The Proliferation of Assistant Physicians Helping The Underserved

[2021Doctor]

In 2014, Missouri became the first state in the nation to enact legislation creating the new professional designation of assistant physician. The Missouri law allows assistant physicians to provide primary care services to individuals in rural and underserved areas with limited physician supervision without completing a postgraduate residency training. The Missouri Board of Registration for the Healing Arts began accepting applications for the assistant physician designation on January 31, 2017. Since the Missouri law was passed, Arkansas, Kansas, and Utah have enacted assistant physician legislation, while New Hampshire, Oklahoma, Virginia, and Washington have considered bills similar to Missouri’s. Arkansas’ new “graduate registered physician” position allows medical school graduates with Arkansas ties to practice before residency with direct continuous supervision. Kansas created a special license for graduates of the University of Kansas School of Medicine who do not match with a residency program to let them practice under continuous direct supervision for a maximum of two years. Recently, Utah created an “associate physician” position that allows medical school graduates to provide primary care services in medically underserved areas with limited physician supervision for up to four years.

https://www.aafp.org/dam/AAFP/documents/advocacy/workforce/scope/BKG-Scope-AssistantPhysicians.pdf

SPRINGFIELD, Mo. – An elected Missouri state representative has been indicted by a federal grand jury for a fraud scheme in which she made false claims about a supposed stem cell treatment marketed through her clinics in southern Missouri, and for illegally providing prescription drugs to clients of those clinics.
“This defendant abused her privileged position to enrich herself through deception,” said U.S. Attorney Tim Garrison. “The indictment alleges she lied to her patients and she lied to federal agents. As an elected official and a health care provider, she deserves to be held to a high standard. This grand jury indictment exposes her deception and holds her accountable for her actions.”
Patricia “Tricia” Ashton Derges, 63, of Nixa, Missouri, was charged in a 20-count indictment returned under seal by a federal grand jury in Springfield, Mo. The indictment was unsealed and made public today following Derges’s self-surrender and initial court appearance.
Derges administered amniotic fluid, which she falsely claimed contained stem cells, to patients who suffered from, among other things, tissue damage, kidney disease, chronic obstructive pulmonary disease (COPD), Lyme disease, erectile dysfunction, and urinary incontinence. In an April 11, 2020, Facebook post Derges wrote of amniotic fluid allograft: “This amazing treatment stands to provide a potential cure for COVID-19 patients that is safe and natural.”
The University of Utah sold its amniotic fluid allograft to Derges for approximately $244 per milliliter and $438 for two milliliters. Derges charged her patients $950 to $1,450 per milliliter. In total, Derges’s patients paid her approximately $191,815 for amniotic fluid that did not contain stem cells.
The Controlled Substances Act
The federal indictment charges Derges with 10 counts of distributing Oxycodone and Adderall over the internet without valid prescriptions.
This investigation began as a result of false or misleading statements made by Derges in April 2020 to a Springfield television station regarding her potential use of stem cells to treat COVID-19. Derges was elected in November 2020 as a Missouri state representative in District 140 (Christian County). Derges, who is not a physician but is licensed as an assistant physician, operates three Ozark Valley Medical Clinic locations in Springfield, Ozark, and Branson, Mo.
Derges is not a physician but is licensed as an assistant physician. An assistant physician is a mid-level medical professional in the state of Missouri. Under Missouri law, medical school graduates who have not been accepted into a residency program but have passed Step 1 and Step 2 of the United States Medical Licensing Examination may apply to become an assistant physician. State law mandates that assistant physicians practice pursuant to a collaborative practice arrangement with a licensed physician.
Derges obtained her medical degree from the Caribbean Medical University of Curacao in May 2014 but was not accepted into a post-graduate residency program. Derges was licensed as an assistant physician by the state of Missouri on Sept. 8, 2017.

