Innovative Way to License Medical Graduates

Innovative Way to License Medical Graduates

In the most recent residency application cycle (2021 - 2022), 11,532 medical graduates did not gain a residency position (1). These are thousands of qualified medical doctors that are in a “limbo” period, meaning that they have their medical degree but they have not completed the compulsory post-graduate training they so desperately need to obtain a full license to practice. This is not a new phenomenon because it happens every single year. Even this past year was no exception despite the global pandemic and an ongoing physician shortage that limits patient access to quality healthcare didn’t make. So what can these doctors do until they obtain a residency position? They can work as a medical assistant, research assistant, scribe, or find an observership where they are limited in practice and do far less than what is expected of a third-year medical student. Fortunately, there is a newer and lesser-known option that is far more suited to the skill sets of a doctor: obtain an assistant physician license.

I had the opportunity to get my license as an assistant physician in the state of Missouri and worked at both an urgent care and primary care clinic in this capacity. The scope of practice can be equated to the level of a nurse practitioner or physician assistant, where you have a collaborative practice with a board-certified physician to work under appropriate supervision. I was able to take histories, complete physical examinations, write/sign medical notes, do procedures, and even prescribe medications. I was managing patients with both acute illnesses (such as COVID-19) and chronic illnesses (diabetes mellitus, hypertension, etc.) so for the first time since graduating medical school in 2018, I was actually practicing medicine.

The particular clinics I worked at were in medically underserved and rural communities. There was a prerequisite 120 hours of directly observed training with your collaborating physician, after which it was up to your supervising physician to gauge the scope of your practice and what you would be comfortable to see independently. We had weekly didactics and case presentations to support our learning as one would in residency training. The urgent care clinics were also the only ones open 24/7 in the St. Louis area so a lot of patients would opt to be seen there rather than wait for hours in the emergency department. The primary care clinic I volunteered at had us taking care of patients with more complex conditions such as uncontrolled diabetes and hypertension; many did not have appropriate prior medical care or even health insurance. Our supervising physician also provided residency preparation like proofreading our personal statements and conducting mock residency interviews.

While the experience was not exactly equal to the rigor or breadth of residency, it gave me a chance to care for patients while also giving me the opportunity to enhance my residency application and connect with physicians that not only wrote strong LORs but also advocated on my behalf.

The eligibility requirements for this type of license is equivalent to that of residency: graduate from an accredited US or international medical school in good standing, completion of USMLE steps 1 and 2, ECFMG certification for International Medical Graduates (IMGs), and have not completed residency training. A few states have other requirements such as completion of the USMLE Step 3, proof of residence in that state, graduation from specific medical schools, or confirmation of employment prior to issuance of the license. It’s as simple as completing an application and providing supplemental documentation. Application review can take anywhere from a few days toa few months depending on the state. These are the states that currently license medical school graduates to work under supervision (2):

Missouri

Arizona

Florida

Washington

Arkansas

Utah

Due to the ongoing COVID-19 pandemic, several states issued temporary licenses to such individuals (4). Illinois and New York are two examples of such states, but unfortunately those licenses have now expired. More states have been joining the bandwagon; there are currently grassroot efforts to propose licensure in California, Colorado, Georgia, Oregon and Texas. The International Medical Graduate Assistance Act (5) was also introduced to Congress in June 2022 to incentivize more states to provide licensure to unmatched medical graduates, particularly to those that are US citizens and legal residents that have graduated from a foreign medical school.

The greatest obstacle for these licenses is finding a collaborative physician. Due to the relative anonymity of this type of license, it has been difficult to find practice opportunities in the states listed above. As this movement continues to gain more traction though, it is an innovative way for practicing physicians to support and teach the next generation of physicians while making a difference in their own communities.

Overall, these licenses are an easy way for medical graduates to work to the full capacity of one’s training, gain the meaningful skills needed to prepare for and succeed in residency and unite two generations of physicians to work together to increase access to care in communities of need.

Resources:

NRMP Data 2022: https://www.nrmp.org/wp-content/uploads/2022/05/2022-Main-

Match-Results-and-Data_Final.pdf

Inside The Match Blog: https://www.insidethematch.com/medical-school-

tips/licensed-without-a-residency

DocWeighsIn Article: https://thedoctorweighsin.com/physician-training-shortage/

COVID-19 Temp Licensing by state: https://licensing.csg.org/covid-policy-

responses/temporary-licensure/

International Medical Graduate Assistance Act 2022:

https://adamsmith.house.gov/_cache/files/5/6/561877ac-e7c1-48ca-baf9-97d7cc0cfea1/AB2CD709015C63AC10C0323D0650FCE7.img-assistance-act-1-

pager.pdf