than three years before license applica- tion and must have passed steps 1 and 2 of the licensing exam within two years of application.
The American Medical Association House of Delegates adopted a policy in June specifically opposing special licens- ing pathways for physicians who are not enrolled in a residency program or have not completed at least one year of residency. The Texas Medical Association House of Delegates adopted the follow- ing policy at TexMed 2014 in May:
Bearing in mind TMA’s vision of “im- proving the health of all Texans,” TMA does not endorse a lower medi- cal licensing standard for medically underserved areas.
TMA’s Council on Medical Education plans to discuss the new license catego- ry at the TMA Fall Conference later this month.
Missouri licensing laws stipulate an assistant physician must have a collab- orative practice arrangement with a phy- sician using written protocols and stand- ing orders. The assistant physician must work at the same location as the collabo- rating physician for 30 days. After that, the collaborating physician no longer has to be continuously on-site but must generally maintain geographic proximity. The license for assistant physicians allows them to prescribe controlled sub- stances through delegation by the collab- orating physician for drugs in schedules III, IV, and V. The collaborating physi- cian must review a minimum number of patient records, for example at least 20 percent of charts every 14 days, in cases where the assistant physician prescribes controlled substances. A collaborating physician can’t have a collaborative ar- rangement with more than three assis- tant physicians.
Only citizens or legal resident aliens
can obtain the Missouri license. They can use the title “doctor” but must iden- tify themselves as assistant physicians. The American Academy of Physician Assistants (PAs) opposed the bill out of concern the title was too close to that of a PA and could confuse patients, as re- ported by the Wall Street Journal in July. The newspaper also reported the Mis- souri State Medical Association, which represents 6,500 physicians, helped draft the bill to address the state’s physician shortages. “We felt it was time for some- one to think outside the box and come up with a solution for rural health care access, so that is what we did,” said Jef- frey Howell, director of government af- fairs for the medical association.
Amy Lynn Sorrel is associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
The Texas Medical Association is advancing the Choosing Wisely® campaign, an initiative to help physicians and patients talk about avoiding unnecessary care.
Through the Choosing Wisely® campaign, TMA is helping Texas physicians spur conversation around evidence-based recommendations created by your medical specialty societies.
One-third of all physicians acquiesce to patient requests for tests and procedures — even when they know they’re not necessary.
For more information about Choosing Wisely®, visit
www.texmed.org/ChoosingWisely/.
Funded by the TMA Foundation. 52 TEXAS MEDICINE September 2014
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