State Lawmaker Indicted for Stem Cell Fraud Scheme, Illegally Distributing Prescription Drugs

An elected Missouri state representative has been indicted by a federal grand jury for a fraud scheme in which she made false claims about a supposed stem cell treatment marketed through her clinics in southern Missouri, and for illegally providing prescription drugs to clients of those clinics.

www.justice.gov

The average urgent care visit is $750 and an average emergency room visit is $2,000. Our office visits are only $135**outside services (imaging, labs), medicines and supplies are not included.

ozarkvalleymedical.com

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[Crayola227]

I'm fine with a supervised practice model for med school graduates that pass all the Steps. They're better than many PAs or NPs and they can do some clinical work.

However, what I don't understand is that they say she isn't a physician, yet she graduated med school. Is her school not accredited? It is the accredited medical degree, not the license, that makes one a physician or not.

 

[DameJulie]

I'm fine with a supervised practice model for med school graduates that pass all the Steps. They're better than many PAs or NPs and they can do some clinical work.

However, what I don't understand is that they say she isn't a physician, yet she graduated med school. Is her school not accredited? It is the accredited medical degree, not the license, that makes one a physician or not.

I am also pretty confused. What's the difference between graduating with a medical degree vs. passing Step 3? Like when do you call yourself a physician? What clinical duties are different between these stages??

 

[Wordead]

I'm fine with a supervised practice model for med school graduates that pass all the Steps. They're better than many PAs or NPs and they can do some clinical work.

However, what I don't understand is that they say she isn't a physician, yet she graduated med school. Is her school not accredited? It is the accredited medical degree, not the license, that makes one a physician or not.

Well it would probably create a lot of confusion if they called themselves physicians. I dont see how it would be any less disingenuous than a PA calling themselves a physician.

 

[VA Hopeful Dr]

Well it would probably create a lot of confusion if they called themselves physicians. I dont see how it would be any less disingenuous than a PA calling themselves a physician.

Sounds like they're trying to differentiate fully licensed physicians from assistant physicians since the very next sentence points out that the doctor in question is licensed as an assistant physician.

 

[Crayola227]

I am also pretty confused. What's the difference between graduating with a medical degree vs. passing Step 3? Like when do you call yourself a physician? What clinical duties are different between these stages??

You have to receive your medical degree in good standing from an accredited medical school. You do not have to pass any of the Steps (licensing examinations) unless as required by your medical school, and most require passing Step 1 and Step 2. But that is only because they include it in their requirements for the degree. One is not eligible to sit for Step 3 unless they have graduated medical school, I believe.

It's my personal opinion to say I am OK with med school graduates practicing as assistant physicians if they have passed all 3 Steps of the licensing exam, as that is a further additional step towards what makes someone eligible and appropriate for full licensure and independent practice - some ways passing the 3 Steps is meant as a standardizing check on one's medical education.

So, to be clear, the requirement to be called a physician or to be a physician is to graduate medical school. This does not get into clinical duties.

Most states have two different types of licenses available to med school graduates or physicians (not getting into any other special kinds or restrictions. One is a temporary or restricted license to practice medicine under supervision. This is the one people get when they have no residency training and are going to do an intern year or residency. This allows these docs to sign order, Rx meds, and the like.

The other one, is an unrestricted license to practice medicine. The requirement is typically the medical degree, in addition to Steps 1 and 2 passing Step 3 (most residencies will require Step 3 at some point anyway, but the real reason it matters is for getting this unrestricted license), and one year of a qualifying intern year completed satisfactorily.

Completing a residency beyond intern year is about board certification in a specialty, not getting an unrestricted license to practice.

No one without a medical license of some type can practice medicine. The clinical duties allowed to medical students falls into a category that essentially anyone could do, provided they are under the direct supervision of a physician. But as you might expect most physicians don't take on that kind of liability for someone off the street. And medical schools are often set up with some kind of liability insurance that covers their students, or accounts for the increased liability to supervising physicians.

 

[Crayola227]

Well it would probably create a lot of confusion if they called themselves physicians. I dont see how it would be any less disingenuous than a PA calling themselves a physician.

