Assistant Physicians: A New Breed of Provider

Unless you’ve been living under a rock, it’s no new news there’s a physician shortage in the United States that’s expected to worsen in the years to come. Existing medical schools have worked diligently for the last twenty years to increase student enrollment and twenty nine new medical schools, along with seventeen new schools of osteopathic medicine have opened in the hopes of getting ahead of the shortage. In spite of these efforts, there is a serious problem that stands in the way of both future doctors and the state of the physician shortage- postgraduate residency programs.

Every medical school graduate must complete a residency program in order to be licensed to practice in the U.S., but because the number of federally supported residency training slots have been capped by Congress since the late 1990s, the number of residency positions have only risen by one percent in the last two decades. Statistically, there is more than a fifty percent chance that a medical school graduate won’t be matched to a residency program which leaves many rejected candidates literally scrambling to find a residency or to find a way to keep their clinical skills sharp. How can the provider shortage be improved when the odds are stacked against medical school graduates? 

In addition to the rising numbers of advanced practice providers who are ready to stand in the gap, as well as a push to pass the Resident Physician Shortage Reduction Act of 2019, one of the multifaceted approaches may lie in the licensure and implementation of a new breed of providers: Assistant Physicians.

Also referred to as associate physicians or graduate registered physicians, APs are allopathic or osteopathic medical school graduates who have not completed an accredited postgraduate residency; however, they must have passed either Step 1 and Step 2 of the USMLE (or the equivalent from a board-accredited examination), the Comprehensive Osteopathic Medical Licensing Examination, or the COMLEX and meet fairly standard requirements for licensure depending on the state in which he or she plans to practice in.

According to the Association of Medical Doctor Assistant Physicians, an AP’s role is extremely broad and flexible; and given that by the end of medical school an AP will have completed an average of 6,000 clinical hours, they can adapt to various roles in primary care settings such as family practice, general practice, internal medicine, pediatrics, obstetrics or gynecology, and in some instances, psychiatry. 

Like an NP or PA, the logistics of an APs scope of practice will depend greatly on the state. Similarly, in all the states that have passed legislation recognizing the profession and allowing for licensure, APs are required to be supervised by a collaborating physician. Within their collaboration agreements, APs can be given the authority to administer or dispense drugs and provide treatment that is consistent with their skills, training, and competence. In some states, APs can also prescribe controlled substances if their collaborative practice agreement allows for such, although they must also be registered with the DEA in order to do so. 

Depending on the state’s legislation, APs may be restricted in where they are allowed to practice. For example, the current proposed legislation in Tennessee only allows APs to provide primary care services in medically underserved rural areas of the state, in rural health clinics, or in a pilot project area that’s been established for graduate physicians to practice. On the other hand, assistant physicians in Arkansas can currently work in any healthcare setting authorized by the supervising physician and in accordance with the facility’s policies. In this state, APs are paid by the same model as PAs. 

Although there are other options for medical school graduates who don’t match with a residency, becoming an AP is a great alternative in order for these individuals to keep their clinical skills current while also an opportunity to care for patients in medically underserved areas that would otherwise have been neglected or marginalized. Furthermore, their presence in the medical community can only help improve the provider shortage. One downside for NPs and PAs, however, is that because APs must also be supervised by a physician, they may be included in the number of APPs one physician can supervise. 

So far, APs are already practicing in Arkansas and Missouri; and legislation is in the works in Utah, Oklahoma, Virginia, Tennessee Washington, and New Hampshire, with more expected to follow. 

How do you feel about assistant physicians possibly working in your practice?