Skip to main content
Sister Publication Links
  • ESG: THE IMPLEMENTATION IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Digital Health
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Unwell in America
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
December 13, 2015 12:00 AM

Skip residency? State efforts to ease doctor shortage face criticism

Associated Press
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    A new Missouri law offered a first-of-its-kind solution to the physician shortage plaguing thousands of U.S. communities: Medical school graduates could start treating patients immediately, without wading through years of traditional residency programs.

    Following Missouri's lead, similar measures were enacted in Arkansas and Kansas and considered in Oklahoma. The idea appeared to be a new model for delivering medical care in regions with too few physicians to meet needs.

    Yet more than 18 months after that first law passed, Missouri regulators are still trying to make it work. And not a single new doctor has gone into practice in any of the three states as a result of the new laws.

    "You've got the need for services on one hand, and you've got a group of people that are capable of providing those services. But we're not making it happen," said Dr. Keith Frederick, an orthopedic surgeon and Missouri House member who is frustrated by the delays in implementing the legislation he sponsored.

    The measure is opposed by some of the nation's most influential medical organizations, including the American Medical Association, which stands against any proposal that allows doctors to gain special licensing without completing a residency program.

    Instead, the AMA wants more government funding to increase the number of available residency positions, something that has proved difficult to pass in Congress.

    The Missouri law also is opposed by the Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medicine. They say medical school is not intended to prepare physicians to go directly into practice but to lay a foundation for clinical residency training.

    Even some rural physicians, who could potentially benefit from the help, don't like the Missouri law.

    Dr. Tammy Hart is the only physician in Missouri's Mercer Country along the Iowa border. She opens her office at 7 a.m. to walk-in patients with urgent needs and often ends up working on days off. But Hart views the new Missouri law as "a very poor answer" to the physician shortage.

    "By no means are you ready to assume being a physician when you graduate from medical school," she said.

    The law is an attempt to address the fact that there are more than 6,200 places nationwide with a shortage of primary-care physicians, ranging from urban neighborhoods to entire rural counties, according to statistics from the U.S. Department of Health and Human Services.

    Universities have been launching new medical programs and expanding student enrollment in an attempt to meet an even larger projected doctor shortage caused by retirements and an increased demand for physicians under President Barack Obama's health insurance overhaul and state Medicaid expansions. Total U.S. medical school enrollment approached 110,000 this past year, up almost one-third over a decade ago.

    Residency programs, which provide an additional three to six years of post-graduate training needed for physicians to be certified, have also grown but have failed to keep up with demand.

    When foreign medical school graduates are added to the mix of U.S. students, more than 8,600 applicants were denied residency positions this year through the nation's main matching service. That's an increase of more than 50 percent from 2005.

    That bottleneck is due partly to a 1997 federal law that limits the growth in federal Medicare funding for residency programs.

    States have taken a number of steps to get more medical professionals in the field. Some have allowed specially trained nurses, physician assistants and pharmacists to assume greater roles. Others have kicked in state money to expand residency positions.

    The Missouri law creates a license for an "assistant physician," defined as someone who graduated from medical school within the past three years and passed the first two rounds of licensing exams within the last two years, but who has not completed a residency program.

    The law allows them to provide primary care services in "medically underserved" areas as long as they are supervised by another physician. They can work as an "assistant physician" indefinitely, essentially sidestepping the residency requirements.

    Once the program is operating, supporters expect it to serve as a prototype that will spread beyond the Midwest.

    "It kind of allows us to be a trailblazer on the issue," said Jeff Howell, the government relations director for the Missouri State Medical Association.

    But Missouri's new rules may not take effect until fall 2016, and supporters of the law are growing frustrated with each passing month that it remains in limbo.

    It's also frustrating to some medical school graduates. Sara Bubenik said she graduated two years ago from medical school at Oregon Health & Science University with about $350,000 in loans but had to retake the licensing exams several times before passing and has subsequently been unable to get a residency position. Although the Missouri law could offer her another route, the implementation delays mean she could soon be disqualified by the law's time limits on testing and graduation.

    "It's heartbreaking for me, because I'm not going to be able to be a physician," Bubenik said in a telephone interview from New York, where she now is pursuing a master's degree in public health. "It's also really disappointing that I owe so much money and will never get to pay it back. I'm bound for the cycle of poverty."

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    373837936 (1).jpg
    New guidelines aim to limit trans healthcare at Catholic hospitals
    InDepth: Private Equity
    Legal questions surround private equity-backed Noble Health
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare A.M. Newsletter: Sign up to receive a comprehensive weekday morning newsletter designed for busy healthcare executives who need the latest and most important healthcare news and analysis.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Digital Health
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Unwell in America
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing