American Medical Association House of Delegates Rejects ‘Assistant Physician’ Concept

Jun 12, 2014

During its 2014 annual meeting on June 7-11 in Chicago, the American Medical Association (AMA) House of Delegates considered and ultimately passed a resolution introduced by the Young Physicians Section to oppose the “use of unmatched medical students as ‘assistant physicians.’”

This new AMA policy will be very beneficial in opposing the “assistant physician” concept if it appears in other parts of the country.

Background on the resolution

The resolution was in direct response to legislation passed by the Missouri General Assembly in its 2014 session to create a new category of medical licensees. Senate Bills 716 and 754 contain language that will authorize the state Board of Healing Arts to license medical graduates who have passed steps 1 and 2 of the United States Medical Licensing Examination as “assistant physicians,” authorized to practice in primary care in rural and underserved areas.

The Missouri Academy of PAs and AAPA opposed the legislation and were joined in opposition by the Missouri Academy of Family Physicians. The Missouri State Medical Association supported the bill.

Passage in the AMA HOD

Reference Committee testimony was in strong support of the Young Physician’s Resolution, which read:

RESOLVED, That our American Medical Association oppose special licensing pathways for physicians who are not currently enrolled in an Accreditation Council for Graduate Medical Education or American Osteopathic Association training program, or have not completed at least one year of accredited post-graduate U.S. medical education.

The only testimony in support of the “assistant physician” concept came from the Missouri delegation.

The resolution again drew strong support when the entire House of Delegates considered it. The Pacific Rim Caucus; Council on Medical Education; Louisiana, Massachusetts and several specialty delegations testified in support of the Young Physicians. A delegate from the Medical Student Section stated that he certainly was not prepared to begin practicing in primary care in a rural area.

Delegates were sensitive to the plight of medical school graduates who do not match. But the testimony followed the sentiment of a delegate who said, “We should not replace a hardship with a danger.”

Although the Speaker cut off testimony as it was clear that the resolution would pass, the delegations from family medicine, psychiatry and several additional states supported the resolution to oppose the “assistant physician” concept.

The resolution passed by a resounding voice vote.

AAPA’s role in the resolution

Mary Ettari, MPH, PA, DFAAPA, AAPA’s liaison to the AMA, and Ann Davis, MS, PA-C, AAPA vice president for constituent organization outreach and advocacy, talked with numerous delegates prior to the vote in support of the idea that the “assistant physician” concept is bad for PAs, physicians and patients.

Other resolutions passed at the meeting

Delegates also passed resolutions to support stricter regulation of e-cigarettes, request that the president take action to provide quicker care for veterans, and to call for better electronic data exchange.

During the meeting, Steven Stack, MD, an emergency physician from Kentucky, was elected AMA president-elect.

Unhappily, the House of Delegates passed resolutions reaffirming and expanding AMA’s commitment to healthcare teams being “physician-led,” a concept that is not supported by a host of healthcare organizations and thought leaders.

Prior to the House of Delegates, the Council on Medical Education held a symposium on re-entry to clinical practice.

Ettari represented AAPA at these sessions and came away with a commitment from AMA to share in the development of resources that will be useful to PAs and physicians who seek to re-enter clinical practice.