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Missouri's Assistant Physician License

Discussion in 'BBS Hangout: Debate & Discussion' started by xcrunner51, May 20, 2017.

  1. xcrunner51

    xcrunner51 Contributing Member

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    https://www.statnews.com/2017/05/15/missouri-doctor-dearth/

    Curious to hear people's opinion on a non-medical forum.

    Background: Thousands of graduates from non-American (and sometimes American) medical schools fail to match to the next step of their training (internship/residency). Some find a job for a year and successfully reapply but thousands of graduates each year are basically finished in medicine (not being eligible for a full medical license), having wasted hundreds of thousands of dollars of money and years of time completing medical school.

    Change: Facing primary care provider shortages, particularly in rural areas, Missouri introduced a new type of medical license which would allow those un-matched graduates to practice primary care in an underserved area without a full medical license or further training.

    Question: is this reasonable or not to allow fresh medical graduates, typically from less-than-stellar schools and of less-than-stellar academic performance, to practice independently to fulfill primary care shortages?
     
  2. xcrunner51

    xcrunner51 Contributing Member

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    Pros: potentially significantly decrease the PCP shortage in rural areas
    Cons: potentially having shitty doctors from diploma-mill schools treating patients independently.

    Nearly every professional healthcare group is against it.
    AMA/ACGME/AAFP (doctors groups): Feels that its both dangerous for patients and that the solution is to provide more funding for ACGME approved training spots.
    AAPA (PA groups): Feels that instead of having doctors without significant clinical training, PA's should be allowed to expand their scope of practice (i.e practice independently) to cover physician shortages.

    My random thoughts: several 3rd world countries require graduates to do 1-2 years of rural medicine before going back for specialty training (/residency). I don't know how supervised those years are, or even if in fact those people complete a formal internship before doing the rural medicine. Certainly those graduates are from domestic programs where the quality of training is much more easy to ascertain than some of these diploma-mills in Caribbean and elsewhere, but the situation is somewhat comparable in nature.
     
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  3. Exiled

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    It's good but it depends on how well equipped these rural areas.
    Experience/knowledge is very important in rural areas or where limited no. of investigation can be done.
    I think they're better fit to work on research area,where there's demand for it.Companies/research center would love to hire those if they've legal status
     
    #3 Exiled, May 20, 2017
    Last edited: May 20, 2017
  4. xcrunner51

    xcrunner51 Contributing Member

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    They're not qualified or 'fit' for much of anything, much less being in demand for research companies. They are literally the bottom of the applicant pool.

    State medical boards in the past have said these people were too sub-standard to practice medicine if they couldn't secure an internship (not a ridiculously difficult task).

    This relative over-supply of medical graduates is almost strictly due to the rise of the for-profit, non-accredited foreign medical schools in places like Grenada, St. Maarten, St. Lucia, or St. Vincent and the Grenadines.
     
  5. Exiled

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    Physician Assistant/Associate is pretty much common occupation that is equivalent to (Ms -Science ), they operate under supervision of consultant, similar to how residents works in teaching hospitals with less privileges than nurse practitioner, pretty much they're Family Physician minus those 2 years of their residency (primary care/referrals )for maybe a fraction of the cost , state of Missouri should be giving credit for thinking out of the box

    the only test they need is the step1 of USMLE/CMP for Royal College , if they can pass it so be it (which is easy i know but its not their fault )they have done their due


    i'm not sure about the oversupply thing , clearly its a matter of money/budget and dry out issues spreading . There're a few opening positions in Universities hospitals, shortage of medical residents and fellows , the trend is to downsize employment/staffs in every possible way.

    listen , on a weekly bases , one of those drugs companies gather the entire department for dinner, by giving my invitation to friends from Colombia/Cuba/Mexico they landed research jobs
     
  6. LosPollosHermanos

    LosPollosHermanos Houston only fan
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    This is exclusively for non-american graduates. If you are an american grad 99.99% of the time you will match. If you don't , it's because you applied to plastics/derm etc with a 220 step 1 score or you pissed enough people off/ red flags to where you shouldn't anyways. I don't think that this is a bad idea, especially considering how much of primary care we have integrated PAs in to. My main issue is with specialist followup visits, where I read many notes in which the patient never gets to see the doctor and follows up with the PA in clinic. If you are going to bill for a specialist then you should get someone that completed 4yrs of medical school, residency training, fellowship training.

