Even before the Affordable Care Act, it was generally accepted that Michigan had a physician shortage. With the addition of 30 million potential patients, the shortage is dramatic and cannot be ignored. More medical schools are being built around the state but this will not solve the problem. Becoming a licensed physician requires more than graduation from medical school. A physician must pass all three “Steps” the United States Medical Licensing Examination (USMLE) and be accepted into a residency program for further practical experience.
Available residency positions are too few to accommodate demand. Indeed, the lack of residencies has been described as a bottleneck in the system of licensing new physicians. Building more medical schools will graduate more doctors but it will not license them, at least not all of them; many will be caught by the existing bottleneck.
The demand for residency training is substantial and growing each year. The problem has been ignored so long that the Association of American Medical Colleges says, even if residencies were added at a level described as “robust”, the shortage of doctors would be reduced only 54% by the year 2025. This projection was made before the enactment of the Affordable Care Act. Unless action is taken to license more health care providers, the Act’s intended goal — to provide access to affordable health care – will remain elusive.
To ease the shortage of physicians, Michigan adopted Public Act 210 of 2011. This act amended existing law by expanding the authority of the Physician’s Assistants. These mid-level providers have been authorized to practice medicine, on a limited basis, under the supervision of fully licensed physicians.
Under existing Michigan law, physicians shut out of a residency because of a lack of space are not permitted to work as Physician’s Assistants — even though they are themselves physicians. Upon passing Step 3 of the USMLE, a doctor is found “to [possess] and can apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine.” Many physicians who have passed Step 3 of the USMLE would practice in Michigan if the bottleneck in the training system were removed. Physicians deemed worthy of “unsupervised practice” are nonetheless considered “unqualified” by Michigan law to work in a clinical environment.
Physician’s Assistants may practice medicine in Michigan, on a limited basis, without having gone to medical school, passed the USMLE or completed a medical residency. When Michigan communities are in need of physicians, it makes no sense to refuse doctors deemed worthy of the “unsupervised practice of medicine” from having a license of any kind. Michigan law must be amended to avoid wasting valuable medical talent.
Senate Bill 1201 (2012) is intended to make use of these doctors while they wait for a residency. The Bill would grant them a full license but only after years of practice under the supervision of a fully licensed doctor. The Bill is in the public interest and deserves the active support of all Michigan residents.
Mark D. DuBay is an attorney in the private practice of law.