Associate Physician Act


With more medical school graduates than open residency positions, the Associate Physician Act would allow medical graduates who have yet not completed a residency to provide primary care services to underserved areas in collaboration with a licensed physician.

Associate Physician Act

Section 1: Associate Physicians; Licensure; Applications; Rules; Definitions

A. An Associate Physician may practice as an Associate Physician as follows:

(1) By providing only primary care services and only in medically underserved rural or urban areas of this state; and
(2) Under the terms of an Associate Physician Collaborative Practice Arrangement

B. For a Physician-Associate Physician team working in a rural health clinic under the 1977 Federal Act (P.L 95-210), as amended, related to rural health clinic services:

(1) The Associate Physician shall be considered a Physician Assistant for the purposes of Centers for Medicare and Medicaid Services regulations.
(2) Supervision requirements in addition to the minimum federal supervision requirements are not required.

C. For the purposes of this section, the [STATE MEDICAL BOARD] shall establish rules that provide for all of the following:

(1) Licensure and license renewal procedures;
(2) Physician supervision and Collaborative Practice Arrangements;
(3) Fees;
(4) And any other matters that are necessary to protect the public and discipline professionals.

D. Any application for licensure may be denied or the licensure of an Associate Physician may be suspended or revoked by [STATE MEDICAL BOARD] in the same manner and for violating the standards prescribed by state law or by [STATE MEDICAL BOARD] by rule. An Associate Physician is not required to complete more hours of continuing medical education than that of a licensed physician.

E. An Associate Physician shall clearly identify himself as an Associate Physician. An Associate Physician may use the terms “doctor,” “dr.”, or “doc”. An Associate Physician may not practice or attempt to practice without an Associate Physician Collaborative Practice Arrangement as prescribed in Section 2, except as otherwise provided in this section and in an emergency situation.

F. The Collaborating Physician is responsible at al times for the oversight of the activities of and accepts responsibility for primary care services rendered by the Associate Physician.

G. An Associate Physician’s license renewal shall include verification of actual practice under a Collaborative Practice Arrangement as prescribed in Section 2 during the immediately preceding licensure period.

H. Each health insurance carrier or health benefit plan that offers or issues health benefit plans that are delivered, issued for delivery, continue, or renewed in this state, shall reimbursed an Associate Physician for diagnosing , consulting, or treating an insured or enrollee on the same basis that the health carrier or health benefit plan covers the service when it is delivered by another comparable mid-level health care provider, including a Physician Assistant.

I. For the purposes of this section:

(1) “Associate Physician” means a medical school graduate who meets all of the following:

a. Is a resident and citizen of the United States or is a legal resident alien.
b. Has successfully completed step two of the United States Medical Licensing Examination or the equivalent of such a step of any other board-approved Medical Licensing Examination either:

i. Within the three-year period immediately preceding application for licensure as an Associate Physician unless, when the three-year anniversary occurred, the person was service as a Resident Physician in an accredited residency in the United States and continued to do so within thirty days before applying for licensure as an Associate Physician; or
ii. Within the three years before graduation from medical school and the graduation occurred within the three-year period immediately preceding application for licensure as an Associate Physician.

c. Has not completed an approved postgraduate residency.
d. Is proficient in the English language.

(2) “Collaborative Practice Arrangement” means an agreement between a Physician and an Associate Physician that meets the requirements of this section and Section 2.
(3) “Medical School Graduate” means a person who has graduated from an approved school of medicine.

Section 2: Associate Physicians; Collaborative Practice Arrangements; Requirements; Rules, Controlled Substances; Definitions

A. A Physician may enter into Collaborative Practice Arrangements with Associate Physicians. Collaborative Practice Arrangements shall be in the form of written agreements, jointly agreed-on protocols, or standing orders for the delivery of health care services. Collaborative Practice Arrangements:

(1) Shall be in writing.
(2) May delegate an Associate Physician the authority to administer or dispense drugs under the authority provided by and conditions [STATUTE GIVING PHYSICIANS AUTHORITY TO DISPENSE DRUGS].
(3) Shall allow the Associate Physician to provide treatment as long as the delivery of the health care services is within the scope of practice of the Associate Physician and is consistent with the Associate Physician’s skill, training, and competence and the skill and training of the collaborating Physician.