Anyone who has graduated an accredited medical school in good standing is entitled to the title of "Doctor of Medicine" and to be referred to as physician.

However if they are not licensed to practice medicine, they have to be careful how they use this title in clinical settings not only not to confuse patients, but to not end up violating rules on practicing medicine without a license to practice. Sometimes it will not be appropriate for them to use it in some situations.

It is not disingenuous. A PA (physician's assistant) cannot call themselves a physician under any circumstance unless they have the degree. I already noted that in order to avoid "practicing medicine without a license" actual physicians without licenses in clinical settings need to be cafeful and some employers will not allow them to use it in such settings for this reason as well as liability from confusion.

Medical boards regulate this, and PAs cannot call themselves physician without the degree. Someone who has received their MD but not completed training or does not have a license certainly can. If you don't like these facts, I guess you can take it up with the very meaning of what is a physician, piss on all the physicians who do not currently practice clinical medicine or do not need a license for their work, and all 50 state medical boards and all medical schools that graduate physicians and confer the title of doctor.

Or do you think when physicians retire from active practice, they retain a license to practice until the day they die? Do you think they stop being referred to as physician because they are no longer practicing or licensed? That's ridiculous.

 

[Crayola227]

Anyway, the OP was talking about Assistant Physicians and what type of practice they have, and brought up someone who violated various rules.

They were not debating the long standing fact that physicians are people who have graduated medical school, whether or not they work clinically or are licensed to practice medicine.

 

[shotgunlagoon]

Going back to the original article, I don't think graduate medical training would have prevented this kind of situation. There's plenty of other doctors that are running pill mills, recommending COVID treatments that do not work (ivermectin, hydroxychloroquine, etc), promoting quackery for their own financial gain.

 

[Matthew9Thirtyfive]

Well it would probably create a lot of confusion if they called themselves physicians. I dont see how it would be any less disingenuous than a PA calling themselves a physician.

A graduate of medical school is a physician. A PA is not. How is that confusing?

 

[Lawpy]

Will Assistant Physicians crowd out the midlevels?

 

[Crayola227]

Will Assistant Physicians crowd out the midlevels?

One could only hope.

 

[Wordead]

Anyone who has graduated an accredited medical school in good standing is entitled to the title of "Doctor of Medicine" and to be referred to as physician.

However if they are not licensed to practice medicine, they have to be careful how they use this title in clinical settings not only not to confuse patients, but to not end up violating rules on practicing medicine without a license to practice. Sometimes it will not be appropriate for them to use it in some situations.

It is not disingenuous. A PA (physician's assistant) cannot call themselves a physician under any circumstance unless they have the degree. I already noted that in order to avoid "practicing medicine without a license" actual physicians without licenses in clinical settings need to be cafeful and some employers will not allow them to use it in such settings for this reason as well as liability from confusion.

Medical boards regulate this, and PAs cannot call themselves physician without the degree. Someone who has received their MD but not completed training or does not have a license certainly can. If you don't like these facts, I guess you can take it up with the very meaning of what is a physician, piss on all the physicians who do not currently practice clinical medicine or do not need a license for their work, and all 50 state medical boards and all medical schools that graduate physicians and confer the title of doctor.

Or do you think when physicians retire from active practice, they retain a license to practice until the day they die? Do you think they stop being referred to as physician because they are no longer practicing or licensed? That's ridiculous.

A graduate of medical school is a physician. A PA is not. How is that confusing?

I guess the scenario Im envisioning is someone who is this assistant physician introducing themselves as a physician in a clinical setting and the natural assumption is they are an attending. It's the same as a PhD calling themselves "doctor" in a clinical setting. Words have specifics meanings to patients and healthcare workers. I dont really care if you want to call yourself a "physician" outside of the hospital. Not sure why that's causing so much consternation.

 

[gyngyn]

Completing a residency beyond intern year is about board certification in a specialty, not getting an unrestricted license to practice.

