Everyone knows there’s a shortage of primary care physicians, especially in rural areas. The state of Missouri has decided to alleviate this problem with a bill, signed into law by the governor this month, authorizing medical school graduates who have not done any residency training to act as “assistant physicians.”

The assistant physicians will come from the pool of 7000 to 8000 graduates, mostly of offshore medical schools, who were unable to match to any residency.

After spending 30 days with a “physician collaborator,” assistant physicians would be allowed to practice independently as long as they were within 50 miles of their collaborator. The physician collaborator is also required to review 10% of the assistant physician’s charts.

Assistant physicians would be expected to treat simple problems and could prescribe Schedule III [including hydroxycodone or codeine when compounded with an NSAID as well as synthetic tetrahydrocannabinol], IV, and V drugs.

Opponents of the bill included the American Medical Association, the Accreditation Council for Graduate Medical Education, and the American Academy of Physician Assistants.

According to healthleadersmedia.com, the Missouri State Medical Association supported the bill. Its government relations director and general counsel, Jeffrey Howell, said the new rules would be no different than those for older doctors. “A lot of those guys didn’t have to go through a residency program. They just graduated from medical school and went back to the farming communities they grew up in, hung out their shingles, and treated people.”

Perhaps Mr. Howell hasn’t heard that medicine is a bit more complex than it was 50 or 60 years ago.

Proponents of the bill felt that rural patients who now have no or limited access to medical care would be better off seeing med school graduates with 30 days of postgraduate training.

There is great potential for patient harm by unsupervised, untrained newbie doctors.

As Dr. Aaron Gray, a family physician from Missouri, said on Twitter, “I’d be terrified to receive care from my former self just after med school with no intern training.”

I’m not sure why there’s a 50-mile limit to where the APs can practice. If they fail to diagnose or treat someone properly, it wouldn’t matter if they were 1, 50, or 100 miles away from their collaborator.

It’s also hard to see how a review of 10% of their charts will accomplish anything. The damage will have already been done.

Who will provide malpractice insurance for APs? Are the third-party payers and CMS in on this? If they allow APs to enroll in their panels, wouldn’t they, as accomplices, become easy targets for malpractice suits? What about the physician collaborators? Are they vicariously liable for acts committed by their assistants?

A better solution for both the unmatched graduates and the patients would be for the state to fund more primary care residency training positions.

Was this scheme cooked up by plaintiffs’ lawyers or did some legislator’s daughter graduate from an offshore school and fail to find a residency?

What do you think about Missouri’s plan to license assistant physicians?

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 9800 followers on Twitter.