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New Law Creates New Healthcare Provider: An Assistant Physician


A new Missouri law creates a licensed healthcare provider called an “assistant physician.” What this means for physicians and the healthcare system.

I get it. I really do. States and legislatures across the United States are desperately trying to fill the unmet need of patients and deal with the shortage of healthcare providers as previously uninsured Americans gain healthcare coverage. This has prompted to state legislatures everywhere to proactively and aggressively deal with the problems.

The most recent example occurred in Missouri. On July 10, Missouri Gov. Jay Nixon signed into law senate bills 716 and 754. These bills contain language calling on the Missouri Board of Healing Arts to license “assistant physicians,” who are medical school graduates who have not yet completed a residency.

In a previous blog post, I wrote about the waste of human resource that medical students who failed to match in their search for residencies represents. Training to become a physician is long and arduous. It represents a pre-med component, a graduate component, and a residency. This is a time-tested and honored method to prepare physicians for the rigors of the practice of medicine as licensed physicians.

Although shorter, the training for PAs is rigorous. It’s not that surprising, seeing as the PA education model is built on the medical school model. That’s why PAs practice medicine, and practice in every medical setting and specialty.

Yet, it looks like Missouri is trying to create a new medical provider instead of improving the ways that clinicians already in the state practice medicine.

The new law creates a licensed healthcare provider called an “assistant physician.” These assistant physicians would be medical school graduates who have failed to match in a residency. They would be required to “collaborate" with a licensed physician and would be allowed to prescribe and be called “doctor.”

Missouri has about 900 PAs, according to the American Academy of Physician Assistants (AAPA), a group that represents the more than 95,000 PAs in the U.S. (not to be confused with the new "assistant physician" license the legislation would create).

AAPA spokespeople have stated in several media interviews recently that the state would be better off by improving the ways PAs practice medicine rather than creating an untested, unproven medical workforce. It’s easy to see that Missouri could be in a better position to retain PAs educated in the state - and even attract those from outside the state - if the state continued to modernize outdated practice laws to allow PAs to practice to the fullest extent of their license and education. I can see that the regulatory and oversight requirements of this new license category are significant, and that doesn’t even account for other more practical issues such as reimbursement.

Why PAs? Because I know from experience that team-based medicine and teams of PAs and physicians is a great way to increase access to quality medicine.
AAPA has strong objections that are shared by the AMA and AAFP, among other groups.

One objection is the name of the new license, which sounds too much like physician assistant, and this could lead to patient confusion.

The AMA recently weighted in on the subject at its June 2014 House of Delegates with passage of the following resolution:

RESOLVED, That our American Medical Association oppose special licensing pathways for physicians who are not currently enrolled in an Accreditation Council for Graduate Medical Education or American Osteopathic Association training program, or have not completed at least one year of accredited post-graduate U.S. medical education.

Family physician Reid Blackwelder, then president of AAFP, weighed in on a blog post by stating, “I learned about a proposal in Missouri regarding so-called assistant physicians, who are not PAs but medical school graduates who have not completed residency training. Not only does this proposed measure create potential confusion because of the title of these would-be health care providers, it also would create significant challenges in terms of how unlicensed providers should be designated, regulated and utilized.”

So what is the solution here? I have worked in medically underserved populations virtually my entire career as a PA. I understand the challenges that face healthcare providers, healthcare systems, and the government in providing care to these special populations. We need more providers, that’s for certain, but we should rely on clinicians and healthcare teams that are already proven to be effective instead of creating new positions for an unproven workforce.

Improving PA practice laws is a good start.

In addition to committing resources towards expanding available residency slots in the United States physician training system, we also need to expand the pipeline for the training of PAs who can be fully trained and prepared for the practice of medicine in 27 months.

The situation that we face the United States in attempting to stretch inadequate healthcare resources to meet the ever-increasing demand for healthcare and our population is daunting. However, allowing these "assistant physicians" to skip what has been deemed to be vital steps in the training of licensed physicians in the United States is not the answer. If we have unmatched medical school graduates who are otherwise qualified to move on in their education, then we need to increase our resources toward expanding residency opportunities for these students.

This blog was provided in partnership with the American Academy of Physician Assistants.

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