To address clinical staffing shortages in underserved areas, some states are licensing assistant or associate physicians, who have graduated medical school but not completed a residency. But some medical organizations argue these individuals lack the necessary training to perform the duties of regular physicians, Mari Devereaux writes for Modern Healthcare.
In 2014, Missouri became the first state to create a licensed role for assistant physicians. To become an assistant physician, an individual is required to have graduated from a recognized medical school, passed the first two steps of the U.S. Medical Licensing Exam, and not matched with or completed a residency program. Since then, four other states—Arkansas, Arizona, Kansas, and Utah—have established similar programs.
According to Keith Frederick, a former member of the Missouri House of Representatives, having medical school graduates who did not match with residencies work in underserved areas allowed the state to "take an available resource and apply it to a real need."
Frederick also noted that the assistant physician role allows individuals who did not match with residencies to earn money to pay back their student loans. "If you have that amount of debt, and you can't continue training, it's kind of like having a mortgage but no house and no job," he said.
After becoming licensed, assistant physicians are required to undergo a month of clinical training before working with a supervising physician under a collaborative practice agreement. Assistant physicians typically perform the same duties as NPs and PAs, including performing patient exams, assisting with surgical procedures, and prescribing medications.
"I perceive it as becoming a professional in the business, and the only way to really learn is to do it," said Trevor Cook, who received his assistant physician license in 2018. Currently, Cook works in urgent care and has many of the same responsibilities as a physician, such as treating and diagnosing conditions and referring patients to specialists.
However, because assistant physicians are required to work in underserved areas, there is concern about their potential impact on health equity. While some view the creation of assistant physicians as a way to expand access to care, Patricia Pittman, director of the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University, says, "There's some concern that they're going to create a kind of second-class physician that is for people who are already socially and economically disadvantaged. Essentially, rich people see physicians and less rich people see those who were not able to become physicians, which is a bit problematic from an equity perspective."
According to Doug Olson, president of the board of directors at the Association of Clinicians for the Underserved, treating patients in areas that lack care often requires more clinical experience rather than less.
Amanda Pears Kelly, executive director for the Association of Clinicians for the Underserved, says increased funding and creating partnerships between stakeholders and teaching health centers to bring more clinicians to these areas would be better ways to increase access to care.
So far, several medical organizations, such as the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC), have pushed back against the assistant physician role, arguing that these individuals do not have the same qualifications and training as those who have completed their residencies.
"We are very much in favor of our trainees following the traditional accepted path to full licensure," said Alison Whelan, chief academic officer at AAMC. "It dictates by specialty the type of learning and clinical experience that the resident must have to be an effective independent practitioner."
According to Whelan, having a medical degree does not necessarily mean that someone can provide safe and effective care on their own, especially without receiving training and supervision in their specific practice area. In comparison to the short training assistant physicians undergo, residency programs can last more than four years, including 16,000 hours of direct clinical experience.
AMA has opposed the assistant physician role since it was first introduced, citing concerns that it may hinder the organization's efforts to increase funding for graduate medical education and create more residency slots.
In June, AMA's House of Delegates rejected a proposal to support assistant physician programs from its Missouri delegation. In addition, the group said it opposed efforts to allow graduating physicians to become independent licensed physicians, as well as expanding the scope of their practice to other services or areas without completing a formal residency program.
Instead of focusing on assistant physicians, AMA has encouraged the support of two federal bills to help increase the U.S. physician supply. The first is the Resident Physician Shortage Reduction Act, which would increase Medicare funding for 14,000 additional residency positions. The second is the Physician Shortage Graduate Medical Education Cap Flex Act, which would allow teaching hospitals an extra five years to set their funding cap if they create residency programs in specialties with shortages. (Devereaux, Modern Healthcare, 8/2)
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