As governing bodies work to develop licensure rules for assistant physicians in Missouri, the AOA continues to advocate for patient safety by urging a limit on license renewals for the new provider designation.
In 2014, Missouri lawmakers enacted legislation allowing DO or MD medical school graduates who have not completed residency training to practice as assistant physicians, providing primary care services to patients in underserved regions. To date, no assistant physician licenses have been issued because the Missouri Board for the Healing Arts has not yet determined final licensing rules for the new type of provider.
Last month, the AOA joined with the Missouri Association of Osteopathic Physicians and Surgeons (MAOPS) and other health care organizations to send the board a comment letter recommending a limit of two license renewals as a measure to ensure that assistant physicians move toward seeking residency training and, eventually, full physician licensure. The letter also asks the board to seek the opinion of the state’s Attorney General before finalizing the proposed legislation.
Coalition urges caution
After the AOA convened an assistant physician summit earlier this spring, a group of key health care stakeholders came together to form the The Coalition for Patients First, which has outlined the following concerns about assistant physicians in a consensus statement.
- Patient safety could be jeopardized if medical school graduates who don’t have complete medical training are allowed to provide care under limited supervision.
- Medical students who don’t match into their desired specialty won’t necessarily make good primary care physicians.
- States who adopt such legislation risk creating a two-tiered physician system. “Patients in rural and underserved areas, who are already at a geographic and often economic disadvantage, deserve the same quality of care as those who live in a more prosperous part of the state,” the statement notes.
The coalition will continue to monitor and respond to similar legislation that’s put forward in other states.
Missouri and beyond
Along with Missouri, Arkansas and Kansas have approved legislation allowing medical school graduates to practice a restricted form of medicine. However, the Kansas and Arkansas laws require continuous physician supervision and limit how many times assistant physicians can renew their license.
Assistant physician legislation was also introduced in Virginia and Washington in 2016, prompting letters of opposition from the AOA expressing the risks of allowing assistant physicians to practice despite their lack of residency training. Washington’s bill died at the end of the legislative session, but Virginia’s is still under consideration.
In Missouri, assistant physician legislation is a hot topic among DOs, says Jeff Davis, DO, MAOPS president. MAOPS members have expressed concerns about DO graduates choosing to work as assistant physicians indefinitely instead of going on to pursue residency training, he says.
“We’ve encouraged the Missouri Board of Healing Arts to limit the number of license renewals for assistant physicians,” says Dr. Davis. “We believe this will encourage assistant physicians to complete their postgraduate education and board certification so they can practice independently and at the top of their education, training, and license.”