Missouri bill would create assistant doctors to boost rural care

Missouri may soon allow licensed medical school graduates to practice medicine and prescribe drugs without having completed a residency.

The proposal (PDF), which has passed the state Legislature and awaits the governor's signature, aims to address the issue of providing adequate healthcare in rural and other underserved areas of the state.

Under the bill, graduates of accredited medical schools could become “assistant physicians” and provide primary-care services in rural or medically underserved areas if they haven't completed residency training. However, they must have completed the first two steps of their medical licensing exam. A collaborating physician would be responsible for all services rendered by the assistant physician.

Under rules from the CMS, an assistant physician would also be considered a physician assistant.

Jeff Howell, director of government relations at the Missouri State Medical Association, who lobbied for the measure, said the policy is “another arrow in the quiver to help fight” physician shortages. The Association of American Medical Colleges estimates the country faces a shortage of more than 90,000 physicians by 2020 as demand of medical services outruns supply because of the aging baby boomer generation.

All states, including Missouri (PDF), require physicians and surgeons applying for a medical license to have at least one year of post-graduate training to become fully licensed and practice on their own, according to the American Medical Association. Residencies usually span three to seven years after students earn their doctorate of medicine degrees, depending on the specialty studied. Previously, it was common for newly graduated doctors to provide primary-care services as general practitioners after school.

Howell said the Missouri measure will benefit medical graduates who aren't immediately matched with a medical training position. Most students are placed with a residency—according to statistics from this year's Match Day, more than 94% of medical school seniors were matched with a program. The legislation would give those who aren't matched an opportunity to get paid and provide basic care until they reapply for a residency.

“Instead of twiddling their thumbs, it allows them to stay active and put what they learned in medical school out there,” Howell said.

Not everyone was supportive of the measure, however. The American Academy of Physician Assistants and the Missouri Academy of PAs have been among the most vocal critics of the bill. The groups argued that “the language has the potential to jeopardize PA practice and confuse patients, health systems and other providers,” according to an AAPA statement.

Kathy Pabst, executive director of the Missouri Academy of Family Physicians, said her group was “neutral on the legislation” and has not issued any opinion.

The bill requires signature from Gov. Jay Nixon, who has not publicly stated a position on it. A spokesman for Nixon's office said the bill is still under review, and the governor has until July 14 to sign or veto the bill.

Follow Bob Herman on Twitter: @MHbherman