I have written previously about Missouri's attempts to create a new category of health care practitioner: assistant physician. You may recall, Missouri's goal is to re-direct non-matching medical school graduates to work as assistant physicians in medically underserved areas in the state.
Who's idea is that, you say? Why, an orthopedic surgeon's, though the bill was supported by the Missouri Medical Association, an organization tilted — as are all classic licensed health care provider organizations — toward non-rural providers. And there's the rub: the rural provider community does not seem to be in love with the idea. Not surprisingly, the AMA and the licensed Physicians Assistant organization hate it.
It is reported that several other states with significant rural populations and chronically underserved areas are watching Missouri's roll out. This is where it gets tricky. Gov. Nixon's signing message included warnings about consumer protection. The new legislation will require significant scope of practice, licensing, and regulatory work to even approach implementation. This all might help explain why, at about 18 months out, Missouri has not seen one assistant physician.
The larger issue is whether sidestepping medical residency (a multi-year experience for the typical practicing physician and at least a one year experience under traditional Missouri standards) is the way to ease the shortage of primary care providers in medically underserved areas.
Why not also expand scope of practice under very restrictive Missouri standards to allow every licensed health care practitioner to work to the limits of their training? Ah, because the fight over collaborative practice requirements for groups like advance practice nurses is a fierce one in Missouri. The assistant physicians hew to the old collaborative practice standards and break no new Missouri ground on independent practice. I suspect that is the tail wagging the dog here.