Associate Physician"

[montanapup]

How many of you are aware of this? I have to say - I'm not exactly thrilled.

 

 

“Associate physician” idea comes to Washington

 

In anticipation of the legislative session, Rep. Eileen Cody (D-West Seattle) has introduced House Bill 2343 , which would create a new “associate physician” license in Washington state. The bill is modeled on laws recently adopted in several states (Missouri, Arkansas and Kansas), and allows a medical school graduate who fails to be matched with a residency to practice medicine under the supervision of a licensed physician.

Rep. Cody is bringing the legislation forward in response to concerns about physician shortages raised in recent years by the WSMA and other groups. The WSMA has been consistent in advocating for increased funding for residency slots to address the need for more physicians (and was successful last year in securing over $24 million for new residencies). While this legislation may be well-intentioned, it has the potential to cause more problems than it solves.

HB 2343 is scheduled to receive a public hearing this Friday in the House Health Care & Wellness Committee, which Rep. Cody chairs. The WSMA will monitor the bill closely.

 

[Reality Check 2]

What do you call a first year medical resident - MS4 plus one day.........................

Not okay in my book - not at all.

If a doc can't get into a residency or just chooses not to do one - why should he/she be allowed to bill as a doctor or practice as a doctor without board certification?

PAs ARE board certified with NCCPA and CAQ.

 

I hope they don't plan to do the same with FMGs.

 

What a slap in the face to residency trained docs and PAs everywhere.

 

Sad, sad idea.

[LKPAC]

I always thought that associate physician should be our title.

[OLW2018]

This is extremely demeaning to all the PAs and NPs out there that worked extremely hard to practice... Now someone who literally fails to receive residency is equal to our caliber? For those who are certified, trained extensively, and have the experience? That makes me nervous even as a patient of one of these potential providers.. I hope this bill doesn't pass. 

[PAMEDIC]

I've worked with some great GMOs who had finished an intern year, but had not done their full formal residency. They were all fantastic providers who all had different reasons for going the GMO route.
As for the APs, the law basically gives them similar privileges as PAs. The law requires that they have taken and passed USMLE Step1 and 2. They are every bit as qualified to work as supervised primary care providers as a PA would be.

 

Edit:

Reading the bill, it actually sounds like the practice restrictions for an AP are more limiting than for a PA. An example is that the law says that the SP has to be physically present at the same location and that supervision must be "continuous". There is also no mention of allowing APs to prescribe Schedule II drugs - only III and above.

[Guest Paula]

WOW!  This is for osteopathic physicians only, but it seems to mirror a scope of practice that PAs typically are under.  It is for primary care only and is limited to four years total to be able to be an associate physician.

 

I think PAs need to be wary that we are going to be replaced by associate (or assistant) physicians eventually. 

[Guest Paula]

If this passed, the question is:

 

 What happens after 4 years of being an associate physician?  Do they then qualify  to become a full fledged physician since the 4 years under supervision qualifies as a residency?  Will they be able to take step 3 USMLE? It's interesting that they don't have to pass COMLEX, but USMLE.

 

Plus, could PAs challenge them and take the USMLE steps after PA school and become associate physicians?  (the answer will be no, because we are assistants.)

 

Will be interesting to follow this new kink in medicine. 

[DiggySRNA]

Interesting. 

 

A Physician, Physician Assistant, Associate Physician, and Assistant Physician all walk into a bar....

 

 

lmao I can see the many faces being made during case presentation! 

[Torshi]

I'm curious how much they can bill for if passed. That'd be a sad thing to find out, a non-residency trained doc billing more than PA's & who are NCCPA/CAQ certified or NPs

[rev ronin]

So... they can order DME and Hospice without restrictions, right?

 

I have not heard from WAPA on this.

[rev ronin]

WOW!  This is for osteopathic physicians only, but it seems to mirror a scope of practice that PAs typically are under.

It's actually not.  The first part is for BOMS (DOs), and the second is for MQAC (MDs).  At a glance, everything appears parallel.

 

What's scarier for me is that this isn't just for US/Canadian graduates.  Any graduate form medical school anywhere could be placed into such a category, if approved by the respective board.

[Maverick87]

I've worked with some great GMOs who had finished an intern year, but had not done their full formal residency. They were all fantastic providers who all had different reasons for going the GMO route.

As for the APs, the law basically gives them similar privileges as PAs. The law requires that they have taken and passed USMLE Step1 and 2. They are every bit as qualified to work as supervised primary care providers as a PA would be.

 

This was my thought as well. Most docs in the military go the GMO/flight surgeon route (which is pretty much the same thing as "AP"). I work with a few right now. One originally matched in surgery, but decided that he didn't want to do that specialty and became an FS instead. He's trying to get into derm now. Another didn't match in EM and is doing a GMO tour. She's a great doctor, but is really set on doing this particular specialty (which is the most competitive military specialty out there).

 

In any event, the presence of these kinds of doctors definitely hasn't hurt midlevels in the military.

[Maverick87]

Interesting. 

 

A Physician, Physician Assistant, Associate Physician, and Assistant Physician all walk into a bar....

 

 

lmao I can see the many faces being made during case presentation! 

 

LOL good point. Can you imagine all of them working in the same practice? Patients will be so confused.

 

"No, I'm not an associate physician. I'm a physician assistant. Here, let me explain the difference."

[Reality Check 2]

I remain perplexed by this. If one of these "docs" doesn't have residency or board certification - how would a hospital credential them? Or an insurance company? Or are they billing under the other physician's name? 

 

If a hospital or insurance company won't credential me as a PA without my "C" - why would a non-residency trained doc get any credentials?

