Missouri targets doctor shortage, expands first-in-nation law

JEFFERSON CITY, Mo. -- Numerous additional doctors from around the U.S. could become eligible 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.

The newly passed Missouri legislation would broaden the reach of a 2014 law that sought to bridge the gap between communities in need of doctors and physicians in need of jobs.

That law created a new category of licensed professionals -- "assistant physicians" -- for people who graduate from medical school and pass key medical exams but aren't placed in residency programs needed for certification.

But it took nearly 2 1/2 years before Missouri began accepting applications Jan. 31. By then, some applicants no longer qualified because too much time had lapsed since their medical exams.

Missouri's new legislation seeks to turn back the clock, so those who became ineligible during the slow rollout still can get licensed as assistant physicians.

Supporters hope the legislation, if signed by the governor, will help jumpstart a program that has been promoted as a model for other states.

"We've been trying for years to address our maldistribution 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," said Missouri Rep. Keith Frederick, an orthopedic surgeon who sponsored the assistant-physician law.

"This bill takes folks that very much want to ply their trade -- they just want the opportunity to provide patient care -- and the bill requires that they serve in an underserved area," Frederick added.

Nearly 6,800 places in the U.S. are short on primary-care physicians, from particular medical clinics to certain urban communities and entire rural counties, according to the U.S. Department of Health and Human Services. Of those, 225 are in Missouri -- a disproportionately high number compared with the state's population.

Since Missouri's original law passed, Arkansas and Kansas approved slimmed-down versions, and Utah enacted a similar measure this year. Lawmakers also have considered similar programs in Oklahoma, Virginia and Washington.

Missouri's assistant-physician license is available to all legal U.S. residents who graduated from medical school within the last three years and passed the first two rounds of medical-licensing exams within the last two years.

It lets them provide primary care in "medically underserved" areas with the supervision of another physician. People can work as assistant physicians indefinitely, essentially sidestepping traditional residency requirements.

So far, 127 people have applied for Missouri's program. Just 23 have been issued licenses, 55 have been deemed ineligible, and 44 remain under review.

Dr. Tricia Derges is among those who have been excluded because the state took so long to implement the program.

Derges sold her candle-manufacturing company about a decade ago to enroll in medical school. She said she completed the second step of the medical exam in January 2014 and graduated from Caribbean Medical University in Curacao three months later. She didn't get matched with a residency program.

Still, Derges opened a clinic for the homeless and poor in Springfield, believing she could get licensed as an assistant physician. While waiting for that license, she has relied on other physicians to volunteer their services.

Derges said her assistant-physician application was denied because more than two years had passed since her medical exam.

The new legislation could allow her to reapply and potentially to expand her clinic.

It "will save a lot of people's lives," Derges said.

The bill also was championed by state Rep. Lynn Morris, a pharmacy owner who said the expanded program could save people long drives to see doctors.

It's "a commonsense approach to help take care of a crisis we've had," Morris said.