In response to the proliferation of states considering assistant physician legislation, the AOA recently convened a group of influential health care stakeholders to discuss potential implications for quality care and patient safety.
The Assistant Physician Summit, held at the National Osteopathic Advocacy Center in Washington, DC, engaged representatives from 19 health care organizations, including the American Medical Association, American Academy of Family Physicians and the Federation of State Medical Boards.
In 2014, Missouri lawmakers enacted legislation creating a new type of health care provider, the assistant physician. The law licenses DO or MD medical school graduates to provide primary care services to patients in rural and underserved areas without completing postgraduate residency training and with limited physician supervision.
As licensure rules are being developed in Missouri, similar bills have been adopted in Kansas and Arkansas, and proposed in Washington and Virginia. The AOA is working with other health care entities to oppose this type of legislation and educate policymakers on patient safety risks.
“With the osteopathic profession’s strong emphasis on providing primary care in rural and underserved areas, the AOA is well positioned to lead advocacy efforts around this critical issue on behalf of physicians and patients,” says Nick Schilligo, the AOA’s associate vice president of state government affairs.
The training gap
According to Rosemary Gibson, senior advisor at The Hastings Center and award-winning author of “Wall of Silence,” the new provider designation poses a significant health threat for patients who may be unaware they are not seeing a fully trained and licensed physician.
“The biggest danger is that these providers don’t know what they don’t know,” says Gibson. “Residency training is essential to help physicians build the knowledge and experience necessary to provide comprehensive, high-quality care.”
The lack of close-proximity physician supervision required for practicing assistant physicians is of particular concern, Gibson notes. The Missouri law requires a DO or MD to continually supervise an assistant physician for one month, after which they can practice within a 50-mile radius of the supervising physician.
“There’s an enormous knowledge gap between someone who is eligible to become an assistant physician and a fully trained and licensed DO or MD,” says Gibson.
Brandon Isaacs, DO, wholeheartedly agrees. Serving as assistant dean for postdoctoral education at the Pacific Northwest University College of Osteopathic Medicine, he works to develop graduate medical education positions in a remote six-state region currently offering less than 2% of the nation’s residency slots. “We have no need for untrained, unlicensed providers who can’t practice independently or in a hospital setting,” he says.
Although proponents of the legislation maintain that licensing assistant physicians will help states address physician workforce shortages in medically underserved regions, Dr. Isaacs says alternate funding for more residencies and elimination of GME position caps present better options for increasing access to care. Other proposed measures encouraging medical school graduates to pursue primary care include physician loan repayment or forgiveness programs and Medicaid payment parity for primary care services.
“By allowing students who don’t match into their desired specialties to become assistant physicians until they can try again next year, we’re just kicking the can down the road, and then throwing more cans in the road for next year,” Dr. Isaacs says. He encourages students seeking to match into highly competitive programs to have a backup plan that includes considering the many primary care residency slots that go unfilled each year.
Following the summit, participating health care organizations are preparing a unified strategy report that will provide a common platform for educating lawmakers and proposing alternative solutions.
“This summit represents a significant step forward,” says Dr. Isaacs. “We now have a collective voice at the table and tools we can use to educate lawmakers about the implications of the legislation.”