There are states in which a single post grad training year is insufficient to get an unrestricted license to practice.
CA requires three years is a single specialty. Three prelim years would be insufficient.

 

[Matthew9Thirtyfive]

I guess the scenario Im envisioning is someone who is this assistant physician introducing themselves as a physician in a clinical setting and the natural assumption is they are an attending. It's the same as a PhD calling themselves "doctor" in a clinical setting. Words have specifics meanings to patients and healthcare workers. I dont really care if you want to call yourself a "physician" outside of the hospital. Not sure why that's causing so much consternation.

What? How is that the same? Should an intern never call themselves a physician to patients? You just be clear about your role.

 

[Matthew9Thirtyfive]

There are states in which a single post grad training year is insufficient to get an unrestricted license to practice.
CA requires three years is a single specialty. Three prelim years would be insufficient.

Oh California. The state where an FP can’t get a license until they’re done residency but an NP can go practice independently after 500 hours of shadowing. That state is ludicrous.

 

[Crayola227]

I guess the scenario Im envisioning is someone who is this assistant physician introducing themselves as a physician in a clinical setting and the natural assumption is they are an attending. It's the same as a PhD calling themselves "doctor" in a clinical setting. Words have specifics meanings to patients and healthcare workers. I dont really care if you want to call yourself a "physician" outside of the hospital. Not sure why that's causing so much consternation.

When I was a resident physician working under supervision, I don't recall being told I couldn't introduce myself as a physician or that I had to specify I was a resident physician. I don't know the rules for assistant physicians. Personally, I always introduced myself as a resident physician because I thought full disclosure was good, nevermind that the nuances of resident physician vs attending physician is lost on most patients.

My point being that physicians working under supervision are still physicians and still identify as such in clinical scenarios. As a resident physician, I had a temporary license to practice medicine under supervision, but make no mistake, I had a license to practice medicine. Seems it's similar for assistant physicians. I still see no issue especially with physicians calling themselves physicians outside clinical scenarios, and I see no issue in a physician with a license to practice medicine also introducing themselves as a physician in a clinical setting. The key here being they specifically have a license to practice medicine.

I have never heard that you needed an unrestricted license to practice medicine in order to introduce yourself as a physician in clinical encounters, that's interesting.

Also keep in mind attending physicians for various reasons can also have various types of "restricted" licenses to practice medicine, and I'm not sure what the rules around disclosure of that are. So if an attending has a restricted license (I think this can happen in some situations, like if they are say being supervised by a PHP for mental health issues or substance use disorder), then they are not allowed to introduce themselves to patients as a physician? It's disingenuous? I don't even think they are required by most boards to have to announce the restriction to patients.

Keep in mind it's hard to talk in generalities as all the rules for these things are set by independent state medical boards.

 

[Crayola227]

There are states in which a single post grad training year is insufficient to get an unrestricted license to practice.
CA requires three years is a single specialty. Three prelim years would be insufficient.

I thought I mentioned in my post that these things can vary greatly from state to state, but I may not have made that clear.

 

[VA Hopeful Dr]

When I was a resident physician working under supervision, I don't recall being told I couldn't introduce myself as a physician or that I had to specify I was a resident physician. I don't know the rules for assistant physicians. Personally, I always introduced myself as a resident physician because I thought full disclosure was good, nevermind that the nuances of resident physician vs attending physician is lost on most patients.

My point being that physicians working under supervision are still physicians and still identify as such in clinical scenarios. As a resident physician, I had a temporary license to practice medicine under supervision, but make no mistake, I had a license to practice medicine. Seems it's similar for assistant physicians. I still see no issue especially with physicians calling themselves physicians outside clinical scenarios, and I see no issue in a physician with a license to practice medicine also introducing themselves as a physician in a clinical setting. The key here being they specifically have a license to practice medicine.

I have never heard that you needed an unrestricted license to practice medicine in order to introduce yourself as a physician in clinical encounters, that's interesting.

