Assistant Physician Update

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN

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John B. -

We have this already. It's called a physician assistant!

Norman P., M.D. -

As a Missouri (UM-Columbia) grad, this is due to the fact that it’s common to leave med school with >/= 1/4million in debt. Rather than address the problem of med school costs, it seems that the gov’ner has decided to try the ‘band-aid’ approach. It will not bode well for the patients.....

jonathan b., pa-c -

FD may be a more suitable name =

Fake Doctor

Chuck S., M.D. -

Interesting was supposed to be for very limited time initially (1yr then 3 yr) then when passed whoops no limit to time. Sounds like the old days when the ED was staffed by us medical students.

Joshua E. -

It is an interesting idea to try to fill a void in their healthcare coverage. A couple of thoughts on this issue. To restate the obvious, this is not ideal for patient care. However, these students will receive more rigorous training and be more prepared to take care of patients then ARNPs coming out of training; so if you are against this proposal than you should be against any ARNPs functioning solely (which I am) to take care of patients. They both undermine physician training. Along those lines, I am curious on the billing issues. Lastly, since Missouri is going through with this regardless of the flaws, they should really set up some sort of "residency program", mentoring program, or CME program.

Megan M. PA-C -

I can't believe that these med students or technically interns are let loose after 30 days of supervision. Aren't these unmatched med students unmatched for a reason? As a PA, there are even stricter laws on us of how we can practice however we tend to pick up our trade a lot quicker granted under the supervision of a supervising physician. In the first year alone I learned so much from my supervising physicians, fellow PAs, and nurses. I would not have been able to do it without them. I cannot imagine being out there on my own trying to provide care for these patients. I imagine that can be overwhelming and subsequently miss things with patient care. I wonder what confusion will come out of the assistant physician/physician assistant/advanced provider. It's bad enough that patients still don't understand what a physician assistant is and requires constant education on my part to teach them.

James H. -

I can speak to something very similar. I have been practicing solo (primary care) for the past 3.5 years with only an intern level of training, however, with a limited patient spectrum - active duty military.
Even during my first year or two solo, I depended on the guidance of senior physicians at the clinic who were board certs in FP for a sounding board to bounce questions off of.

I can tell you this - the concerns in the podcast and posted above are real and very founded.

This system will work only with the following in place:
- A year of internship or a year being tightly supervised, not just a month.
- A more senior physician in house or very close by for support if needed even after a year of supervision.

Australia has something similar to this to fill the void in primary care and the Navy still utilizes physicians with an intern level of training to provide primary care in the operational setting to active duty Marines and Sailors (General Medical Officers, Flight Surgeons and Dive Medical Officers).

A better model would be a larger county clinic with several assistant physicians and a few supervising FP or IM docs. Yes there are already PAs out there but there is still a shortage in PCMs/PCPs. This type of concept can help fill the shortage but does not seem well thought out and would need adjusting for the obvious reason already stated - patient safety.

BTW there are several other physicians like myself that I work with and I do think that loneliness would be an issue if solo.

E Gail T., PA-C -

This is a recipe for disaster not only to the patient but also to my profession as a board certified PA in Emergency Medicine. These Assistant Physicians will be confused with a PA by not only the patient but also by the medical community. It will continue to muddy the water as to who or what you are as a practitioner. Patients still have to be educated daily as to my profession and cope of practice and I've been practicing in EM for 22 years. It surprise me also that my prescribing rights are limited yet someone with only 30 days of training with a senior physician gets full prescribing rights.

Michelle S. PA-C -

From what I understood from the pod cast, they only have schedule III-V. As a PA, most states give us schedule II Rx rights.

Evan S., M.D. -

The bill was actually written by a physician member in the legislature and supported by the MSMA. The Missouri College of Emergency Physicians did speak with the sponsor of the bill, and we expressed our concerns, many of which were discussed in the EM:RAP segment. While the bill has been passed, I don't believe anyone has been licensed yet as the board is still trying to figure out all the requirements and some have been trying to make the bar for licensing very difficult to prevent implementation of this. The other area where it will be interesting to watch is if anyone wants to take the responsibility (in addition to the legal responsibility) of training someone for such a short period of time and then letting them practice independently while still being responsible for them.

James P. -

I think it's a big leap to say these individuals will be working in the ED. After all, hospital bylaws and group standards will prevent that part from happening. There would obviously be a problem if that started to happen. That said if supervised even remotely I would not have a problem with them seeing routine clinic patients and punting patients with an acute problem to the ER or their residency trained supervisor. I would also push that these individuals continue to apply through the match to obtain a position and cap the number of years ie 1-3 that they could practice in this this way.

J. B. L., M.D. -

We already have this in Israel. The physician is trained to know red lights and there is an attending aviable 24 hours to answer questions. better than folk medicine , paramedics practicing medicine and other falied solutions to underserved areas. It may work

Justin R., MD -

I agree this would be a dangerous alternative to residency trained physicians practicing and patient care would likely suffer. However, the only difference with these physicians and NP's/PA's is that these physicians have two more years of training/medical studies before they begin practicing. So I agree with Joshua E., if your against these physicians working then you should also be against NP's/PA's working in this same setting. I work at a main level 2 referral facility in a rural Midwest state that sees many patients who are strictly managed/treated by mid-levels with no physician oversight.

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