Missouri Governor Jay Nixon has signed into a law a bill that makes it legal for medical students who have not yet completed a year of residency to work as “assistant physicians” within the state, delivering primary care services with 10 percent of their work reviewed by a physician.

The idea behind the bill is to increase access to basic primary care services that do not require they type of training and experience that equates to having earned a medical doctorate. It also gives medical students who failed to match with a residency slot a chance to continue accumulating valuable experience (and pay down loans) while continuing to try to land a residency slot.

The idea for the law was initially proposed by Edmond Cabbabe, M.D., a St. Louis, Missouri, plastic surgeon. He worked with state Rep. Keith Frederick, a republican, to get the bill introduced in the state legislature, where it picked up the support of the Missouri State Medical Association.

However, other groups are concerned about the outcome of the new law. Physician assistant groups have expressed concern about whether the public will be confused by the new assistant physician job category (which sounds very similar to physician assistant) and wondered if the change in law was really necessary. A bill passed last year expands the role of physician assistants in the state, and it could be that assistant physicians might not really be needed once physician assistants are fully deployed across the state.

“If we’re not fully utilizing PAs to their maximum ability in the state of Missouri, then I have to question — Why are we inventing a new profession?” asked Paul Winter, president of the Missouri Academy of Physician Assistants, in an interview with public radio station KCUR 89.3 before the law was passed.

The lack of a time limit on how long an assistant physician could work in primary care in Missouri also has physicians worried. Could a medical student who fails to match with a residence slot work a whole career as a primary care provider without ever going on to earn his or her M.D.

"I didn't see that there would be a time limit to this career path. That would be scary — a B-team of doctors," said Hans Duvefelt, M.D., family practitioner for 30 years in the rural town of Van Buren, Maine, in an interview with MedPage Today.

The Missouri Academy of Family Physicians also has opposed the law. The Academy favors legislative changes that would enable the state to attract more real physicians to rural communities instead — for example, tort reform to create a more favorable practice environment and programs that pay off new M.D.s’ education loans.

In addition, the American Medical Association (AMA) House of Delegates voted to officially make the AMA opposed to any special licensing pathways for physicians who "are not currently enrolled in an Accreditation Council for Graduate Medical Education or American Osteopathic Association training program, or have not completed at least one year of accredited post-graduate U.S. medical education."

In Missouri, the law would become effective August 28 of this year. Assistant physicians would be allowed to use the title physician and would be able to provide primary care services largely unsupervised after completing a 30-day training period with a physician who practices within 50 miles of where the assistant physician will be practicing. Every two weeks, 10 percent of the assistant physicians charts would be pulled and reviewed by a licensed physician to make sure there are no problems.