Assistant physician: A new form of midlevel provider?

Nonphysician providers such as nurse practitioners and physician assistants have become key players in a post-Affordable Care Act marketplace, but many experts stand by predictions that the country will experience a shortage of primary care physicians (PCPs) as health reform unfolds. Meanwhile, residency slots to train new PCPs are in short supply, driving organizations and states to innovate new ways to meet demand.

In Missouri, for example, a law passed earlier this year would give the green light to an entirely new form of midlevel provider: the assistant physician, according to a report from the Columbia Missourian. Assistant physicians, not to be confused with physician assistants, would be composed of medical school graduates who were unable to secure residencies.

According to the bill, these professionals would be allowed to practice somewhat autonomously in rural or underserved areas and be able to prescribe schedule III, IV and V drugs.

The new type of provider is unique to the state, and the national medical community is watching closely to see whether the position might help alleviate the scarcity of primary care doctors without compromising quality of care by introducing inexperienced doctors into the workplace, the article stated.

In the meantime, the proposal has raised several queries and criticisms.

"A patient being seen by a doctor who has successfully completed residency training can have some measure of security that the physician caring for them has more than a basic understanding of their current issue," Turi McNamee, program director and vice chair of training and education in the department of medicine at the University of Missouri, told the Missourian. "Absent such oversight it would be hard to say with much confidence what physicians are being taught."

In addition, opponents say more clarity is needed regarding the specifics of assistant physicians' collaborative practice arrangements, including physician liability for their mistakes; scope of practice; and legal limit for how long one can practice under that license.

The bill, sponsored by Missouri state Rep. Keith Frederick (R) and state Sen. Dan Brown, (R), went into effect Aug. 28, but applications for the new license likely won't be accepted until the summer or fall of 2015, according to the newspaper.

To learn more:
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