Recently Enacted Statute Permits Collaborative Practice Arrangements

A recently enacted bill allows medical school graduates to practice medicine in collaboration with supervising physicians. The statute, known as Section 334.036, permits assistant physicians to practice medicine in rural or underserved locations in Missouri. The law facilitates delivery of health care services to citizens who have little or no opportunity to avail themselves of quality health care while providing aspiring physicians with a forum for practical skill development. The law delineates the practices an assisting physician may undertake as well as identifies the ethical responsibilities of the assisting physician and supervising physician. Missouri professional licensing attorney Danielle Sanger advises that physicians who agree to supervise a student physician under a collaborative practice arrangement must familiarize themselves with the requisite ethical standards to avoid potential pitfalls.

An assistant physician may practice medicine only in compliance with strict adherence to established guidelines. An assistant physician must be licensed in Missouri. An applicant must have graduated from medical school and be a citizen of the United State or a legal alien. Moreover, the applicant must have successfully completed Steps 1 and 2 of the United States Medical Licensing Examination within two years of applying to become an assistant physician.  However, the applicant is ineligible if applying to be an assistant physician more than three  years after graduation. A person is also eligible to apply if the postgraduate residency has not been completed but has passed Step 2. Moreover, the applicant must be fluent in English.

The assistant physician is limited in practice. The assistant physician’s medical practice is limited to primary care in rural or underserved areas or as part of a pilot project area. The assistant physician may self-identify as an assistant physician but is permitted to use the terms “doctor” or “doc.”  The assistant may administer medical treatment in an emergency situation; however, the practice of medicine is prohibited unless the assistant physician is a signatory to a collaborative practice arrangement with a supervising physician. The assistant physician may prescribe narcotics listed in Schedules III, IV, and V of Section 195.017 once they properly obtain a certificate to prescribe drugs and have appropriate registrations filed with the Federal Drug Administration as well as the Missouri bureau of dangerous drugs. The assistant may only prescribe medications listed in Schedule II if the medication contains hydrocodone and the prescription is limited to a five-day course. Moreover, the assistant physician may not prescribe medication for personal use or to members of their families.

A collaborative practice arrangement must be executed between assistant physician and supervising physician. To be valid, the collaborative practice agreement must be in writing and contain agreed-upon protocols or “standing orders for the delivery of medical services.”  In addition, the collaborative practice agreement can give the assistant physician authority to administer treatment and write prescriptions, consistent with statutory limitations, provided that the care administered is consistent with the assistant physician’s skills, training, and experience. The arrangement must include a provision indicating that a notice shall be displayed in the physician’s office including a list of prescriptions the assistant physician may prescribe and a notice that the patient may be seen by an assistant physician. The notice must include a statement that the patient has the right to be examined by a physician and not the assistant.

The collaborating physician has many obligations when undertaking the role of supervising physician.  The supervising physician must review a minimum of 10 percent of the assistant physician’s charts every 14 days. Additionally, the collaborating physician must review a minimum of 20 percent of the assistant’s charts in which prescriptions were written.  Moreover, the collaborating physician must document a one-month time frame during which the assistant practices exclusively with the collaborating physician before the assistant can see patients alone.  Additionally, the assistant must practice with the collaborating physician for 120 hours in a four-month period before the assistant is permitted to prescribe medications.

Attention To Detail Will Prevent Disciplinary Action

The assistant physician is practicing medicine on the license of the collaborating physician. Any ethical transgressions committed by the assistant may be attributed to the collaborating physician. Contact Missouri Professional Licensing Attorney Danielle Sanger at 785-979-4353 to schedule a no-obligation consultation to discuss disciplinary issues you face as a result of a collaborative practice arrangement.

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