Also keep in mind attending physicians for various reasons can also have various types of "restricted" licenses to practice medicine, and I'm not sure what the rules around disclosure of that are. So if an attending has a restricted license (I think this can happen in some situations, like if they are say being supervised by a PHP for mental health issues or substance use disorder), then they are not allowed to introduce themselves to patients as a physician? It's disingenuous? I don't even think they are required by most boards to have to announce the restriction to patients.

Keep in mind it's hard to talk in generalities as all the rules for these things are set by independent state medical boards.

My state has a law specifically requiring physicians in training to identify that they are still in training. I always introduced myself as "Dr. VA Hopeful, the resident who will be taking care of you"

 

[Matthew9Thirtyfive]

My state has a law specifically requiring physicians in training to identify that they are still in training. I always introduced myself as "Dr. VA Hopeful, the resident who will be taking care of you"

That is reasonable. I hear a lot of the residents saying I’m dr. Whatever one of the resident physicians taking care of of you.

 

[Crayola227]

I would agree that it's most appropriate that an assistant physician introduce themselves that way in a clinical encounter. But a news article shouldn't say they aren't a physician, as that isn't accurate. I get that this is all confusing for laypeople and journalists.

And a PA should NEVER refer to themselves as a physician, ever, unless they earned an MD/DO.

 

[drducky.]

Sounds like assistant physicians are basically just permanent residents

 

[MDMechEngr]

most of us would take an associate physician over an NP or PA all day, every day, twice on sunday.

 

[Banco]

It makes sense to have such a position for people who go unmatched. Otherwise you have a bunch of graduates just sitting on the sidelines and wasted.

If an NP or PA can do a similar role, why can't a medical school graduate who has more basic science and clinical training? And get paid well while doing it?

 

[Splenda88]

It makes sense to have such a position for people who go unmatched. Otherwise you have a bunch of graduates just sitting on the sidelines and wasted.

If an NP or PA can do a similar role, why can't a medical school graduate who has more basic science and clinical training? And get paid well while doing it?

I am not against it but it seems like many in the medical community think it will create a 'second class' doctors

 

[MDMechEngr]

I am not against it but it seems like many in the medical community think it will create a 'second class' doctors

would still rather take a 90% doctor than a wanna-be-doctor perpetrator.

 

[VA Hopeful Dr]

would still rather take a 90% doctor than a wanna-be-doctor perpetrator.

I wouldn't make a blanket statement on the subject. Lots of people don't match for very good reasons and I wouldn't want them taking care of me. That said, there is undoubtedly some portion who don't match for reasons that won't effect their performance as physicians and having some system in place to keep them on the path to being a physician should be entertained.

Likewise there are some midlevels who are pretty good at what they do. Admittedly that's almost certainly a minority, for what that's worth.

 

[YCAGA]

It is extremely, extremely rare for someone who passes all the Step exams within 2 attempts and has no professionalism violations to be unable to match eventually. Academic failures normally don’t prevent someone from ever matching FM/IM/peds. DO match rates in those specialities for people with barely passing COMLEX is almost 100%.

So all of that begs the question, who are these assistant physician programs for? The answer is Caribbean students who can’t match and US grads with serious professionalism issues. The former have an objectively inferior education both in the preclinical and clinical years. The later shouldn’t be around patients in many cases and should have never graduated medical school.

Who would you rather have as a midlevels: a US-trained PA who received standardized training and has no hint of professionalism issues, or a 4th quartile Caribbean grad/a U.S. MD/DO with serious professionalism violations? At a certain point, passing a harder exam than PA’s (Step vs their boards…idk the name) is really not the issue to be discussed.

Finally, they aren’t as bad as NP’s should not be the bar…that’s just playing the “good enough” game like the NP lobby and hospital admin does.

 

[shotgunlagoon]

So all of that begs the question, who are these assistant physician programs for?

It specified that for a couple states, there's a time limit on these programs.

Kansas created a special license for graduates of the University of Kansas School of Medicine who do not match with a residency program to let them practice under continuous direct supervision for a maximum of two years. Recently, Utah created an “associate physician” position that allows medical school graduates to provide primary care services in medically underserved areas with limited physician supervision for up to four years.

I think these are fine with this limit added. I agree that an indefinite license to practice is a bad idea when there is a genuine reason why they haven't been able to match with a residency.

 

[Crayola227]

Keep in mind they still have to apply through the medical board, and most apps for a license of any type will still ask about disciplinary action in medical school, and can still investigate if needed. I don't know what else similar to what programs ask for in ERAS (like a Dean's Letter) the board may ask for.

If someone doesn't match because of professionalism issues, presumably the school created a paper trail of some sort that contributed to that outcome. Then it would just be up to medical boards to do the quality control they are already doing for traditionally matched applicants applying for a license. It's not exactly reinventing the wheel, and it doesn't necessarily mean they can't easily construct a license process to filter out some of these med grads of concern.

 

[DiveShallow]

The former have an objectively inferior education both in the preclinical and clinical years

You do realize that the big 3 Caribbean schools do clinical rotations in USA hospitals alongside US trained physicians, right? That would be objectively identical clinical training, no?

And your assumption that everybody who doesn’t match who is US MD has professionalism or misconduct issues is just flat out wrong. Don’t be a troll.

 

[Lawpy]

You do realize that the big 3 Caribbean schools do clinical rotations in USA hospitals alongside US trained physicians, right? That would be objectively identical clinical training, no?

And your assumption that everybody who doesn’t match who is US MD has professionalism or misconduct issues is just flat out wrong. Don’t be a troll.

What? @YCAGA makes good points and definitely isn't trolling.

 

[YCAGA]

You do realize that the big 3 Caribbean schools do clinical rotations in USA hospitals alongside US trained physicians, right? That would be objectively identical clinical training, no?

And your assumption that everybody who doesn’t match who is US MD has professionalism or misconduct issues is just flat out wrong. Don’t be a troll.

Big oof if you think being dropped into a satellite hospital with a preceptor who a) doesn't really want you and b) whose only exposure to up to date medicine is teaching a handful of medical students every year for your core rotations is going to be the same as LCME-accredited clinical rotations. That is not to diss community or rural rotations, because they have their place, especially when combined with "mothership" rotations, and combined with standards kept up by administration in the same state (or at least the same country in the case of DO schools).

If you have seen the difference between a "big 4" DO clinical rotation and a "low-tier state school" MD clinical rotation, you would know what I mean. The fact that it is a big logistical problem to get DO students 1-2 months of "GME" time should tell you even more. It would be hard to get 1-2 months of non-GME at my "average" MD school.

There are DO medical students whose IM rotation is shadowing outpatient clinic for 20 hours/week and maybe 2 weeks of rounding for a few hours with one attending. Their OBGYN rotation is begging private practice patients to let them shadow because their preceptor averages 0.3 deliveries a shift. Tough luck if you have a bad experience because that preceptor is the only OBGYN affiliated with your rotation site...should have picked one of the other 14 options. Having residents and attendings that are used to teaching makes a noticeable difference in the education you get as a medical student.

And Caribbean is worse than everything I just described.

So in other words, your naiveté to claim that all US physicians are equally qualified and motivated to teach medical students does not make me a troll.

 

[YCAGA]

And your assumption that everybody who doesn’t match who is US MD has professionalism or misconduct issues is just flat out wrong. Don’t be a troll.

I did not say who doesn't match. Of course people apply ENT, derm, nrsg and do not match, but I said no one who doesn't match eventually.

I would love to hear a scenario or an example where someone cannot match FM on a 2nd or 3rd application cycle and has a spotless professionalism record and 2 or less board attempts on each exam (which I also specified). It just doesn't happen. A mildly affable US MD/DO with passing Step 1,2,3 will be able to match FM and the stats prove it.

I mean come on...41/71 of non-US citizen IMG's with a Step 1 of 190-200 matched last year into FM. The only way you aren't matching at all as a US grad is if you have documented issues or bomb every interview with cluster B traits.

