First-of-its-kind Missouri law addresses acute doctor shortage

Health care prognosticators have been predicting a doctor shortage in the U.S. for some time now, but in rural America it’s already here. The problem is particularly acute in Missouri, where 110 of 114 counties have been declared underserved in both primary and mental health care.

To remedy the situation—at least temporarily—Missouri passed a law allowing medical school grads who have not yet been placed in a residency program to practice medicine, as long as they practice in underserved areas. This law is the first of its kind in the nation.

Medical school grads can’t find residencies

The law essentially creates a new category of licensed physicians—“assistant physicians.” It also addresses the shortfall between applicants for residency training programs and available residencies. Each year, there are about 40,000 doctors applying for 30,000 residency slots, so the number of doctors who’ve graduated from medical school and passed their exams, but are still looking for a residency, is substantial.

Doctors looking for a job? Counties in need of doctors? The Missouri law is one possible solution.

The solution, of course, is not ideal. Residencies of one-to-three years give doctors significant experience and mentoring before they begin to practice medicine on their own. Addressing the lack of experience, newly minted assistant physicians in Missouri must practice under the supervision of a licensed physician.

To be sure, more fully-accredited doctors is the ultimate solution. But when you have a doctor shortage today, and it takes a decade or two to correct the situation, you make do.

Many med professionals expanding responsibilities

In reality, the Missouri law is an extension of a much larger trend to fill the gaps in our health care system by expanding the scope of responsibilities for certain medical professionals. Think nurse practitioner. The success of such efforts usually hinges on whether the insurance industry decides to cover the expanded responsibilities.  Currently, some health plans credential and reimburse mid-level providers – nurse practitioners and physician assistants – while others do not.

In the longer run, we need more medical students and more residency programs. Meanwhile, laws like Missouri’s, as well as greater use of telemedicine and other team-care strategies, will have to suffice.

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