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JEFFERSON CITY, Mo. — Numerous additional doctors from around the US could become eligible to treat patients in Missouri’s underserved areas as a result of a planned expansion of a first-in-the-nation law aimed at addressing a pervasive doctor shortage.

The newly passed Missouri legislation would broaden the reach of a 2014 law that sought to bridge the gap between communities in need of doctors and physicians in need of jobs. That law created a new category of licensed professionals — “assistant physicians” — for people who graduate from medical school and pass key medical exams but aren’t placed in residency programs needed for certification.

But it took nearly 2½ years before Missouri finally began accepting applications on Jan. 31. By then, some applicants no longer qualified because too much time had lapsed since their medical exams. Missouri’s new legislation seeks to turn back the clock, so those who became ineligible during the slow roll out can still get licensed as assistant physicians.


Supporters hope the legislation, if signed by the governor, will help jumpstart a program that has been promoted as a model for other states.

“We’ve been trying for years to address our maldistribution of physicians in the country. We have all sorts of incentive programs and all sorts of ways to try to get them to go out to Podunk, but a lot of them just don’t want to go to Podunk,” said Missouri Rep. Keith Frederick, an orthopedic surgeon who sponsored the assistant physician law.


“This bill takes folks that very much want to ply their trade — they just want the opportunity to provide patient care — and the bill requires that they serve in an underserved area,” Frederick added.

Nearly 6,800 places in the US are short on primary care physicians, from particular medical clinics to certain urban communities and entire rural counties, according to the US Department of Health and Human Services. Of those, 225 are in Missouri — a disproportionately high amount compared with the state’s population.

Since Missouri’s original law passed, Arkansas and Kansas approved slimmed-down versions, and Utah enacted a similar measure this year. Lawmakers also have considered similar programs in Oklahoma, Virginia and Washington.

Missouri’s assistant physician license is available to all legal US residents who graduated from medical school within the last three years and passed the first two rounds of medical licensing exams within the last two years. It lets them provide primary care in “medically underserved” areas with the supervision of another physician. People can work as assistant physicians indefinitely, essentially sidestepping traditional residency requirements.

So far, 127 people have applied for Missouri’s program. Just 23 have been issued licenses while 55 have been deemed ineligible and 44 remain under review.

Dr. Tricia Derges is among those who have been excluded because the state took so long to implement the program.

Derges sold her candle manufacturing company about a decade ago to enroll in medical school. She said she completed the second step of the medical exam in January 2014 and graduated from Caribbean Medical University in Curacao three months later. She didn’t get matched with a residency program.

Derges nonetheless opened a clinic for the homeless and poor in Springfield, believing she could get licensed as an assistant physician. While waiting for that license, she has relied on other physicians to volunteer their services.

Derges said her assistant physician application was denied because more than two years had passed since her medical exam. The new legislation could allow her to reapply, and to potentially expand her clinic.

It “will save a lot of people’s lives,” Derges told The Associated Press.

The bill also was championed by state Rep. Lynn Morris, a pharmacy owner who said the expanded program could save people long drives to see doctors.

It’s “a commonsense approach to help take care of a crisis we’ve had,” Morris said.

— David A. Lieb

  • An experienced physician can be very valuable, because he/she encountered different complicated cases through the years practicing as a doctor. I practiced more than 15 years and passed the USMLE exams with very high scores, but unfortunately because of “these years of experience” , I wasn’t match for residency and right now I can’t work at least as a GP. Using physicians like me will save thousands for health care system, because they don’t need to spend money for training us!!!

  • Very sad …always the bureaucrats make simple things complicated….
    The solution should be create a state commission that regulate the medical practice….. for these professionals …that could work for a modest salary …not for the 120k that make a family practice.
    Other solution is give the opportunity to people to decide …?

  • Dear Sir,
    I am an IMG with ECFMG CERTIFICATION in feb 2017, registered for step 3 in March 2018. I have 10 plus years of clinical experience in Family medicine /Emergency medicine outside USA with out any gap. Currently living in Dallas and working as a faculty teaching Anatomy PHysiology in Fort Worth TX along with managing a Dallas physicians Clinic as a medical assistant and a office manager.
    In addition to that I am also a medical Technologist certified by AMT Liscence no 2827939.
    Sir I am very much interested in getting assistant physicians license in MO.
    Kindly advice.
    Taha ahmed.

