Care concerns emerge from Missouri's 'assistant physician' licensure program

After the Missouri legislature created a category of physician licensure to curb primary care physician shortages in rural areas, researchers are concerned these assistant physicians' low first-time pass rates on licensing exams could lead to worse clinical outcomes, JAMA reports.

The assistant physician must be a citizen or legal resident of the U.S., a graduate of a recognized medical school, have English-language proficiency, have passed steps one and two of the U.S. medical licensing examination and not have finished a residency.

Assistant physicians are limited to providing primary care services in underserved areas and can only practice under collaborative practice agreements with fully licensed physicians. They have a scope of practice and responsibilities consistent with physician assistants and advanced practice nurses.

To assess the qualifications of assistant physicians and the care quality they provide, the researchers looked at data on all assistant physician licensees from Jan. 1, 2017, through Dec. 31, 2017, from the Missouri Board of Healing Arts.

The researchers raised concerns about assistant physician licensure based on assistant physicians' first year of experience in Missouri. 

The study found assistant physicians were considerably less likely to have passed steps one and two of the medical licensing examination on the first attempt than all graduates of U.S. medical schools from 2012-16. Failure of step two is linked to increased disciplinary action and worse clinical outcomes, the researchers said.

Only 25 percent of the licensees had secured collaborative agreements during the first year, meaning they were the only ones who could practice. Additionally, despite requirements that the collaborative practice be in underserved areas, 20 percent were not in areas facing a primary care shortage.

The study is limited by a lack of data on licensees, practice settings and employers as well as the fact that data was available only for one year, the researchers said.

"Future research should study the quality and safety of the care that assistant physicians provide and their clinical roles and career path, as well as patient perceptions," the researchers wrote. "The Missouri legislature recently broadened the licensure beginning in 2019; however, it is unclear what effect these changes will have."

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