The Doctors: Doctors Forgoing Residency Training?
Dr. Travis Stork asked if you would trust your health to a recent medical school graduate who never completed residency training. A new law in Missouri has recent medical school graduates treating patients right out of school, forgoing residency training.
Dr. Stork said when he first read the articles he misunderstood the intent. He said the idea is that the new graduates will have 30 days of supervised training and then the MDs will be able to practice medicine.
The Doctors were joined by Missouri State representative Keith Frederick, who is an orthopedic surgeon who championed the bill. Dr. Frederick explained that at first there was the indication that there was no ongoing supervision after the initial 30 days, but said there is a provision for the bill that says the graduate will work with a licensed physician in a collaborate practice agreement, in the same fashion that nurse practitioners do.
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Dr. Rachael Ross said that what scares her is that when nurse practitioners finish their schooling, “they’re very much prepared clinically to get out there.”
Dr. Ross said she remember being a fourth year resident and having “gung-ho” students around her that felt like they were “super doctors.” She said it scares her to think that those fourth year residents could be “released” to practice on their own.
Dr. Ordon said the intent is that instead of using P.A.s or nurse practitioners, they’re using doctors. He said when you get the diploma, you are a doctor, but that doesn’t mean you’re prepared. Like Dr. Stork said, you have to pass all your exams and become licensed.
Dr. Jennifer Berman said being able to take what you learn in a book and apply it to a human is an entirely different skill set that not everyone has.
Dr. Ross said basically the idea is to “treat a problem of lack of care.” She said she felt like they were going to take people who can technically call themselves doctors, but aren’t fully trained as doctors. Dr. Frederick said to claim that the doctors are not qualified to step into a collaborative practice arrangement, as a P.A. or nurse practitioner are, “is just silly.”
The Doctors: Missouri Legislature Allowing Doctors To Forgo Residency?
He said those doctors have had much more training than a nurse practitioner. “What do you think they’ve been doing the last four years?” Dr. Frederick said. He said they’re used to presenting a case upstream to those with more knowledge than them and they’re “perfectly suited” to that role. He said he was proud of the legislature and of the governor for signing this into action, because it was able to bring people out to rural areas and provide medical care, which is currently sorely lacking.
Dr. Stork asked Dr. Frederick if he was at least branding the new doctors as “assistant physicians” and he said he was. He said they’re going to be mid-level practitioners not fully licensed physicians. But they’re perfectly capable of filling that role. Dr. Ross argued that they’re fully capable, and shared that when she was fresh out of medical school, she had a patient who had a really bad rash. She thought it was contact dermatitis so she gave her some steroids. The lady had shingles, and because of that case, she’ll never misdiagnose shingles. She said her point was that she was fresh out of medical school and was not prepared to go “50 miles away and give her knowledge.”
Dr. Ordon said he still misdiagnoses contact dermatitis today.
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Dr. Stork said medicine is hard and diagnoses are not always simple, but he said 30 days out of medical school, he was dangerous because he knew just enough to make a lot of mistakes, especially in the emergency department. He said it probably took him 18 months to feel comfortable, and two years into his training he went and practiced at a rural medical hospital.
Dr. Stork wanted to know was quality assurance is in place for a med school grad, to make sure there’s enough checks and balances in place to make sure a misdiagnosis of a serious medical condition won’t happen. Dr. Frederick said for the people who are concerned about the quality of the new physicians, he wondered where they have been for the past couple decades as they’ve ruled out the collaborative practice arrangements for nurse practitioners all over the country.
The Doctors: Collaborative Agreements For New Doctors
He said some states have no requirement for an ongoing collaborative agreement, but they do have a requirement that a nurse practitioner has a collaborative agreement. The new physicians will have the same thing in place. He said there will be a chart review both for patients who’ve had narcotics prescribed, and for those who haven’t. He said it will be somewhat flexible, allowing for more chart review and interaction.
Dr. Ross brought up the apps that allow Dr. Frederick didn’t think about that as a potential solution to the problem of having lack of care in the state. He said that have done that and it’s his goal to see to it that tele-medicine is part of the collaborative agreement between physicians. He said another difference between this bill and other collaborative agreements is that when its between a nurse and the physician both the nursing board and the board of healing arts have to be in an agreement.
To clarify, Dr. Stork explained that typically, medical school is a four year program that trains doctors to get ready for residency training. Residency training can be up to 6 or 7 years sometimes and is a program where you’re directly learning and following attending physicians. All The Doctors agreed that no MD is ready to practice medicine on their own until they’ve completed an accredited residency program.