HLM: But we value foreign medical school education do we not?
Nasca: The assumption that medical school education is the same outside the United States as inside the United States has not been proven.
HLM: Why don't we have more U.S. residency slots?
Nasca: They're supported by and large by federal funding of residency positions, the number of which has been capped at 1998 levels. The number of slots has gone up slightly because hospitals will fund those internally, but it hasn’t gone up dramatically.
The response from the state of Missouri, if it has an inadequate number of formally trained physicians, should be to create more graduate medical education programs.
Missouri is just looking for a way out. A better example is Utah, which has the same shortage problem. But Utah has decided to fund residency programs independent of federal money. And they're now producing more doctors to serve their state.
I'm not minimizing the challenge of getting medical care to rural populations. But I think the state has responsibility to do things correctly.
HLM: These assistant physicians would be supervised by a collaborative physician on site for 30 days. After that, the assistant physician could practice within 50 miles of his or her collaborating physician. What's wrong with that?
Nasca: Think about that, they're 50 miles away. Who's supervising what they're doing? That level of supervision would not be permitted for any resident even up to seven years into a residency training program. Yet we would allow individuals with no training to have that degree of distant supervision? That's not just no oversight, it's inadequate in the extreme.