 

[Angus Avagadro]

To the OP. I believe the undeserved deserve a real doctor,...." not almost as good as a licensed physician" . I'll stay out of the mid level fray for now.

 

[collegestud2013]

I did not say who doesn't match. Of course people apply ENT, derm, nrsg and do not match, but I said no one who doesn't match eventually.

I would love to hear a scenario or an example where someone cannot match FM on a 2nd or 3rd application cycle and has a spotless professionalism record and 2 or less board attempts on each exam (which I also specified). It just doesn't happen. A mildly affable US MD/DO with passing Step 1,2,3 will be able to match FM and the stats prove it.

I mean come on...41/71 of non-US citizen IMG's with a Step 1 of 190-200 matched last year into FM. The only way you aren't matching at all as a US grad is if you have documented issues or bomb every interview with cluster B traits.

The more common reason for a USMD grad not to match after multiple times is that they refuse to switch specialties to one that is less competitive than what they were going for. Or they are very particular about which program they want to go to (for example for family reasons the have to be in a geographic area).

 

[collegestud2013]

I am also pretty confused. What's the difference between graduating with a medical degree vs. passing Step 3? Like when do you call yourself a physician? What clinical duties are different between these stages??

In most states you need to pass all the USMLEs (or COMLEX) up to Step 3 and complete at least 1 year of post-graduate training (eg internship) to get a full, unrestricted physician license to practice independently. Getting a medical degree alone usually only qualifies you to get a training license that residents and fellows most commonly hold. Obviously since any full residency is at least 3 years long having only completed intern year means you'll never be able to take the board exam in any specialty, so you would not be board certified. Only a few places will employ someone as a full physician with only a PGY1 training, but you could in theory still open your own practice and practice independently but you'll run into other problems.

 

[collegestud2013]

I'm fine with a supervised practice model for med school graduates that pass all the Steps. They're better than many PAs or NPs and they can do some clinical work.

However, what I don't understand is that they say she isn't a physician, yet she graduated med school. Is her school not accredited? It is the accredited medical degree, not the license, that makes one a physician or not.

Sounds like they're trying to differentiate fully licensed physicians from assistant physicians since the very next sentence points out that the doctor in question is licensed as an assistant physician.

Exactly. This person doesn't qualify to be a fully licensed physician since he/she hasn't completely any post-graduate training. In most states you usually need at least the PGY-1 year AND past all the USMLEs and COMPLEX for a unrestricted physician license.

That being said, I would support more states allowing any medical school graduate who has passed at least Steps 1 and 2 to license practice at the same level as a PA without having to go back and do 2 years of PA school. After all 4 years of med school training is already twice the amount PAs receive so on average they should have the same knowledge or experience.

The main benefits would be:
1) opening up more moonlighting opportunities for residents to work as PAs if they're not yet comfortable practicing independently yet, 2) allowing those who can't repeated match into residency to make a decent living while they re-apply for residency (or just stay practicing as an Assistant Physician), especially Caribbean grads since this is common among them. For non-US IMGs, I would be more hesitant to allow most non-US IMGs to do this unless they can demonstrate US.-based clinical experience.

 

[Zeldaspikes]

In most states you need to pass all the USMLEs (or COMLEX) up to Step 3 and complete at least 1 year of post-graduate training (eg internship) to get a full, unrestricted physician license to practice independently. Getting a medical degree alone usually only qualifies you to get a training license that residents and fellows most commonly hold. Obviously since any full residency is at least 3 years long having only completed intern year means you'll never be able to take the board exam in any specialty, so you would not be board certified. Only a few places will employ someone as a full physician with only a PGY1 training, but you could in theory still open your own practice and practice independently but you'll run into other problems.

I’m curious what other problems, besides insurance and malpractice.

 

[collegestud2013]

I’m curious what other problems, besides insurance and malpractice.

