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Missouri legislation would allow assistant doctors

Monday, June 23, 2014 | 6:30 p.m. CDT

ST. LOUIS — Medical school graduates could start seeing patients sooner under legislation that is intended to address doctor shortages in parts of Missouri.

The bill pending before Gov. Jay Nixon would create a classification of "assistant physician" for graduates who have passed licensing exams but have not completed residency training. They would be allowed to provide primary care and prescribe drugs in rural or urban areas that are considered to be medically underserved.

Nixon has not said whether he will sign the legislation.

The Missouri State Medical Association says the legislation could encourage recent medical school graduates to remain in the state or come to Missouri from elsewhere.

"Missouri truly has an opportunity to be a trailblazer on this type of licensure and solving the health care access problem," Jeffrey Howell, an attorney and lobbyist for the association, told the St. Louis Post Dispatch.

The first two years of medical school are typically classroom-based. The third and fourth years include clinical work with patients under direct supervision of other physicians. Medical school seniors then apply for residency programs at teaching hospitals, which provides them additional clinical training for a period of three to seven years.

The Missouri legislation would require assistant physicians to be overseen by another physician who would have to be physically present for at least the first month as they see patients.

Rosemary Gibson, a board member of the Accreditation Council for Graduate Medical Education, questioned whether four years of medical school was enough preparation to be taking care of patients so quickly.

"People in rural and under-served areas deserve a fully trained, competent physician just like everyone else," she said.

Kathryn Diemer, assistant dean for career counseling at Washington University in St. Louis, said she is concerned about the amount of education assistant physicians would receive when practicing in rural areas. An internship, which is the first year of a doctor's residency program, is a critical learning opportunity, she said.

"I'm not sure medical students after two years of clinical experience could be ready to be that independent," she said.

The Missouri Academy of Physician Assistants has raised concerns that the new category of doctors could confuse patients.

Missouri already allows "physician assistants," who have bachelor's degrees and an average of two years of additional clinical training. It also allows advance practice nurses, including nurse practitioners, who have graduate degrees in nursing. Those categories of medical providers have been granted greater autonomy in recent years but, unlike the assistant physicians, they cannot be called "doctors."


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