B. The Collaborative Practice Arrangement shall contain at least the following provisions:

(1) Complete names, home and business addresses, zip codes and telephone numbers of the Collaborating Physician and the Associate Physician;
(2) A list of all other offices or locations besides those listed in paragraph 1 of this subsection where the collaborating Physician authorizes the Associate Physician to prescribe;
(3) A requirement that there be posted at every office where the Associate Physician is authorized to prescribe, in collaboration with a physician, a prominently displayed disclosure statement informing patients that they may be seen by an Associate Physician and have the right to see the collaborating physician;
(4) All specialty or board certifications of the collaborating physician and all certifications of the associate physician;
(5) The manner of collaboration between the collaborating physician and the Associate Physician, including how the collaborating physician and the associate physician will:

a. Engage in collaborative practice consistent with each professional’s skill, training, education, and competence;
b. Maintain geographic proximity, except that the Collaborative Practice Arrangement may allow for geographic proximity to be waived for a maximum of twenty-eight days per calendar year for rural health clinics as defined in 42 United States Code Section 1395x. As long as the Collaborative Practice Arrangement includes alternative coverage as required by subdivision (c) of this paragraph, the geographic proximity exception applies only to independent rural health clinics, provider- based rural health clinics if the provider is a critical access hospital as provided in 42 United States Code Section 1395i-4 or provider-based rural health clinics if the main location of the hospital sponsor is more than fifty miles from the clinic. The collaborating physician shall maintain documentation related to this requirement and present it to the board on request; and
c. Provide for alternative coverage during absence, incapacity, or infirmity or an emergency.

(6) A description of the Associate Physician’s controlled substance prescriptive authority in collaboration with the physician, including a list of the controlled substances the collaborating physician authorizes the Associate Physician to prescribe and documentation that it is consistent with each professional’s education, knowledge, skill, and competence;
(7) A list of any other written practice agreement of the collaborating physician and the Associate Physician;
(8) The duration of any other written practice agreement between the collaborating physician and the Associate Physician;
(9) A description of the time and manner of the collaborating physician’s review of the Associate Physician’s delivery of health care services, including provisions that the Associate Physician must submit a minimum of ten percent of the charts documented the Associate Physician’s delivery of health care services to the collaborating physician for review by the collaborating physician or any other physician designated in the Collaborative Practice Arrangement, every fourteen days; and
(10) A requirement that the collaborating physician, or any other physician designated in the Collaborative Practice Arrangement, review every fourteen days a minimum of twenty percent of the charts in which the Associate Physician prescribes controlled substances. The charts reviewed under this paragraph may be counted in the number of charts required to be reviewed under paragraph 9 of this subsection.

C. The [STATE MEDICAL BOARD] shall adopt rules regulating the use of Collaborative Practice Arrangements for Associate Physicians that specify:

(1) Geographic areas to be covered,
(2) The methods of treatment that may be covered by Collaborative Practice Arrangements,
(3) In conjunction with deans of medical schools and primary care residency program directors in this state, the development and implementation of educational methods and programs undertaken during the Collaborative Practice Service that facilitates the advancement of the Associate Physician’s medical knowledge and capabilities and that may lead to credit toward a future residency program for programs that deem such documented educational achievements acceptable.
(4) the requirements for review of services provided under Collaborative Practice Arrangements, including delegating authority to prescribe controlled substances.

D. The [STATE MEDICAL BOARD] shall adopt rules applicable to associate physicians that are consistent with guidelines for federally funded clinics. The rulemaking authority granted in this subsection does not extend to Collaborative Practice Arrangements of hospital employees providing inpatient care within accredited hospitals.