  • I just want to point out that this law is not reserved for foreign medical graduates. Some of us, who completed med school & passed the required boards in the US, simply did not match. Or as in my case, I did match. But I was forced to quit due to severe health problems of my own. I was only able to complete 6 months of my residency program. The problem is, getting back into the system is not likely. I live in an underserved area & truly wish that my state had this law…

  • Give the healing person an opportunity and he/she will developed the skills to progressively manage more and more complex situations better yet if basic education and training have been provided as well.
    It is great that technically speaking someone with three years of medical education PA Program referred could have accomplished in probably state-of-the-art medical setting what others do with a little bit of it and tons of respect, appreciation and dignity for the healing sciences, their practitioners and the public from which we are all part too.
    Healthcare professionals around the globe use to engage in more sensible and productive talks in their blogs and other media platforms allowing you to join without resentment, friendly and enthusiastic constructive ways to learn from each others.
    Please consider the person, time and place around this and any topic and you will have a better picture. That’s where you go with medical education to a complete approach to patient needs and secure roads to optimal solutions. The PA never mentioned if out of the super skills, at least to him and his apparently absent supervising licensed physician he may have mentioned there were unexpected outcomes.
    Some Non developed countries have better health indicators in critical areas of healthcare than US, because they have better human values in their medical professional workforce. They practice Medicine to save lives and or improve their quality starting with the passion to do so.
    Many of the leading Doctors and Nurses in human history have not been the followers of broken/fragmented medical system, but the challengers, fighters of the obsolete and creators of the new, brave enough to pursue it against a stuck establishment usually represented by managers of conveniences and not the circumstances.
    May your years of retirement allow for math exercising and puzzles and finally realize that the unmatched pool of Doctors grows bigger and bigger and so their debt and lives issues as less Residencies are given, then do yourself the match between the actual physician workforce demographic/distribution and the population they serve.
    Regardless of our titles we are all in one side of the equation and the establishment on the other. If you pick a fight against any of yours that easy who can assure the patient who could be anyone of us will receive an optimal care he/she deserves?

  • assitant physician are having medical degree and are MD.They went to medical school for 6 years and are well trained in the foreign conutries not only that they already passed their USMLE WHICH IS LICENSING EXAM FOR both us and international medical graduates some of them had post graduate training in their countries and most them already certified by ecfmg and are exellent compassionate doctors and the law has already made and already licenses issued it is greatest chnage in medical care in america and i hope this law will sweap all over the nation to bridge the gap to serve the underserved population of USA .And they will be working under supervision of collaborating physician i hope they will be very good doctors will be proving care to american people.

  • NO. NO. This is wrong. I don’t care how they try to make it sound good, it’s wrong. Why are they making up a new profession and unleashing them, untested, incompletely educated to provide healthcare to the unknowing rural population, instead of hiring an already available medical providers, Physician Assistants, who are licensed, Board Certified medical professionals? Or nurse practioners who also provide healthcare.

    First, these people haven’t completed residency, so their education isn’t complete and to just make up a name which closely resembles that of a proven recognized profession is wrong and deceptive.
    Leave it to a poor, deep southern state to try something such as this.

    Assistant physician? Who are they assisting? Why another medical profession? There is already a legitate profession, Physician Assistant; board certified medical providers. PAs serve people throughout the country in all areas of medicine, including rural areas.

    Our profession was begun by Dr Eugene Stead over 50 years ago to help meet the needs of the underserved public. ( I’m a retired PA). Following undergraduate education and medical experience (frequently pharmacists, paramedics, physical therapists, nurses etc) PAs are educated in medical schools along side medical students, for the equivalent of 3 years of medical education. We graduate with Masters or Doctorate degrees.

    Following PA school, we sit for National Board Exams to become certified. We must retake these boards every 10 years.

    We work with physicians, in all areas of medicine and surgery. We most frequently work independently but always have a supervising physician with whom we can contact fir consultation whenever needed. We are widely used throughout the community, the VA system and the military. PAs are on the medical staff in the WH.

    So if these Missouri citizens need medical providers, why not hire PAs … or Nurse practioners who also serve in similar capacity as PAs? Their education is somewhat different as they are trained in the nursing model vs the medical model but essentially provide similar medical care. They frequently serve in rural areas.

    Dont make up a new profession with a title that can be confused with a licensed, board certified professional medical provider, Physician Assustant. The citizens deserve better care.

    • The answer to your requests is you
      First of all, your degree was an extra degree that has no clear role in the medical practice. The nursing system is far way more useful than the PA. Second the system uses P.A. because 2 major reasons, 1- lower salaries, 2- less lawsuit.
      You studied a medical study nut the level of that study you got is much way less than the medical school study. The experience you got and will get deals with that study, which is very limited.
      I know overseas medical graduates with skill and experience that would put them on top of the list, but because of the shady residency system which depends on connections and does not even look at how they are experienced makes them losing their chances in getting into residency.
      There are couple studies gave statistics that foreign medical graduates’ patients have less mortality rate than patints of doctors who did the mdical school here in the US
      So please if you have a personal issue toward doctors do not share it with others.
      Then there is another issue with the P.A.s, these areas with shortage of docotrs usually need medical staff who has full knowledge about the health and the body, because they do not have the specialists who can deal with their conditions, so they depends on the primary care providers to deal as much as they can with their conditions without any referrals, and because of the limited exposure of the P.A.s to the wide medical knowledge they can not handle these conditions, and can not deal with patients who have multiple disorders at the same time.
      And by the way this law is applied all over the world, the Drs can practice as what they call it “General Practitioner” M.D.
      Canada, U.K., Australia, Ireland, Newzealand, otherwise they would not be able to cover the requirement of the patients needs.
      Finally, these doctors stated in this law are done with already qualified medical school through the ECFMG system which is the system that evaluate there medical schools and their M.D. degrees, after that they have to take 2 emaxs, technically 3 exams because second hexam is 2 parts, and many of them took even step 3 exam, and usually their acheivement is higher than graduates in U.S.
      By taking these exams they are M.D. titled in U.S. because these ECFMG processes and exams will appraise their degrees to an American M.D. degree.
      A quick question, how many patients can the P.A. legally cover and whta variety of cases they are allowed to cover? And can the doctors do?
      So please before being judgmental, try to know more