 

What DO these folks do after four years? Are they expecting some sort of clemency and sudden appointment to being "trained"? How does that compare to me with 25 years and perpetual certification and retesting, CME?

 

Are they required to do CME? How much? Who governs it since they don't belong to a board of any type?

 

Would a less than scrupulous doctor hire a revolving door of these docs to improve billing in a practice while ignoring a PA? Four year cycles of billing machines that are dependent on their "owner".

 

The questions abound. The potential answers frighten me…..

[rev ronin]

What DO these folks do after four years?

I would assume the implication is that they have three more chances to match into a residency, and if they can't after that, then they should probably go to PA school.... ;-)

[jmj11]

When we were children, we were taught that it is impossible to coin a new term for a medical provider because those names were given to Moses on Mount Sinai. The names given were Doctor, Nurse, Physician, Physician Assistant and Nurse Practitioner. If anyone attempted to create or change one of those names, the universe, as we know it, would start to unravel. So, you really can introduce a bill to create a new title or fix an old, broken one? 

[ventana]

When we were children, we were taught that it is impossible to coin a new term for a medical provider because those names were given to Moses on Mount Sinai. The names given were Doctor, Nurse, Physician, Physician Assistant and Nurse Practitioner. If anyone attempted to create or change one of those names, the universe, as we know it, would start to unravel. So, you really can introduce a bill to create a new title or fix an old, broken one? 

 

 

and yet AAPA has for years said name change is impossible...

 

in a few short years the "Associate Physician" has gained traction in numerous states...

 

AAPA is wrong...

[LaurelAllison]

We had our PA lobby day yesterday here in VA and this bill was one that we opposed. I think its scary that a year 4 could practice with little to no hands on clinical experience. Plus what about Rx rights? How can prescriptive authority be given to someone who is not board certified? 

 

The only state where this bill has passed thus far is Missouri and it has failed to be implemented. 

Yikes. 

[PAMEDIC]

I think its scary that a year 4 could practice with little to no hands on clinical experience. Plus what about Rx rights? How can prescriptive authority be given to someone who is not board certified? 

 

1) Where did you get the idea that a medical school graduate has 'little to no hands on experience'? They have as much or more as any New grad PA.

2) Regarding prescriptive rights... they would be working under direct constant supervision of a physician and are limited to schedule III drugs and above. This is more restrictive than a PA.

3) And though they are not board certified,they would have still taken and passed the first two USMLE steps, which honestly is probably a much more difficult test of medical acumen than the PANCE.

[Acebecker]

1) Where did you get the idea that a medical school graduate has 'little to no hands on experience'? They have as much or more as any New grad PA.

2) Regarding prescriptive rights... they would be working under direct constant supervision of a physician and are limited to schedule III drugs and above. This is more restrictive than a PA.

3) And though they are not board certified,they would have still taken and passed the first two USMLE steps, which honestly is probably a much more difficult test of medical acumen than the PANCE.

 

It depends on the program, I think.  I would bet that MS4s have 2000-3000 hours of clinicals under their belt, similar to most PA programs.  However, they are training differently than we do - they are not preparing to hit the ground running upon graduation.  They are prepared to hit the ground with 2 levels of residents checking up on them *and* and attending physician.  We are preparing to hit the ground running essentially as a senior resident with only our attending as backup.  We are designed by training to be the decision makers, they are designed by training to continue learning to become decision makers.  I'm not saying MS4s lack good judgment, but the training and goals are different and they are not designed to be what we are designed to be. 

[JBH11]

It depends on the program, I think.  I would bet that MS4s have 2000-3000 hours of clinicals under their belt, similar to most PA programs.  However, they are training differently than we do - they are not preparing to hit the ground running upon graduation.  They are prepared to hit the ground with 2 levels of residents checking up on them *and* and attending physician.  We are preparing to hit the ground running essentially as a senior resident with only our attending as backup.  We are designed by training to be the decision makers, they are designed by training to continue learning to become decision makers.  I'm not saying MS4s lack good judgment, but the training and goals are different and they are not designed to be what we are designed to be. 

 

What is different about our training that allows us to "hit the ground running"? I'm a first year PA student but I've always been under the impression that PA students and medical students had the same roles during their clinical years. 

[Acebecker]

All through my training I was mentally preparing to bear the responsibility of my patient panel.  My preceptors prepared me for this, the docs I worked with were excellent and understood what we do.  PAs are designed to work as part of the team, but we bear a disproportionate amount of responsibility compared to interns.  The intern year is largely where MS4s incorporate their training and rubber begins to meet the road.  PAs are expected to operate at a higher level than that from day 1.  My story is that as a 2nd year PA student I was expected by my preceptors to carry a patient load like an intern would in the inpatient setting.  Pre-rounds on my own, rounds, order and interpret imaging and labs and document, etc.  In the outpatient setting, there were days when I would carry the whole patient load for the day.  MS4s don't do that.  I  had *great* preceptors and while not every PA student has this experience during training, it is not out of the ordinary. 

[PAMEDIC]

My experience working with GMOs is that their knowledge and experience tends to be superior to any PA fresh out of school. When the PAs have a problem or a question, the GMO is the first person they turn to.

[rpackelly]

GMOs in the Navy have had an internship.  Big difference......

 

Medical students are these days not permitted to do very much and never make independent decisions.  Big difference from 30 years ago. 

[rpackelly]

Also, medical students in the 3rd and 4th year have vacations, leave for residency interviews, have "research" rotations and several generally easy rotations in their 4th year (EKG reading, radiology, electives) where they pretty much shadow and are frequently dismissed early from call nights.   It would be extremely unusual for a medical student to do 4000 clinical hours during those two years.   They do tend to do one 'sub-internship" in an area of interest where they have some responsibility although they are carefully supervised.