A turf war is likely as Missouri plans to allow medical school graduates who did not match into residency programs to practice as “assistant physicians” in rural, under-served areas. The law was signed by Governor Jay Nixon, and officially creates the new position of “assistant physician.” An assistant physician is defined as any medical school graduate who has passed the prescribed medical examinations and who has not entered into postgraduate residency training prescribed by rule of the State Board of Registration for the Healing Arts.
The new Missouri program, as I understand it, permits medical school graduates who have not completed “any” internship or residency training to practice in a rather loose association with a fully-licensed physician within a 50 mile radius of the assistant’s location after only 30 days of close supervision. After that, they could treat patients without direct supervision in settings 50 miles away and will be able to prescribe Schedule III, IV, and V drugs and restricts their practice to providing only primary care services and only in medically under-served rural or urban areas of the state or in any pilot project areas.
The Missouri State Medical Association reportedly is in favor of the proposal while the Missouri Academy of Family Physicians and the American Academy of Physician’s Assistants are opposed.
Missouri has roughly some 900 PAs in their State who provide health services under some of the most restrictive supervision rules in the nation and consistently are awarded an “F” by the “Pearson Report” (www.webnp.net) for its policies on NPPs.
Like this plan for “assistant physicians”, the NPP must practice on site with the supervising physician for a minimum of 30 days before being permitted to practice more independently within a 50 mile radius of the collaborating physician in a HPSA designated area with the requirement that the collaborating physician work on site with the NPP at least once every two weeks and review at least ten percent of the nurse practitioner’s charts overall, including at least twenty percent of charts in which the patient was prescribed controlled substances.
We are curious as to how “prescriptive authority” will be handled for the assistant physicians and if the State law that requires any patient evaluated and treated by an NP that does not have a “self-limited or well-defined condition” be reevaluated by a physician within two weeks will be observed.
Our Advisory Board has mixed feelings on the concept but as head of the compliance division, I can already see an avalanche of issues with Medicare, Medicaid and virtually all the major meds since, to my knowledge, NO State permits medical school graduates to practice or be licensed without a least one year of internship.
I am also a little concerned as to why these graduates would not have been accepted for a first year’s program. According to available statistics, there are more than enough first year openings for every U.S graduate and every year, we see residency openings for primary care specialties (family medicine, general internal medicine, and general pediatrics) go unfilled by our U.S. medical school graduates.
While I recognize the real shortage in rural and inner-city locations, I am not convinced this is a “practical” solution that would be embraced by the healthcare community especially with the resistance we have seen on direct contract privileges for experienced PAs and NPs.
I am inclined to recommend a more reasonable approach for NPP regulations where they can be used more effectively and perhaps get some State funded incentives for physicians to enter primary care and also some funding for wider availability of telemedicine with specialist.
What say You?