The state of Indiana has a bill before the Legislature (SB 400) that would allow medical graduates who have not matched to a residency to practice under licensed physicians. This is important because more than 10,000 medical graduates fail to match to a residency program each year. Many of those will try again the following year but many will ultimately never complete a residency program. In most states medical graduates who never complete a residency will never have an opportunity to care for patients.
Missouri passed a similar law in 2014, although it experienced some controversy unrelated to the law itself. One of the main proponents of the law was sentenced to federal prison for fraud. However, other states have followed suit and have created a path to practice for medical school graduates who were not able to finish their training.
Assistant physicians — sometimes called associate physicians, and not to be confused with physician assistants — are medical school graduates who have not yet completed residency training. Similar licenses also now exist in Arizona, Arkansas, Kansas, and Utah. Virginia is considering adding one, and model legislation is making such licenses easier than ever for other state legislatures to adopt.
The Indiana bill would create a category of health care providers called associate physicians and regulate their scope of practice similar to nurse practitioners. Side note: There are also proposals in Indiana to expand the scope of practice for nurse practitioners and no longer require collaboration with physicians. The Indiana Senate bill aims to help urban and rural areas underserved by physicians by allowing associate physicians to practice primary care in those areas. Associate physicians would be required to collaborate with licensed physicians, who would review 20% of their patient cases.
The bill to create a collaborative practice arrangements with associate physicians is a good starting point that will hopefully expand to other states. The following is an excerpt from SB 400 that explains what Indiana hopes to achieve.
8 (page number)
40 ARTICLE 4.5. ASSOCIATE PHYSICIANS
41 Chapter 1. Definitions
42 Sec. 1. The definitions in this chapter apply throughout this SB 400—LS 7336/DI 141
9 (page number)
2 Sec. 2. “Associate physician” means an individual who:
3 (1) meets the qualifications under this article; and
4 (2) is licensed under this article.
5 Sec. 3.”Board”refersto the medical licensing board of Indiana.
6 Sec. 4.”Collaboratingphysician”means a physician licensed by
7 the board who collaborates with and is responsible for an associate
9 Sec. 5. (a) “Collaboration” means overseeing the activities of,
10 and accepting responsibility for, the medical services rendered by
11 an associate physician and that one (1) of the following conditions
12 is met at all times that services are rendered or tasks are
13 performed by the associate physician:
14 (1) The collaborating physician or the physician designee is
15 physically present at the location at which services are
16 rendered or tasks are performed by the associate physician.
17 (2) When the collaborating physician or the physician
18 designee is not physically present at the location at which
19 services are rendered or tasks are performed by the associate
20 physician, the collaborating physician or the physician
21 designee is able to personally ensure proper care of the
22 patient and is:
23 (A) immediately available through the use of
24 telecommunications or other electronic means; and
25 (B) able to see the person within a medically appropriate
26 time frame;
27 for consultation, if requested by the patient or the associate
29 (b) The term includes the use of protocols, guidelines, and
30 standing orders developed or approved by the collaborating
More on this bill can be found at: Indiana-2023-SB0400-Engrossed.pdf (legiscan.com)