E. [STATE MEDICAL BOARD] may not deny, revoke, suspend or otherwise take disciplinary action against the license of a collaborating physician for health care services delegated to an associate physician if this section and the rules adopted pursuant to this section are satisfied.

F. The board shall require each physician, on licensure renewal, to identify whether the physician is engaged in any Collaborative Practice Arrangement, including collaborative practice arrangements delegating the authority to prescribe controlled substances, and to report to the board the name of each associate physician with whom the physician has a collaborative practice arrangement. The board may make such information available to the public. The board shall track the reported information and may routinely conduct random reviews of the Collaborative Practice Arrangements to ensure they are carried out in compliance with this chapter and the rules adopted pursuant to this chapter.

G. A collaborating physician may not enter into a Collaborative Practice Arrangement with more than six full-time equivalent Associate Physicians or full-time equivalent physician assistants, or any combination thereof.

H. The collaborating physician shall determine and document the completion of at least a one-month period of time during which the Associate Physician practices in a setting in which the collaborating physician is continuously present before practicing when the collaborating physician is not continuously present. Board rules may not require the collaborating physician to review more than ten percent of the Associate Physician’s patient charts or records during that one-month period.

I. A Collaborative Practice Arrangement under this section may not supersede current hospital licensing regulations governing hospital medication orders under protocols or standing orders for the purpose of delivering inpatient or emergency care within an accredited hospital if such protocols or standing orders have been approved by the hospital’s medical staff and pharmaceutical therapeutics committee.

J. A contract or other agreement may not require a physician to act as a collaborating physician for an associate physician against the physician’s will. A physician may refuse to act as a collaborating physician, without penalty, for a particular associate physician. a contract or other agreement may not limit the collaborating physician’s ultimate authority over any protocols or standing orders or in delegating the physician’s authority to any associate physician, and a physician, in implementing such protocols, standing orders or delegation, may not violate applicable standards for safe medical practice established by a hospital’s medical staff.

K. A contract or other agreement may not require any Associate Physician to serve as a collaborating associate physician for any collaborating physician against the Associate Physician’s will. An Associate Physician may refuse to collaborate, without penalty, with a particular physician.

L. Each collaborating physician and Associate Physician in a Collaborative Practice Arrangement shall wear identification badges while acting within the scope of their Collaborative Practice Arrangement. The identification badges shall prominently display the licensure status of each collaborating physician and Associate Physician.

M. An Associate Physician who is granted controlled substances prescriptive authority as provided in this chapter may prescribe any controlled substance listed in schedule iii, iv or v, and may have restricted authority in schedule ii, when delegated the authority to prescribe controlled substances in a Collaborative Practice Arrangement. Prescriptions for schedule ii medications prescribed by an Associate Physician who has a certificate of controlled substances prescriptive authority are restricted to only those medications containing hydrocodone. Such authority shall be filed with the board. the collaborating physician may limit a specific scheduled drug or scheduled drug category that the Associate Physician is allowed to prescribe. Any limits shall be listed in the Collaborative Practice Arrangement. Associate Physicians may not prescribe controlled substances for themselves or members of their families. Schedule iii controlled substances and schedule ii hydrocodone prescriptions are limited to a five-day supply without refill, except that buprenorphine may be prescribed for up to a thirty-day supply without refill for patients receiving medication-assisted treatment for substance use disorders under the direction of the collaborating physician. Associate physicians who are authorized to prescribe controlled substances under this chapter shall register with the United States Drug Enforcement Administration and shall include the United States Drug Enforcement Administration Registration Number on prescriptions for controlled substances. The collaborating physician shall determine and document the completion of at least one hundred twenty hours in a four-month period by the Associate Physician during which the Associate Physician practices with the collaborating physician on-site before prescribing controlled substances when the collaborating physician is not on-site.

N. This section and other sections of this bill do not limit the authority of hospitals or hospital medical staff to make employment or medical staff credentialing or privileging decisions.

O. For the purposes of this section, “Associate Physician” and “Collaborative Practice Arrangement” have the same meanings prescribed in Section 1.