Cut-Rate in Podunk

“We’ve been trying for years to address our maldistribution <sic> of physicians in the country. We have all sorts of incentive programs and all sorts of ways to try to get them to go out to Podunk, but a lot of them just don’t want to go to Podunk.”

So a fix is proposed by orthopedist and Missouri Rep. Keith Frederick, in a plan “to treat patients in Missouri’s underserved areas as a result of a planned expansion of a first-in-the-nation law aimed at addressing a pervasive doctor shortage.”

Hey, cool, they’re going to actually pay doctors extra to go … to … aw hell.  First we had PA’s and NP’s evolving from “extenders” to solo practitioners, pharmacists providing primary care, and more recently, the world-changing innovation of “nurse doctors.”  It may be that the logical gymnastics are nearing full circle.  Missouri wants a new category of providers for people “who graduate from medical school and pass key medical exams but aren’t placed in residency programs needed for certification.”

(make sure you sign up for our weekly newsletter for reminders and extra insights/columns)

This amazing new category is called – drum rolllllllll, please – “assistant physicians.”  The AP’s are to give primary care in “medically underserved” areas with the supervision of another physician, and can work as assistant physicians indefinitely, “essentially sidestepping traditional residency requirements.”  Well that’s just fan- (insert copious profanity here) -tastic.    The AP applicants are those who didn’t pass their board exams, or did not pass subsequent tests within the time limit, or for whatever reason did not actually finish a residency.  So they are sort of non-physician doctors, with all the expertise I had on my first day of residency, which is to say, almost none.  And for these sub-substantially trained that fail to “match” there will now be the opportunity for politicians, themselves eager to expand state compassion, to match them with second-class patients.

How dare I refer to patients as “second-class”?  I didn’t.  Their political caregivers did by pushing cut-rate, pre-physicians on them as though that were a fix to bad economic policy (which is of course, the same thing they did with solo flying PA’s and NP’s).  The rhetoric is out that a new crop of AP’s will “save lives” in Missouri, and it’s being considered in several other states.  And they won’t have the worry of those extra years of lost income that we post-residency saps had to incur.

For years the ABFM has worked diligently to make primary care as unpleasant as possible, even as they extolled the excellence that only they through their extorted certifications can provide.  Ditto the ABIM.  Can we expect these two cash pig rip-off groups to issue emergency statements condemning assistant physicians as dangerous to patients?  Will the American Board of Medical Specialties sound the alarm that pre-boarded, MOC-ineligible doctors will not have the confidence expected by such discerning patients who demand more?  No, I’m not holding my breath either.  Will separate modifiers be issued by Medicare/’caid to pay AP’s less, given the lesser degree of – ahem – “quality” that they would be expected to render?

This is yet another demonstration of how our society is willing to devalue those who have achieved more and worked harder.  And Missouri has the language wrong.  The term “assistant physician” could be to easily confused with another, similar professional title, many members of which would have superior expertise.  For the sake of precision, I propose “LELT doctor.”*  Catchy, huh?

* Less Educated, Less Trained

100270cookie-checkCut-Rate in Podunk