COLUMBIA — It’s been nearly two years since Missouri pioneered a program to allow medical school graduates without residencies to practice medicine as assistant physicians.

In that time, zero licenses for this new classification have been issued.

After the law was signed by Gov. Jay Nixon in July 2014, the Missouri Board of Registration for the Healing Arts began creating the rules and regulations for the new position. That discussion has taken the better part of a year and a half. Rulemaking is a “lengthy process,” said Jeffrey Carter, the president of the board, in an email.

Carter said that a draft of the rules was approved in October 2015, and the final version is currently under review. Once approved, they will be filed with the Missouri Secretary of State’s Office, the Joint Committee on Administrative Rules and the Small Business Regulatory Fairness Board. From there, it typically takes around six to nine months for them to go into effect, according to a timeline provided by Carter.

Once the board approves the final rules and the process is complete, the state can begin granting assistant physician licenses.

Missouri State Rep. Keith Frederick, R-Rolla, an orthopedic surgeon and chairman of the standing Committee on Health and Mental Health Policy, sponsored the original assistant physician bill in 2014.

Typically, a new medical school graduate will apply for and earn a residency, where they’ll spend a few years working under a physician at a hospital or clinic in order to get more in-depth training than they did in medical school. But by becoming an assistant physician, a graduate would still be able to practice medicine — albeit in a limited way — without having to complete a residency. Frederick said he got the idea for the assistant physician position after noticing a mismatch between the number of medical school graduates and the residency slots open.

“So the number of new graduates who are just out there, it’s like playing musical chairs, and the music stops, and there’s not enough places to sit down,” Frederick said.

An assistant physician would be required to work in a “collaborative practice arrangement” with a licensed physician. Assistant physicians are also obligated to practice in medically underserved areas, Frederick said.

“No. 1, we don’t have enough doctors in our rural areas,” Frederick said. “No. 2, we don’t have enough residencies for the doctors that are graduating. And No. 3, we continue to increase the number of graduates without any care for what happens to the ones who don’t have a place to go.”

Frederick sponsored legislation to create the assistant physician program to fill that void.

When the Board of Registration for the Healing Arts first began discussing rules for the new medical provider classification in late 2014, according to previous Missourian reporting, members faced several challenges, mostly stemming from the perceived ambiguity of many components of the initial legislation.

Frederick has said that he would be open to the idea of drafting more legislation to clarify some vague points. Now, though, he has changed his tone.

“There was no defect in the legislation, and no repairs in the legislation were needed, nor have they been done,” Frederick said.

“It’s done; it’s signed into law," he said. "It’s now in the hands of the administrative folks at the Board of Healing Arts and the Division of Professional Registration.”

In a conference call in October 2014, board members and staff expressed concern about defining key features of the program, regulating the practice of assistant physicians and figuring out the workings of the mandatory relationship between the assistant physician and a supervisory “collaborating physician.”

The April 2015 draft rules addressed many of these issues. The “Definitions” section, which originally consisted of seven terms, was completely rescinded and replaced with 18 more relevant and clearly defined terms. The draft rules also contained 14 pages of new rules, regarding applications, renewal of licensure, prescribing drugs and disciplinary action. Other language relating to the responsibilities of the collaborating physician was added or clarified.

“Hopefully we will get our rules and regs done and we will begin to allow the first of this new class of category to practice,” Frederick said. 

“It doesn’t require any more statutory authority; it just requires the bureaucratic process to run its course.”

Supervising editor is Katherine Reed.

  • Formerly an assistant city editor & reporter on the public health and safety beat. Reach me at or on Twitter @Jaredography.

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