Assistant physicians could relieve shortage of health care around nation, supporters say

This slide was shared by Keith J. Frederick, DO, a former Missouri legislator who worked to change the law in that state to create "assistant physicians," doctors who are allowed to practice medicine with other physicians if they do not match into a residency. Frederick was a speaker during “Expanding Access to Primary Care by Removing Barriers to Assistant Physicians,” an online policy forum sponsored by the Cato Institute.

Assistant physicians could provide health care in areas of the country where it’s badly needed while enhancing their own medical training, advocates say.

The Cato Institute held “Expanding Access to Primary Care by Removing Barriers to Assistant Physicians,” a live online policy forum, on May 22.

Graduating medical students who do not match into residency programs could become assistant physicians, or apprentice physicians working in primary care while building their own knowledge and skills, according to the Cato Institute. Missouri became the first state to change its medical licensing laws to create assistant physicians and six other states have similar laws: Arkansas, Kansas, Utah, Arizona, Louisiana, and Idaho.
Cato Institute Senior Fellow Jeffrey A. Singer, MD, moderated the discussion. He is coauthor of the April briefing paper “Expand Access to Primary Care: Remove Barriers to Assistant Physicians.”

Much has been made of the increasing demand for health care as the general population ages, and the potential physician shortage as physicians also grow older, said Kevin D. Dayaratna, PhD, a senior research fellow at the Center for Data Analysis of the Heritage Foundation.

But each year, several thousand medical graduates who don’t get a placement in the National Resident Matching Program, known as the Match, “can’t do anything because medicine is a licensed profession,” Dayaratna said.

“So from a policy perspective, these medical graduates have acquired a vast amount of knowledge and it can be very useful to tap this surplus of talent to ameliorate the physician shortage,” Dayaratna said.

Opponents argue the licensing change would create an underclass of doctors or jeopardize patient care. But assistant physicians would practice under supervision of collaborating physicians, he said.

When lawmakers began considering licenses for assistant physicians, the Missouri State Medical Association endorsed the concept, said Keith J. Frederick, DO, a former Missouri legislator who worked with the bill. It passed in 2014 with bipartisan recognition that the state had “a tremendous need” for more doctors and clinicians, he said.

Supporters can expect opposition from “medical elites” who argue assistant physicians would provide substandard care. But by the end of four years of medical school, students can have up to 6,000 hours of clinical training, far more than the 500 hours of training for nurse practitioners, Frederick said.

Now, Medicare and private insurance reimbursement has been a challenge. Supporters hope that will change as more states adopt assistant physician licensing laws and Congress changes reimbursement rules, Frederick said.

Residency requirements for physicians mean residency programs have “absolute power” over budding physicians, said Lyman Wostrel, MD, who practices under Missouri’s assistant physician law as CEO of Zion Asher Family Physicians, a direct primary care practice.

Many residency programs create wonderful doctors, he said. But some do not, Wostrel said, sharing examples of comments from physicians who were overworked, sexually harassed, or faced opposition due to religious beliefs.

“We expect that through the continued growth of this program that more and more able bodied and highly trained individuals can continue to practice medicine and take care of people for which they spent all this time training to do,” Wostrel said.