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Medical school graduates could go directly to patient care in Missouri under proposal

Medical school graduates could go directly to patient care in Missouri under proposal


It could get easier to be a doctor in Missouri under a proposed law to add the classification of “assistant physician” to the state medical license.

Under the measure, an assistant physician would be a graduate of a four-year medical school program who has passed licensing exams but has not completed residency training. Residency programs are the three to seven years after medical school that doctors spend in primary and specialty clinical training.

Assistant physicians who are licensed by the state board of healing arts would be allowed to practice primary care and prescribe drugs in rural and underserved areas of the state. Their practice would be overseen by a physician who would be required to be on-site only for the first month.

The measure was approved by the Missouri Legislature. Gov. Jay Nixon has not said whether he will sign it.

“I question whether four years of medical school is enough to go out and take care of patients,” said Rosemary Gibson, a board member of the Accreditation Council for Graduate Medical Education. “People in rural and under-served areas deserve a fully trained, competent physician just like everyone else.”

The first two years of medical school are typically classroom-based. The third and fourth years include clinical work with patients under direct supervision.

Medical school seniors then apply for residency programs at teaching hospitals, and most of them find a match. Just 583 of the 17,374 seniors at U.S. medical schools graduated without a residency position this year, according to the National Resident Matching Program.

Jeffrey Howell of the Missouri State Medical Association said the number of potential new doctors in Missouri could be much higher when graduates of foreign medical schools are included. As the only state in the country with the assistant physician designation, Missouri could attract medical school graduates looking to start practicing medicine, he said.

“Missouri truly has an opportunity to be a trailblazer on this type of licensure and solving the health care access problem,” Howell said. “This is a brand new idea and something that we should take advantage of as a state.”

About 37 percent of Missouri residents live in rural counties, but only 18 percent of the state’s primary care doctors practice there, according to the state health department. Several programs through the state and the University of Missouri use student loan forgiveness and other incentives to encourage new doctors to open shop in rural areas.

Critics of the proposed law, including the Missouri Academy of Physician Assistants, have said the new classification will confuse patients and providers.

Physician assistants have bachelor’s degrees and an average of two years of additional clinical training. Advance practice nurses, including nurse practitioners, have graduate degrees in nursing. These midlevel providers have successfully pushed in recent years for greater autonomy in response to the doctor shortage. But unlike the assistant physician, they cannot be called “doctor.”

At Washington University, a handful of medical school graduates do not match with residency programs each year. Usually it is because they have limited their options for geographic or personal reasons. Those students often spend another year at the school in research and clinical settings before reapplying for a residency slot, said Dr. Kathryn Diemer, assistant dean for career counseling.

Diemer said she is concerned about the amount of education the assistant physicians would receive when practicing in rural areas. An internship — the first year of a doctor’s residency program — is a critical learning opportunity, she said.

“That was a year that I learned so much about decision-making and learning how to trust my judgment,” she said. “I’m not sure medical students after two years of clinical experience could be ready to be that independent.”

The proposed law is Missouri Senate Bill 716.

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