Regulatory Reform

States Help Solve the Physician Shortage Crisis

The physician shortage crisis has no clear end in sight. Earlier this month, the American Association of Medical Colleges released a study estimating a shortage of up to 124,000 physicians in the US by 2034. According to the Department of Health and Human Services’ Health Resources and Services Administration (HRSA), 84 million people currently live in areas with too few primary care providers. In order to close the gap, over 15,000 primary care providers are needed.

In response to this need, many states are taking action. One innovative approach that addresses both the primary care shortage and the residency gap involves medical school graduates. After completing medical school and the first two steps of the United States Medical Licensing Examination, medical school graduates must participate in a medical residency before being fully licensed to practice medicine. Of all qualified applicants to medical residency programs this year, over 8,000 were unmatched with a residency, 23% of the total applicant pool.

In 2017, Missouri became the first state to give these graduates who lacked a residency the ability to work. Jeff Howell, the Executive Vice President of the Missouri State Medical Association told Marketplace News that “we have medical students that are graduating, [so] rather than have them drive Ubers for a year, before they can attempt to match again, [we] allow them to have some clinical experience.” The state’s Assistant Physician (AP) licensure option is what makes this possible.

The AP option allows unmatched medical school graduates to work with a fully-licensed physician in collaborative partnership. At first, the physician must be “continuously present” with the AP. After at least a month, the AP continues to practice under the authority granted by the supervising physician, who reviews at least  10% of all cases and 20% of cases where controlled substances were prescribed. They are only allowed to practice in underserved areas, guaranteeing that they are filling a need rather than over-saturating a particular market. The Missouri law states that patients still have a right to see the practice’s physician, if they so desire.

The Primary Care Coalition reports that medical school graduates have 6,000 clinical hours upon medical school graduation coming from their clerkships and clinical rotations in the last two years medical school, along with their first two years of classroom studies and 4-year undergraduate degree. This knowledge is demonstrated, in part, in their completion of two steps of the medical licensing exam. By comparison, a licensed Physician Assistant is required to have only 2,000 hours of clinical rotations and three years of advanced schooling culminating in a multiple choice certification exam.

This licensure for medical school graduates is not unique to Missouri. Arkansas and Utah have both passed similar legislation, calling the position a Graduate Registered Physician and Associate Physician, respectively. This year, Arizona also passed legislation. It allows a “one-year transitional training permit” for unmatched medical school graduates.

States are the laboratories of democracy and often lead the way with innovative solutions. In this case, the physician shortage crisis will only get worse unless something is done. In order to provide people with the care they need, states are taking advantage of the resources they have, such as medical school graduates. Allowing and encouraging them to put their knowledge, skills and experience to use in underserved areas may just save some lives.


In Depth: Regulatory Reform

In his first inaugural address, Thomas Jefferson said that “the sum of good government” was one “which shall restrain men from injuring one another” and “shall leave them otherwise free to regulate their own pursuits of industry.” Sadly, governments – both federal and state – have ignored this axiom and …

+ Regulatory Reform In Depth