Get ahead of the physician shortage curve

The coronavirus pandemic is unlike anything our healthcare system has seen in the century since the Spanish flu pandemic of 1918. COVID-19 is already forcing us to ration protective equipment, quarantine large numbers of patients and worry if our intensive care units (ICUs) have enough ventilators. In the coming weeks we are likely to contend with an equally serious problem: physician shortages.

We are physicians on the front lines right now, and we have grave concerns that there will not be enough of us able to work in the weeks ahead. There is little doubt that we and many of our colleagues will become infected during this time. Even if our symptoms are mild, we will have to quarantine for two weeks and we will not be able to provide crucial patient care during that time. Someone else will have to fill in for us.  

Both of us are inspired by stories of physicians coming out of retirement to man the frontline of defense in this pandemic. Yet it remains to be seen if there will be enough of them. 

Many European countries have already been forced to respond to physician shortfalls by fast-tracking medical students through their clinical training in a desperate attempt to staff hospitals. 

While this stopgap approach may temporarily ease the staffing shortage, it places tremendous pressure on students who are still learning the basics of clinical care and it risks potential harm to patients. 

Instead, we propose that the United States permit any individual who has graduated medical school to work as a physician. This policy change alone would allow over 4,000 medical school graduates in the United States who did not match to a residency program to immediately enter the physician workforce.

Under current law, completing a residency program is necessary to gain the full breadth of medical training and is a prerequisite for licensing and board certification. 

In our current crisis, we cannot afford to turn away anyone with medical skills. Any individual who completed medical school and has the desire to serve our nation in this time of dire need should be put to work to alleviate our critical shortage of healthcare providers.  

There is already precedent for such an action. In 2018, the state of Missouri created a new category of healthcare providers called “assistant physicians,” defined as individuals who have graduated from medical school, but who have not completed a residency program.

Assistant physicians may practice at a level similar to nurse practitioners and physician assistants. They can perform various procedures, order medications, assist with lifesaving treatments and conduct medical triage under the supervision of a licensed physician. This policy was implemented in order to improve healthcare access in underserved areas of the state, in particular those affected by the opioid crisis. 

In our current coronavirus crisis assistant physicians would be invaluable in states with large numbers of COVID19 cases, such as Washington and New York.  In these areas, doctors are already being reassigned to the most urgent health care cases, elective surgeries have been canceled and anesthesia and surgical residents are often treating critically ill patients in intensive care units. This leaves general medicine services understaffed. After all, doctors are still needed to treat other medical conditions necessitating hospitalization such as heart failure, strokes and kidney disease. 

Some may argue that assistant physicians would pose a risk to patients, given that many of them have lower scores on the Medical Licensing Examination, or point to other “red flags” in their applications that prevented them from finding residency positions. Individuals who did not match for a residency, however, often have the same or better clinical qualifications than those who did. 

That’s because the total number of residency positions has been capped by Congress since 1997. Yet the number of medical school graduates has continued to grow. This has created a bottleneck: many well-qualified medical school graduates who have earned their MD or DO are unable to move on to the next phase of their career. 

In addition, there are nearly 3,000 “unmatched” international medical graduates (IMGs). Many IMGs live in the United States, but work below their skill level. Their expertise would be invaluable in our current crisis, especially as our country begins difficult but unavoidable conversations about treatment rationing and resource allocation. 

We call on governors throughout the United States to issue executive orders allowing any individual who completed medical school to practice at the level of an “assistant physician,” under the supervision of a licensed physician. This will greatly expand the labor force of clinical staff, and help hospitals meet the explosion of demand that is sure to worsen in the next few weeks due to COVID19. Such action may be our best hope of getting ahead of the physician shortage curve. 

Aamir Hussain is a resident physician in internal medicine at Northwell Health. Greg Jasani is a resident physician in emergency medicine at the University of Maryland.