Questions

What are some of the top Health Law and Policy questions you would like answered? Please comment in the comment section below.

Negligent Referral

Did you know that physicians can be sued under the theory of negligent referral? If the referring physician knew or should have known that the specialist would act below the standard of care, he can be liable for negligence. The plaintiff has the burden of proof in this particular situation. In one particular case, the court stated that the referring physician must be diligent and as a gatekeeper for referrals. 

Physicians can also be held liable for referring the patient to the wrong type of specialist, for example, if you refer a patient to a Neurologist, when they really need to see a Neurosurgeon. 

What is the best way to avoid getting sued under this doctrine? When referring a patient to a specialist, unless you know of the specialist qualifications and a reasonable physician would also refer the same specialist, it is probably best to tell he patient what type of specialist they need and let them research and find a specialist they would like to see within their health plan. 

American Association for Justice. Negligent referral is a valid claim, court says. The Free Library. June 1, 1999. http://www.thefreelibrary.com/Negligent+referral+is+a+valid+claim,+court+says.-a054939489

Crane, M. Legal Pitfalls when you Refer Patients. Medscape. August 21, 2014. http://www.medscape.com/viewarticle/828402

Medical Liability Risks Associated with Communicating with Patients "Virtually"

With the increased use of technology in medicine, some physicians have started to interact with patients via this method. Some interact with well-established patients, other with new patients they have never met before. Some interact via email, telemedicine, or videoconferencing. This use is sure to increase exponentially over the next few years. Since this is a relatively new method of communicating with patients, the medical-legal landscape is unknown. 

On one hand, some argue that you cannot have a good physical exam and evaluation of a patient without actually having the opportunity to touch and examine the patient in person and that without doing so, you are providing substandard care. On the other hand, some argue that this is a very efficient way to see low acuity patients, and if they need more examination or care, they can always make an appointment to visit the physician in person, or be directed to go to the emergency room or call 911 if deemed necessary. 

According to a recent article, the number of “remote patient visits” is still very low when compared to actual in person visits, therefore there are a low incidence of malpractice claims to date. Malpractice insurance does cover telemedicine and it seems to have been accepted as the standard of care in medicine in appropriate situations. Most of the virtual networks will also limit their liability; again, by only seeing minor, low-acuity patients, that will again, limit their liability and risk. 

Another concern is with physicians that communicate with patients in other states. Every state has different rules for online consultations or telemedicine, most will likely require some type of licensure in that state in order to legally conduct this service. 

This topic has been of great interest to me over the years (and the topic of my Masters in Health Law Thesis and subsequent publication). My advice; first, for physicians that are contemplating beginning online medical consultations or telemedicine, they should first contact their current malpractice insurance carrier to determine if this service would be covered under their policy. Second, if attempting to practice in multiple states, physicians should contact those states medical licensing boards to determine their telemedicine requirements. Third, notify your insurer if your plan to practice in multiple states. 

Overall this appears to be an efficient method of seeing low acuity patients. I will be keeping a close eye on the developments in this area. 

Bailey, R. The Legal, Financial, and Ethical Implications of Online Medical Consultations. 16 J. Tech. L. & Pol’y 53 (2011).

Chesanow , N. Do Virtual Patient Visits Increase Your Risk of Being Sued? Medscape; October 22, 2014 http://www.medscape.com/viewarticle/833254?src=wnl_edit_tpal&uac=184121PG 

Sensitivity to Medical Malpractice and Defensive Medicine

This is a link to an article I wrote reviewing whether physicians that are more sensitive to malpractice are more likely to turn to defensive medicine: http://www.policyprescriptions.org/sensitivity-to-malpractice/