ASSISTANT PHYSICIAN RESOLUTION: Follow-up from the 2022 HOD

By JOSEPH F. ANSWINE, MD, FASA

The 2022 Pennsylvania Medical Society House of Delegates has come to a close. I, again, submitted a resolution to legislate for an assistant physician program in our state. To refresh memories, an assistant physician is an MD or DO that has not completed a residency, however, can practice under the supervision of a licensed physician in a primary care setting in an underserved area. Five states utilize or are in the process to utilize these doctors.

At the house, the resolution was referred for study. A positive move forward. Most comments whether written or stated at the house were in support. However, the comments against were concerning. They came from the society “elite” for lack of a better word; individuals that do or have held high offices. The comments (with slight paraphrasing due to memory) include: 1). This assistant physician idea keeps coming up and data show it doesn’t work. 2). The match/residency problem is not as bad as we think. 3). The AMA and our state society do not support such legislation and practice, and the societies are working to fix the residency deficit problem. 4). The problem with these doctors without residencies is that they picked the wrong specialty. 5). Why would we subject underserved areas to untrained physicians? 6). They already want independent practice.

There are no significant data stating that the assistant physician program does not work. The truth is there are no data available either way as per an article in Missouri Medicine (2021). However, the same article outlines the growing discrepancy between the number of available medical school graduates and residency spots, as well as the growing physician shortage. This of course leads into the second absurd statement above. The article also stated that in 2021, there were 10,000 more applicants than first year positions in the match. Nothing leads one to believe it will get better which now addresses the third statement above. The AMA nor PAMed will fix the problem because they cannot. It’s not in their power to do so. At least, nothing done by these organizations demonstrates a desire or ability to do so.

As for the fourth statement, these young docs didn’t pick the wrong specialty. In fact, they apply to multiple specialties at an extreme cost just to successfully achieve residency and an ability to practice.

Why would we subject our patients to untrained doctors? They have completed medical school and passed the required standardized exams. Furthermore, they are supervised by licensed physicians.

But most importantly, this comes from a representative of the same organization that just last year agreed to a pilot program allowing nurse practitioners to practice independently in underserved areas in Pennsylvania. What does this say to our membership? And, do they want independent practice? Of course they do as residency trained, board certified physicians. Lastly, THEY are US! It’s easy to represent successful physicians, but effort is required to represent those physicians in need.