Those would be the the major ones. Many malpractice carriers won't want to insure someone who they don't consider to be fully trained as they see it as a very high risk (or if they do it's will be a very high cost). I suppose you could go to a state that doesn't require physicians to carry malpractice insurance and just go bare. Also some health insurances won't want to be in network to reimburse you appropriately if you're not board-certified after several years out of training so you would have to go more to a cash-based practice.

You could have a harder time attracting patients (in the same way some patients don't want to see a midlevel in their office) as well to build up your practice, but you could always go to a more rural/undeserved area where there's less competition to offset that. Also, especially in the beginning your experience and medical knowledge would probably not be enough for you to comfortably practice independently.

 

[Sleepingdoc]

When NP's are allowed to practice with online degrees, the med school graduates should be allowed to practice supervised. Key word is supervised. You honestly need an intern year as well to really know what you are doing.

 

[Angus Avagadro]

Rather than create a " New" form of physician, which ultimately a new class of physician, why not give them another year training license to function in a "Supervised" fashion. Not like NPs who have a card with a name and phone number to call if they don't know what to do.

 

[DiveShallow]

Big oof

I would love to hear how you speak to people in person. You are saying a lot of stuff that you just don’t really know. Again, the big Caribbean programs I’m familiar with do rotations at big hospitals in places like NYC and Chicago alongside USA MD students. So, I’m just not sure what to make of anything you say, because most of it seems to be based on your feelings rather than actual familiarity with the facts.

 

[YCAGA]

I would love to hear how you speak to people in person.

It is truly an SDN classic that as soon as someone disagrees with you, it is just a matter of time until they make some comment about how you talk in person/attendings must love you/you must be fun at parties/etc.

I hope your flair is correct and you, as a pre-med, are defending the honor of the poor, misunderstood Caribbean medical schools. Glad there is someone to stand up for the little guy.

 

[YCAGA]

Again, the big Caribbean programs I’m familiar with do rotations at big hospitals in places like NYC and Chicago alongside USA MD students.

To address the actual claim of your reply...being so confidently familiar with multiple Caribbean programs is...kinda a red flag to your credibility.

Do you go to a "big" Caribbean school? Otherwise you are being hilariously misled by their websites and/or coping Caribbean students that try to act like or even tell themselves that they are getting the same clinical education as US MD's. Many US DO's struggle to get a half-way decent clinical education, but you think the "big Caribbean programs" have hacked the system and do core rotations at major US hospitals with good teaching...

 

[Redpancreas]

Will Assistant Physicians crowd out the midlevels?

The challenge will be employers who want long term deals/continuity which PAs ideally provide given they probably aren't doing this to gain experience to start another residency.

That said, I'm happy for further saturation/competition for PAs/NPs many of whom took the easy path but still want to gradually work themselves up to do what a physician does.

 

[Ganon]

There is a huge variance in the quality of clinical rotations.
One of my preceptors was a Caribbean grad from one of the "good ones."

She told me stories about how one of her main rotations ended up just being her in a room with zero patient contact. They just studied for boards.

Same thing can happen in DO or USMD schools, but I feel like in general the quality of training is more standardized the higher up the ladder you go. I go to an average state school and our rotations are incredibly regimented and frequently fine-tuned. I have a lot of frustrations with my school, but I can't complain about the variety and intensity of clinical training.

 

[Splenda88]

There is a huge variance in the quality of clinical rotations.
One of my preceptors was a Caribbean grad from one of the "good ones."

She told me stories about how one of her main rotations ended up just being her in a room with zero patient contact. They just studied for boards.

Same thing can happen in DO or USMD schools, but I feel like in general the quality of training is more standardized the higher up the ladder you go. I go to an average state school and our rotations are incredibly regimented and frequently fine-tuned. I have a lot of frustrations with my school, but I can't complain about the variety and intensity of clinical training.

Agree. I attended an MD school and my psych/neurology rotations were just like shadowing. My FM rotation was good but it was only 3 wks instead of 6. My other rotations were ok.