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Doctor Shortage 'Fix' Is a Disaster Waiting to Happen

Cheryl Clark, for HealthLeaders Media, July 10, 2014

'This Is Nuts'

"The magnitude of the potential for harm is so striking, it's hard to put into terms," says Thomas Nasca, MD, CEO of the Accreditation Council for Graduate Medical Education. In the third and fourth year of medical school, students have only four months of experience evaluating patients, yet "the scope and diversity of diagnoses is measured in the thousands.

"These are physicians with rudimentary experience. But you'll then turn them loose to manage patients with complex diabetes, congestive heart failure, arrhythmias? Malignancies? This is nuts."

But the bill's proponents, including the Missouri State Medical Association (MSMA), which represents some 10,000 practicing Missouri physicians and helped draft the legislation, say Bravo! Allowing these new physicians to treat patients who otherwise have miserable access to care is a brilliant solution to a dire physician shortage.

After all, Missouri last year received a federal designation as one of the 10 most medically underserved states in the nation. Acknowledging that many more doctors are needed to treat thousands of newly insured, Jeffrey Howell, the MSMA's government relations director and general counsel, insists the pending bill does not set up a different standard of care.

Only Worried About Competition

"The people who are objecting to this are only worried about competition. They can talk about standards of care, or what happens if someone gets hurt all they want, but all this really just boils down to competition," Howell contends.

"You can help people in rural areas by thinking outside the box, and come up with solutions, or you can continue to allow those people to not get care. We prefer Option A."

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25 comments on "Doc Shortage 'Fix' Is a Disaster Waiting to Happen"


Mike (7/30/2014 at 2:49 AM)
Anne Walsh's "There is a reason your "assistant physicians" can't pass their boards (Step 3) or get into a residency program (many spots in primary care go unfilled each year, and still, programs would leave them unfilled and lose federal money rather than accept these marginal applicants???)" comment is completely false. Medical graduates are not required to take step 3 of their boards until after their first year of residency training. Many medical school graduates HAVE passed step 3 of the U.S. licensing exam are still unable to obtain a residency position. There were 40,000+ applicants last year for 29,000 first AND second year residency positions. These applicants passed all required exams. A limited number of residency positions go unfilled because many positions can go to different departments. For example many preliminary surgery positions go unfilled each year and are converted to obstetrics or internal medicine residencies. Currently, Physician Assistants are not required to attend any type of residency training. If Physician Assistant's were required to complete a mandatory residency with 20,000 qualified applicants and 15,000 applicants each year, I think nurse Walsh would rethink her negative comments regarding graduate doctors. Implying that any 4-6 year medical school graduate who has passed all 3 required exams to attend residency training (USMLE step 1, step 2 clinical knowledge, and step 2 clinical skills) is substandard to a Physician Assistant who receives 2 years total of training and passed only 1 exam is just silly.

Amy (7/29/2014 at 3:36 PM)
I think it is a great idea as there are competant,intelligent doctors who miss out getting into residency.Off course some are not[INVALID]-but in the residency program too some are not to the par and get in. I think medical students are very smart and study hard and it is un fortunate dont get into Residenct

Anne Walsh, MMSc, PA-C, DFAAPA (7/27/2014 at 5:40 PM)
To Eugene, who knows "for a fact that they can diagnose way better than a PA or a NP" - you apparently don't read enough healthcare research (or even just browse any of the dozens of daily-weekly-monthly [INVALID]s from a variety of professional medical organizations) to know that your anecdotal statement has no basis in fact, MOST ESPECIALLY in primary care and in chronic disease mgt. PAs and NPs, state licensed and nationally certified, have long provided high quality medical care that is at minimum equivalent to, and often, superior to, that of physicians, usually at lower cost; this statement is backed by extensive research over the 50+ years of our professions' existence. There is a reason your "assistant physicians" can't pass their boards (Step 3) or get into a residency program (many spots in primary care go unfilled each year, and still, programs would leave them unfilled and lose federal money rather than accept these marginal applicants???). Shame on you for supporting any legislation that perpetuates healthcare disparities, only serving to KEEP the medically disadvantaged, disadvantaged! The solution to Missouri's problem is simple: adopt the same practice laws for PAs and NPs found in other states, where we are able to actually do the job for which we are trained. The PA profession was created BY PHYSICIANS in the late 1960's specifically to address the primary care physician shortage by teaming us up WITH a physician. We actually do a great job when allowed to do so; the vast majority of my patients (in 15 years of practice) prefer to see me for their visits, rather than my excellent supervising MDs, even when I insist they schedule with the MD because of complicated issues. Why? My superb medical training and clinical experience (which by the way tells me there is a whole lot more to quality medical care than "diagnosis"). In fact, the "diagnosis" can often be made by the patient herself searching the internet; oh, that medicine, particularly primary care, were as simple as "diagnosis." I am a Family Medicine PA and a medical school faculty member in California, a state that well-knows how to effectively use PAs and NPs in their abundant healthcare shortage areas. I was born, raised, and college-educated in Missouri, and my entire family still lives there - some in rural areas. This new law makes me embarrassed for and ashamed of my home state, and scared to see what the healthcare future holds for disadvantaged Missourians...God help them all.