Arizona grants special practice licenses to medical school graduates

PHOENIX (AP) — Arizona is one of the few states to issue special practice licenses to medical school graduates who have not completed residency. But six months into the program, use of permits is low.

Proponents of the program say it’s a way to address Arizona’s severe doctor shortage while providing experience for medical school graduates who apply for a first-year residency program position but don’t match. to one due to an ongoing shortage of residency slots.

These graduates are often referred to as “unmatched,” meaning they graduated from medical school but were not matched to a medical residency program.


So far, few are using the permits, which first became available in November. While 99 licenses had been issued as of May 12, only 12 licensees practiced under the direction of a supervising physician, according to data from the Arizona Medical Board. It is unclear if the program will expand in the future.

Senate Bill 1271, signed by Governor Doug Ducey on May 4, 2021, created a one-year transitional training license for medical school graduates who have passed Stages 1 and 2 of the exam. United States medical license or equivalent exams but have not passed the residency required to become a fully licensed physician in Arizona.

Governor Doug Ducey signed Senate Bill 1271, which created a one-year transitional training license for medical school graduates who passed Stages 1 and 2 of the states medical licensing exam United States or equivalent exams, but who have not passed residency.

A residency is a postgraduate program where physicians spend three to seven years working in a healthcare facility to further their training in a specialized area of ​​medicine.

Transitional Training Permits are only available to physicians who, within the previous two years, either applied for a residency position and failed to match, or were selected for a residency position but did not failed to complete it for reasons that are not considered grounds for disciplinary action.

This year, only 80% of applicants were matched to first-year residency positions in the United States, leaving nearly 8,500 doctors unmatched, according to the National Resident Matching Program, which matches doctors with residency positions. Program data shows that the number of residency positions has increased since the 1980s, but not enough to meet demand.

Arizona is among five states that have passed legislation creating special licenses allowing physicians who have not completed residency to practice medicine under the supervision of a licensed physician.

These licensees are often called assistant physicians or associate physicians. In 2014, Missouri became the first state in the nation to pass such legislation. Since then, Arkansas, Kansas and Utah have enacted similar laws.

Missouri’s license program has come under intense scrutiny after a prominent licensee, Missouri State Representative Tricia Derges, was indicted for selling fake herbal treatments. cells, illegally prescribed drugs and fraudulently received COVID-19 relief funds, Kaiser Health News reported.

Arizona is the only state to offer these licenses which limit them to medical school graduates who did not qualify for a residency. But Arizona is more permissive than Utah and Missouri in specifying where licensees can work. Arizona licenses incumbents to work in various health care facilities, while Missouri and Utah require incumbents to provide primary care in medically underserved areas.

The Arizona Medical Board has a list of licensees and their supervising physicians on its website. According to the council’s physician database, the majority of supervising physicians are in Maricopa County, and most of them specialize in family medicine or internal medicine.

SB 1271 sponsor Sen. Nancy Barto, R-Phoenix, told The Arizona Republic in an email that she sponsored the bill to help address Arizona’s doctor shortage.

According to a June 2021 report from the Association of American Medical Colleges, an estimated doctor shortage of 19,800 in the United States in 2019 is expected to reach between 37,800 and 124,000 by 2034.

The AAMC report indicates that this shortage is mainly due to an increase in demand for doctors, as the American population grows and ages, as well as the fact that a large part of the medical workforce is approaching retirement. retirement age. More than two in five working physicians will be 65 or older in the next decade, according to the report.

The shortage is particularly notable in Arizona, which ranks 42nd in the nation for the number of active primary care physicians relative to population, according to a 2019 report from the Center for Rural Health at the University of Arizona. The report found that Arizona’s primary care physicians are able to meet only 40% of the state’s primary care needs.

Michael Dill, director of workforce studies at the AAMC, told The Republic that the solution to the shortage was to train more doctors. US medical schools have increased student enrollment, he said, but the problem is a shortage of residency positions available to doctors after they graduate.