    Foreign medical graduates that fail to match can do a much better job, if we're going to allow someone that has never been to medical school to follow up with patients post-op etc, I'm pretty sure an FMG could do it too, and better. The reason why a lot of the physicians of today don't want to is because how badly we get shafted at every corner. You will find it hard to name one profession where you are expected ot work as much, assume this extent of liability ....and in a lot of instances expected to work for free. It is maddening and ridiculous.Medicare drops compensation yearly to where they can get by with just breaking even with physicians and play games to where they deny claims for whatever reason. it is the reason private practice is dying out. Groups are forming, people are preferring to work for hospitals (where you get shafted too) but don't ahve to put up with the B.S. Now throw another group of people to add to the supply of physicians...who the hell is going to like it?

    Now tying into my earlier rant, nobody that hasn't attended medical school/ completed a residency should prescribe medications/ see patients independently. If we are going to let NPs (not trying to offend, they are essential for the future of primary care) do it, why not FMGs that pass certain benchmarks? It doesn't take a genius to diagnose CHF, COPD exacerbation, etc, which is what you normally see on an inpatient basis for medicine.
     
  7. xcrunner51

    xcrunner51 Contributing Member

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    Where I did my internship, we had one guy who graduated from a caribbean medical school. Relatively bright guy, graduated from Vanderbilt undergrad. He was god-awful terrible at clinical surgery. He was far worse than our MS-4's in terms of clinical decision making and probably at or below the level of the MS-3's.

    I asked him what his clinical experience/clerkships were like. He said there were 90 people from his caribbean school doing the surgery clerkship (at a big-name American hospital) at the same time with sometimes up to 9 MS-3's on the same service. They would send half the med students home after rounds. He basically said that the intern year was the equivalent of his MS-3 year because the 3rd and 4th years of medical school provided by his diploma mill were a joke. Really nice guy, but he was dangerous on the wards.

    After seeing that, I just can't imagine some IMG with potentially only 12-16 weeks of questionable IM and FM rotations practicing primary care relatively unsupervised in a safe manner. Primary care is actually really freaking difficult. As noted in the article, they are "supervised" by another physician but that physician has no obligation to teach.
     
  8. xcrunner51

    xcrunner51 Contributing Member

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    Not the same thing. Missouri's Assistant Physician license (AP) is not the same thing as a physician assistant (PA). PA's come out raw, but are expected to be competent. New med school graduates are not expected to be competent to practice medicine; that's what the internship and residency are for.

    Missouri's requirement is passing USMLE steps 1 and 2. I would not say that's any sort of sufficient indicator of clinical competence.

    For the most part, there is a huge (and growing) oversupply of medical graduates (AMG + IMG + FMG) relative to the number of ACGME-approved residency spots. The number of ACGME-approved spots has not significantly grown over the last few decades compared to the pace of new american medical schools/added seats. In Texas alone, we've opened 2 new UT med schools recently and a second osteopathic school (Incarnate Word) is set to open in San Antonio.

    What is happening is all the new American medical seats are pushing the IMGs out of ACGME match positions, creating this oversupply. It doesn't help that there are also a ton of diploma mill schools in the caribbean.

    I bet your friends had completed some post-graduate training in their home country, if not finished their training. They probably aren't practicing here because they weren't able to pass the steps or secure a residency position. A fresh medical school graduate without any post-graduate training doesn't have a ton of value to convey.
     
  9. Air Langhi

    Air Langhi Contributing Member

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    There are way too few doctors graduating. When people with 3.7 gpa and 30 mcat are getting turned down from med school something is wrong. They need to have more residency slots and way more medschool slots.
     
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