What is an Assistant Physician?

In 2014, then-Missouri Governor Jay Nixon signed the bill that created a new “mid-level” medical provider position, making Missouri the first state to license Assistant Physicians. But what is an Assistant Physician?

An Assistant Physician (NOT to be confused with a Physician Assistant!) is a graduate of a medical school, who therefore has a Doctorate in Medicine (MD), but has yet to complete a residency program. This medical school experience contains intense learning and skill development, covering ALL areas of medicine. For physicians, the residency that follows hones those skills into a particular specialty, such as Internal Medicine or General Surgery.

So why didn’t these medical school graduates get into residency? Is it really that difficult to get into a residency program?

Most folks don’t care if their physicians have an MD or a DO behind their name, which is good.  They are still “doctors.” There are differences in the methodology of the two schools, but overall competency is pretty much equivalent between the graduates who matriculate from medical schools or osteopathic schools.  Take a look at the chart below and note the 2016 percentages of MD and DO graduates in the U.S., as well as International Medical Graduates, who are degreed from non-U.S. medical schools.

Figure 1

Figure 1:Society of Teachers of Family Medicine

This gives you some idea of what the competition looks like, but not as clearly as this second graph I found:


When I graduated from my US medical school in 1999, it was so easy to get my first choice– notice the difference between number of available slots in Family Medicine residencies (blue line) and the number filled (red line). Nearly 600 residencies went unfilled in 1999, versus just over 100 empty spots this year. No wonder my second choice wanted to convince me to be their first choice – I was a U.S. medical school grad! Easy-peasy!!!

But take another look at that same graph – what happened around 2013? The number of residency positions in Family Medicine had decreased over the years, because they weren’t filling. Then in 2013 they started filling again. The number of available positions gradually increased, but the rate of filling those positions remains the same. In short, it has become a fierce competition to get into residency.

I know, I know – I’m throwing a lot of boring statistics at you. But the bottom line is this: getting into residency has become extremely competitive. Unfortunately, this leaves many competent doctors left behind in a cartoonish dust cloud. So they re-apply the next year. And the next. After a couple years out of medical school – with the medical school debt they can’t possibly pay back on a non-physician salary – it becomes harder and harder to get into residency.

Okay, this is all very well and good, but I have been speaking in a vague and abstract manner.  Let me put a face and a soul to this problem:

Meet Amber Milward M.D., AP. She received her Bachelors in Science from the American University of Antigua, St. Johns, then went on to earn an M.D. from their accredited medical school in 2013. While attending medical school, she also earned her online Masters in Healthcare Administration from Walden University in Minnesota, with the goal of gaining a competitive edge when applying to residency programs. Upon graduating in 2013, she applied for residency positions in multiple primary care specialties. And then again in 2014. And again in 2015. She was told by every residency program director that they “ranked” her as a potential candidate, but she had not matched – meaning, she had yet to get a foot in the door of a residency program.

Since then, she has done volunteer work to keep her skills up, and studies to stay up-to-date. But stuck in the limbo-land of Medical School/Residency purgatory, she could not get a paid position that allowed her to use the knowledge and skills she has obtained. Until Missouri’s Assistant physician program became reality. This program gives her –and the many other qualified medical professionals just like her– an opportunity to use their earned medical degrees to benefit patients in need of care.

Dr. Milward, Assistant Physician, will begin a collaborative practice agreement with me in April. Dr. Milward is originally from Arkansas and is no stranger to the Ozarks. She can learn a lot from our members and this experience will give her a lot of additional training.  I hope you will all welcome her and help her learn even more about Family Medicine. As I will attest, the ONLY excellent way to learn the practical side of family medicine is from listening to you – our patients.