What’s the Difference Between a Physician Assistant and an Assistant Physician?

If you can't answer that one easily, you are not alone.  But those of us who reside in the "Show Me State" better get working on it because Missouri has just passed legislation allowing medical school gradutes who have not completed residency to treat patients in underserved parts of the state.  What do we call that? Well, one thing we call it is an "assistant physician" license that may only be exercised in collaboration with a licensed physician, sort of like the confusingly similarly named physician assistant.

What's the difference? You most definitely do not have to be a medical school graduate to be a PA, though you do to be an AP. You may not call yourself "doctor" when introducing yourself as a PA (though, this gets complicated if you are a PA with a PhD) and you may, in fact, introduce yourself as "doctor" when working as an AP.

Is it you say potato and I say potato time or is something else at stake here?

First, PAs are understandably uneasy about APs.  After all, if a practicing physician can have another "doctor" in collaborative practice with them in their office, just what was your role again?

Second, just how nuanced will the presentation of the AP doctor be or would it be reasonable to think that patients will latch onto the introduction by the term of "doctor" to indicate their quality concerns are met?

Third, so just what use is one year or so of internal medicine medical residency to someone planning to move into primary care or is one year of collaborative practice a fine substitute?

The question I really want answered is why the Missouri legislature might think there would be a good source of APs in the "unmatched" recent medical school population in and around Missouri.  What is going on with the "match" process, that there would be enough potential AP candidates to begin to resolve Missouri's rural health care crisis? The conventional wisdom is that recent medical graduates don't match because they have over-estimated their attractiveness to certain highly popular residencies (hint: internal medicine is not on that list) or over-estimated their attractiveness to certain geographic regions of the counry (hint: rural Missouri is not on that list).

So, if I have this right, the Missouri legislature has identified these perennial over-estimators as likely candidates for careers in rural primary care? I am not saying there is not an increasing population of un-matched medical students.  In fact, the numbers of the un-matched are up by all accounts. When you allow the number of medical school seats to grow but do not increase the number of federally funded training spots for those medical school graduates, this kind of thing happens.

But trolling among the disappointed most highly coveted specialist candidates for wanna-be rural primary care physicians is an interesting take on opportunistic hiring.