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Missouri Creates Unique Medical Classification: Assistant Physician

Adrian Clark


Missouri now boasts a new category of medical licensee: assistant physicians.

Despite strong opposition from some healthcare groups, Missouri Gov. Jay Nixon on Thursday signed into law a measure that would allow medical school graduates who have not completed residencies – or even obtained medical licenses — to practice medicine.

Nixon, however, issued signing statements warning of the need for additional safeguards to ensure that patients are not placed in jeopardy.

“Considering that this new category of licensure would make Missouri unique among states and would embark upon unchartered waters in providing health for Missourians, it is imperative that there be comprehensive and rigorous oversight and regulation of such ‘assistant physicians,’” Nixon wrote.

The law allows medical school graduates who have passed licensing exams but not completed residencies to practice primary care and prescribe drugs in rural and underserved areas of the state. They would be overseen by licensed physicians, who would have to be physically present with them for a portion of their tenure.

More than a fifth of Missourians, especially those who live in rural areas, don’t have adequate access to health care, according to the Department of Health and Human Services.

The assistant physician measure drew the support of the Missouri State Medical Association, which said it could help attract medical school graduates to Missouri. But it was strenuously opposed by the American Medical Association and the Missouri Academy of Physician Assistants, which represents members of a similarly named but long recognized type of health provider.  

“We’re not concerned about the idea that this is somehow going to put a damper on PA practice; it doesn’t,” says Ann Davis, a vice president of the American Academy of Physician Assistants. “But we are concerned about the confusion for patients and the fact that this is an untested model.”

Physician assistants have been around for more than half a century and are authorized to provide a variety of medical services, including taking health histories, performing physical exams, ordering X-rays and laboratory tests, and treating various patient health problems.

Unlike the newly created assistant physician, however, they cannot call themselves doctors.

The two Senate bills creating licenses for assistant physicians also contained other public health measures. One extends Missouri’s Rx prescription drug program until August 2017. The program pays half the out-of-pocket prescription drug costs for lower-income seniors who are covered through Medicare Part D.

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