Assistant Physicians / Associate Physicians
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Assistant or Associate Physicians (APs) are Physicians or medical school graduates who have not undergone residency training. The AP license is a newly crafted healthcare provider license type in the United States of America (USA). APs are medical school graduates who have not undergone residency training but have completed three out of four United States Medical Licensing Examinations (USMLE). APs are eligible to enter residency training based on their academic qualification, clinical training, and medical competence as assessed by national level standardized examinations. APs are physicians and abide by the ethics, art and science of medicine, analytical skills, and critical thinking, similar to their counterparts who have completed residency training.
BACKGROUND[edit]
Assistant or Associate Physicians (AP) are Physicians and healthcare professionals with a doctoral level degree in Doctor of Medicine (MD/MBBS) or Doctor of Osteopathy (DO). APs are physicians who have graduated from a medical school program and completed Step 1, Step 2 CK and the now obsolete Step 2 CS exams of the United States Medical Licensing Examinations (USMLEs), but have not completed or currently enrolled into an ACGME accredited residency program in the United States. APs are considered as mid-level healthcare providers for billing and all other purposes. The one unique characteristic of the AP statute, depending upon the state, is that APs are permitted by law to use the terms "doctor", "Dr.", or "doc" when identifying themselves to patients. As conventional wisdom would go, they are also obligated to inform their patients that they are “Assistant Physicians" and not fully licensed physicians.[1]
HISTORY[edit]
The “Assistant Physician” law has been passed and implemented in many states at various times. Moreover, the AP profession is known by various names in various states (Associate Physicians, House Physicians, etc.). However, the main AP movement was driven by a law passed in the Missouri state legislature (334.036). The AP law was sponsored by Rep. Keith Frederick (R-MO, District 121) [2]. The origins of this law dates back to the Missouri State Medical Association (MSMA),[3] who had drafted the concept of a mid-level healthcare provider license for medical school graduates without residency training. The idea was to utilize these graduates in addressing the rising need of primary care services in Missouri. The original bill H 307, was introduced in the Missouri House of Representatives on February 12th, 2014, by Rep. Frederick (R-MO, 121) and was passed to go into effect on August 28th, 2014 [4]. Even though it was passed and signed into law, it faced resistance and lobbying from other healthcare organizations. Due to this, AP licenses were not issued by the Missouri Board of Healing Arts until January 2017. A 2017 amendment (HB 330) sponsored by Rep. Lynn Morris (R-MO, 140) and co-sponsored by both Keith Frederick (R-MO, 121) and Jim Neely (R-MO, 8) made some structural changes to the eligibility criteria, which opened the opportunity for medical graduates to apply and acquire the AP license.
TENETS OF LICENSURE[edit]
The AP license was created with the foresight of addressing the lack of primary care services in underserved areas. Hence, the tenets / principles of licensure for AP license are focused on fulfilling the primary care service needs of an underserved population [5].
APs can work with collaborating physicians who operate within the primary care specialties of internal medicine, family medicine, OB-GYN, pediatrics and addiction medicine. However, the area in which the collaborating physician practices must be legally classified as being medically underserved; these areas can be urban, suburban or rural in nature. The clinical setting is currently either outpatient primary care or outpatient urgent care. The first 120 hours need to be directly supervised by the collaborating physician. After that, the AP is permitted to work within 50 square miles of the collaborator (during COVID-19, this mileage has been increased to 75 square miles.) APs can apply for a National Provider Identifier (NPI) number, see patients, prescribe routine/maintenance medication, chart patient encounters via EMR, order blood work and imaging studies, generate specialist referrals, counsel and follow up with patients in the capacity of their PCP and perform basic outpatient procedures. APs are also eligible to provide telehealth services.
Comparison with other mid-level provider groups[edit]
AP's are medical doctors, Doctor of Medicine (MD/MBBS) or Doctor of Osteopathic Medicine (DO), who graduate from a 4-year (or more depending upon country of education) medical school program but do not complete a residency program. In general, residency training develops the basic skills learned in medical school and provides experience in specific settings and specialties; Residents are supervised by an fully licensed physician in their specialty , known as an attending physician..
APs have a minimum 4 years of doctorate level education and over 5,000 hands-on clinical training hours to just graduate medical school. APs are tested on their clinical competency in each medical specialty throughout training. The basic requirements for becoming eligible to apply for an AP license are: graduating from medical school and successfully completing three out of four United State Medical Examinations (USMLE) examinations: Step 1, Step 2 CK, and Step 2 CS. Moste practicing APs have also completed USMLE Step 3, which is technically required to be completed after the first year (Intern/PGY01 year) of medical residency training. APs are required to maintain continuing medical education credits similar to other licensed medical providers.
bridge to residency[edit]
The AP license in Missouri and other states was created as a means to bridge the gap between medical school graduation and residency training. This license was never intended to provide a pathway to independent practice. T
CURRENT WORK[edit]
Currently, there are more than 400 APs licensed in the state of Missouri and a quarter of them are actively providing vital healthcare services as mid-level providers. APs have also recently played a key role in helping to curb the impact of COVID-19 pandemic [6]. APs have jumped into critical emergency response missions for COVID screening, testing, basic patient care and vaccinations within the state of Missouri under the employment of Missouri’s disaster medical assistance team (MO-1 DMAT).
IN OTHER STATES[edit]
In addition to Missouri, currently, the AP license already exists in five separate states of the US: Arkansas, Kansas, New York, Florida, and Utah. Albeit, it is known in many different forms like Associate Physicians, House Physicians, Medical Graduates License, etc. Similarly, the licensing procedure and duration of license is different for each state. Currently, there is ongoing legislature in multiple states of the US to introduce and pass similar legislation.
REFERENCES[edit]
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