Advocacy in action

Assistant physicians: In Missouri, AOA urges limiting license renewals

In the interest of patient safety, quality care and assistant physicians’ own career prospects, AOA says license renewals should stop after two.


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.”


  1. Kevin M Riccitelli

    Now that opinion is a GOD COMPLEX…those in favor are suddenly much better and smarter physicians???
    When I graduated from OU-COM, a one year residency was new and only recommended; and as with all FP residencies, it focused on inpatient care.
    I went right into practice and have excellent patient health reviews; and good reviews by my peers and my hospitals.
    I am board certified under the grandfather clause, but for those in rural areas w/o a hospital that requires board certification, that FP residency is not going to make a difference on how they care for those in the outpatient setting….and just as I did, they can learn OJT @ making appropriate referrals and ordering diagnostic studies.
    I have coworkers with residency training who can verbalized their residency knowledge but have NO IDEA on how to apply it correctly.
    Graduating from a medical school provides one with a DO / MD degree; and my certificate states that I am an Osteopathic Physician…not an Assistant Physician.

  2. Karen Slater, DO

    They let Nurse Practitioners loose on patients with 18mos of training. I’d still rather see an MD/DO over this. In my state (NM), NPs are autonomous and the docs spend quite a bit of time correcting missed/wrong diagnoses.

  3. Joe Morgan

    This entire idea seems to me much ado about nothing. If someone does not get a residency within 5 years of graduation, they may never get one. Many residencies state the graduate must not be more than 5 years from graduation or last training.
    Now that ought to be considered before urging graduates to go back into a residency.
    Also, when FP residencies started and certification started, there was a transition where a certain number of years of practice equaled residency experience and they could take the exam.
    In this instance, it seem to target doctors who did not do a residency and many may not be able to get one now.
    All states now have mandatory CME requirements which means the graduate must have some education annually. If that is not enough then the mandatory number needs to be raised for everyone.
    The other aspect of this process is the cookie cutter concept. All doctors in a certain group must act and practice exactly alike according to the epocrates app on the smart phone. There is no room for individual growth or discovery within clinical practice due to the narrow constraints of the standard of care. Now doctors even have to meet legislative regulations on clinical practice, not even created my doctors but by legislators. We all know the mental ability of legislators- dubious at best.
    I hope many doctors will oppose this process and it dies a fast death.

  4. Rebecca Jenkins DO

    I don’t agree that those students not getting into a particular residency are necessarily inferior to those getting in. Since medical students at this time have more years of medical classwork and student training then physician assistants, I see no reason (except perhaps politically with the American Board of Physician Assistants and Physician Assistants themselves perhaps) why they should not be able function as a physician assistant under physician for a time and then also be allowed to re-apply to residencies or be able to sit for the physician assistant board exams and become a certified physician assistant. Some excellent physicians actually started out as physician assistants, nurse practitioners, chiropractors, or even specialty trained physicians in other countries and some medical students go through their training and decide on other fields of study for personal reasons that have nothing to do with their competence. I don’t think we should deny a graduated medical student (who is now has an MD or DO behind their name) future career options unless there is a specific and legitimate concern about their ability to practice. It is quite possible that one of the smartest students does not get into a highly competitive residency due to the high number of applicants in one year and might be actually a better candidate next year among those available applicants, not only because of baseline capability but perhaps added experience if they worked as a PA for a year or more.

  5. Flash T.

    Missouri board will accept applications FOR Assistant Physician starting January 31, 2017.
    AMG and IMG apply!
    Good luck!
    I’m delighted for you all.

    1. saurav kayastha

      I am excited as well. Do you mind,if detailing your profile Flash.T.
      I am an IMG. Where can we practice in Missouri,if we are given the license?

      1. Paul W. Hannam MD

        I think it is silly that with there being more US med school graduates than there are residency slot, these so called “professional organizations” still feel they have to “manage the situation” And instead of lobbying the federal government for more residency slots, they want to lobby away the earnings of hard working well trained professionals.
        There are a couple point that go against their reasoning.
        1. PAs practice out of PA school without a residency with less clinical experience than med students.
        2. Nurse Practitioners and PA don’t have limited renewals on there licenses
        3. Most residencies have a limit on how long after graduation they will take a medical graduates.
        4. Many GPs go on to practice and have successful thriving medical practices.

        We don’t not need to set up walls around the profession and bar those who have done the education and have the student loans to prove it. If residencies won’t take them let them have the opportunity to work and make descent money to repay their student loans and take care of their families.

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  9. Frank Underwood

    More states need to follow suit and limiting licensing will just add to the student debt and lack of access to medical care for out most vulnerable populace. There is no such thing as a USMLE in PA and NP schools both shorter and cheaper to complete than a MD, they dont have any such arbitrary limitations in their renewals.

  10. Gregory A Avetisov

    I absolutist support thous MD/DO,who passed 1,2,3, levels and did not match for some “unknown” reason can practice as a GP under supervision!
    I worked with PA after 2 years out of program ,they knowledge,hours in patient care way less then MD/DO.They only have one board exam ,only 1 vs MD/DO 3steps !
    yet they can practice medicine.
    Obviously to have equal number of residency programs which will guaranty 1:1 ratio,and all who is passed exams will match, that would be a dream. But not in our life time unfortunately.

    I was IMG then I graduated from DO school in USA, even then it is impossible to get what is your Heart,and your mined build for it …so many subjective obstacles,like your age,your accent and so on…
    I totally support that bill which passed in state of Missouri to satisfying patients in remote areas ,they are deserve to be able seeing by the Doctors .
    I believe USA land of equal opportunity’s.

  11. Paul Viola

    I know this article is three years old, but this is a summary or paraphrase of the email I sent to the Association of Medical Doctor Assistant Physicians:

    What is the Association’s position on residency funding? As a prospective medical school applicant, I am concerned that a policy maker in the future may use the assistant physician profession as a reason to limit residency funding. My desire has always been to be an independent practitioner and to be a leader in my field, as opposed to a dependent or collaborative practitioner such as a physician assistant [or nurse practitioner]. To that extent, I currently possess one bachelor’s degree, am working on another to gain knowledge in fields related to my proposed research and clinical interests – namely performing arts medicine and rare forms of epilepsy such as musicogenic epilepsy – [as well as to work on medical school prerequisites], in addition to my future medical degree if I still remain on this path. At the end of the path, I want to be an independent practitioner: a physician, a teacher and leader.

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