A new Missouri law is creating some controversy while trying to address the shortage of primary care providers in rural parts of the state.
Under the law, medical school graduates who were unable to secure residencies may be licensed as “Assistant Physicians” and provide primary care services in rural parts of the state.
Missouri has a significant primary care shortage and of Missouri’s 101 rural counties, 98 are designated Primary Medical Health Professional Shortage Areas. A lack of physician retention has made the problem even worse. The state produces 2.7% of the country’s medical school graduates yet it’s the second leading exporter of doctors to other states.
The new licensure has prompted criticism from several medical organizations because they feel the graduates are not fully prepared to handle the work their license allows. The greatest concern is that the lack of a residency will create health care providers who are not fully prepared to handle many of the complicated problems seen in the primary care setting. Primary care isn’t easy and primary care patients aren’t sorted into groups of simple and complex problems. Primary care may be the most complex role in the health care delivery system.
The law does contain some safeguards. It will be governed by the Board of Registration for the Healing Arts. Assistant Physicians will have to enter a collaborative agreement with a licensed physician who practices less than 50 miles away and who will be required to review 10% of the assistant physician’s charts.
GVMH is fortunate to have a great primary care base. We have talented and devoted primary care physicians who provide excellent care every day and our entire service area is fortunate. There is a national shortage of primary care physicians and something needs to be done about it. I’d suggest a better solution is the creation of more primary care residency slots. If we are creating laws to license medical school graduates who weren’t able to secure a residency spot then the real problem is there aren’t enough slots to go around . More spots = more doctors.