The vast majority of funding for residency positions comes from the federal government through Medicare. In 1997, the federal government capped the number of residency positions funded by Medicare. Congress added 1,000 more slots in December 2020, but Dill told The Republic that wasn’t enough. He said the AAMC estimates an additional 14,000 slots are needed.

Barto said SB 1271 helps address the doctor shortage by allowing unparalleled medical graduates to practice medicine.

“As these graduates wait for a residency slot, rather than settle for far less paying jobs, they can now put their medical training to good use,” Barto said.

Dill said this type of legislation would not solve the doctor shortage problem. He said a better solution is to fund more residency slots.

Barto said SB 1271 was not intended to completely solve the problem. However, she said Arizona shouldn’t ignore viable solutions while waiting for the federal government to add more residency slots, which she says hasn’t been a priority in the past and likely won’t. not in the future.

Dr. Zobia Aijaz is one of the doctors holding a transitional training permit. Aijaz moved to the United States in 2016 after graduating from medical school in Pakistan, but was unable to match a residency position, leaving her unable to continue her medical education. She’s had related jobs like research, but she said what she really wanted was to be able to practice medicine, because that’s what she was trained to do.

“(It’s) a waste of my skills and knowledge,” Aijaz said.

Aijaz, who lives in Texas, which does not have a transitional training license for medical school graduates, applied for a license in Arizona and received one on April 5. Aijaz said she wanted to move to Arizona to practice medicine under her license, but she hasn’t been able to find a supervising physician. One reason for this is that doctors don’t want to have to pay for additional malpractice insurance, she said.

A Transitional Training Permit is valid for one year and the holder may have it renewed for an additional year up to two times, provided that each year they apply for renewal they apply for at least three primary care residency positions and, once again, does not match.

Aijaz said she’s worried she won’t be able to find a supervising physician before her license expires.

Permittees are authorized to perform the types of health care duties typically performed by residents. In addition, each year, licensees are required to participate in at least 60 hours of continuing medical education. The supervising physician must ensure that the health care tasks performed by the incumbent correspond to his field of experience.

A physician can act as supervising physician for only one holder at a time. Supervising physicians are required to directly supervise permittees by being physically present while they provide care during their first six months of full-time practice.

After that, supervising physicians are required to supervise indirectly by being present in the facility and available to provide direct supervision. Supervising physicians must review all medical records related to clinical encounters conducted by the incumbent as part of an incumbent performance appraisal process.

The Arizona Medical Association initially opposed SB 1271, but later changed its position and registered as neutral after the bill was rewritten via amendments. Dr. Ross Goldberg, outgoing president of the Arizona Medical Association, told The Republic it was because they were able to negotiate to get the bill in a form they found more palatable.

The initial version of the bill would have allowed medical school graduates who have not completed their residency to practice medicine as “associate physicians.” It did not specify that licensees should be unmatched, but it limited them to providing primary care in medically underserved areas, which the final version does not.

The first version also did not include a time limit for the duration of the permit, and its monitoring requirements were less stringent.

The Arizona Academy of Family Physicians opposed both versions of SB 1271. Its president, Dr. Shanyn Lancaster, told The Republic in an email that the organization believes the bill would endanger patient safety and reduce the quality of medical care.

“Doctors who recently graduated from medical school still need experienced teachers, in accredited programs, to teach them the skills of safety, efficiency, professionalism, humanity and communication to become quality doctors,” Lancaster said.

Barto said patient safety is not an issue because doctors graduate from medicine with an average of 6,000 hours of clinical training, which is more than other non-physician healthcare providers such as physician assistants and nurse practitioners.

Barto pointed to a 2018 report by the right-wing American Enterprise Institute that found vulnerable populations such as Medicaid recipients, the uninsured, and people living in rural areas are more likely to receive primary care from practitioners than physicians.

“The training license program is designed to put patient safety first,” Barto said.

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