    • –MO

      Your final questions are senseless. If you are as deeply apprised of modern medical practice as your attempt to proclaim, you would know the answers. Instead you attempt to paint in poor light a profession which has served the underserved in this country since inception. However, allow me to answer so the public reading this can have an enlightened understanding. 1) A PA has no limit on the number of patients they treat. Just as there is now law capping a physicians patient panel this no law capping the PA panel. I don’t say “well thats patient 102, I am going to have to lose two patients today.”
      2) As a Cardiothoracic Surgical PA I take care of patients in all settings of care. I independently harvest conduit in the OR for bypass surgery, and first assist in cases. I provide care in our cardiac ICU independently, including invasive procedures (Arterial line placement, Central line placement, Chest tube insertion, Swan Ganz insertion, etc.) I see patients on our floor, discharge them to home, preform consults, take follow-up calls from patients at home or in rehab centers and see patients in the clinic as outpatients. There is no law saying this case is “too difficult” for your to take care of, they can only be seen by a physician. I competently care for patients with many conditions; including the coding patient who need an emergent resternotomy — yep I reopen chest in a coding patient who needs urgent access to internal cardiac massage, internal defib or release of tamponade as an example. Or the IV drug abuse endocarditis patient with roaring Mitral regurgitation who tanks in the middle of the night with multi organ failure, sepsis and respiratory failure who needs a ventilator, pressors, and dialysis access. Oh yeah– thats all in the middle of the night when no physician wants to be bothered to be there to manage the patient. If a patient is complicated or has an problem which I do not manage I do the SAME THING a physician does– consult the provider who does provide that care. Patient in renal failure needing possible dialysis — I call my Nephrologist, patient needing AICD or PPM – I call the EP department. Your attempt to delegitimize the entire PA profession by trying to outline patients who cannot be cared for by a PA is ridiculous. Thank you for allowing me to educate the public after your thinly veiled attempt.

    • I don’t know when being anice IMG board certified physician is less than being a PA of NP . Please inform yourself about the medical education in other countries before saying that the education is unfinished. In my country for example, you are able to touch patients since first year of medicine and on the 3rd year you have already at least 30 patients that are under your responsibility. That is a huge different in the American system where during your medical school you are just an observer . Thanks

    • Sad that you spent so many years in the medical field yet have absolutely no idea on how in-depth physicians are trained before they even start a residency. Compare an MD to a PA education is a joke. Please try again. One has twice the basic sciences and clinical skills and only about 1500 more standardized questions on 4 different exams compared to one time 4 hour PANCE where your scores dont even matter lol.

    • The citizen deserves better care than a bunch of PA want to be doctors. How many clinical hours did you get before you actually prescribe medication? 1500 compare to a doctor which typically get around 6000? How many board exam did you pass? just one, and your scores don’t matter. And you don’t have an entire world competing for a limited amount of PA license. Talk to me when you get a real education.

    • I dont understand why you believe that an MD who graduated and passed the USMLE license exam cannot see patients in a similar way that a PA and NP could? The education and training is intense. How could you assume that a PA is more qualified than a MD? That is ridiculous. Its absurd. You have no good argument at all. This could be the solution to many problems including bullying within residency programs and the funding required to open more residency spots. This could help many people. This is a wonderful solution. Absolutely brilliant. Finally some redemption for those of us whos talents and training have been wasted by dumb regulations that make no sense and prevent access to healthcare. It may also save lives by prevention of suicides. Mr. PA. You didnt go through residency either so why would you claim that a MD who didnt complete residency is untrained? Its not true.

  • Lucky you Missouri! You get undertrained poorly qualified doctors from sketchy med schools because your state has become a hellhole no one wants to live in

    • That’s not a fair statement at all. In fact I personally know two American citizens who had Ivey league educations but changed careers later in life and went to med a school in the Caribbean and didn’t end up matching into a residency. Look at the stats, it’s a fact that more med students are graduated then there are spots. Plus practicing physicians from other countries are applying to US residency programs as well. The system is broken! It’s not that the men and women that didn’t match are dumb or unqualified, it’s that there aren’t enough positions for them to complete graduate medical education. Many of us could never even get through medical school…so in my opinion if you can graduate and pass the usmle exams you should get a spot in a residency somewhere. I think this Missouri plan is a fantastic idea because so many of these unmatched physicians are hundreds of thousands of dollars in debt and have far more drive than the students that everything was handed to on a silver plate!

    • They’ve passed the standardized exams. While they may be undertrained, that does not mean they are poorly qualified. Besides, when they are getting absolutely no treatment, something is better than nothing, no?

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