Missouri law allows doctors to practice without residency

'Assistant physicians' seeing patients statewide
Posted at 3:30 PM, Dec 18, 2017

KANSAS CITY, Mo. — Every year, thousands of people graduate from medical schools, but not all of them are able to get into a residency program. With that in mind, the state of Missouri was the first in the nation to pass a law creating a new medical category: assistant physician. 

It's a designation for a medical school graduate who, under certain rules, can treat patients without going through residency. 

The law was actually signed by former Governor Jay Nixon in 2014 but took three years to implement. Now, the number of physicians in this category is slowly growing in clinics across the state.

The only place where they're practicing in the KC metro right now is in Grandview at the Medina Clinic.

Dr. Yaser Mustafa is one of the assistant physicians there. He speaks three languages and calls caring for people his passion. 

"That's what I signed up for, from day one," Mustafa said.

Mustafa is one of only 25 assistant physicians now licensed in the state of Missouri. He graduated from medical school, passed his required tests, but wasn't accepted into any of the nearly 60 American residency programs where he applied. 

"You've spent so much time, all these years, med school, undergrad," Mustafa said. "It gives you an opportunity to become stronger, and experience more things that you would not have experienced."

Mustafa was living in Chicago when the new Missouri law went into effect in mid-2017. Now, he sees patients at the free clinic in Grandview, all the while hoping that this stint will make his qualities more attractive, as he reapplies for residency. 

"Not being able to get paid for it, and still do it, that shows how much passion a person has in a certain area," Mustafa said. 


  • Speak English
  • Medical school graduate
  • Passed the first two steps of the U.S. Medical Licensing Examination
  • Primary care services, in an medically underserved rural or urban area
  • Work with a collaborating physician, who must be within 50 miles

Dr. Patricia Derges, another of the state's 25 assistant physicians, actually helped State Rep. Lynn Morris craft the law. She finished medical school in her 50's, but couldn't get into a residency program. 

"For us to literally throw away qualified doctors by the thousands every year is ludicrous," said Dr. Patrica Derges, one of the 25 assistant physicians currently working in Missouri.

She opened clinics in the Springfield area, where fellow assistant physicians see patients.

The law requires them to have a collaborating physician to check their work. That doctor doesn't have to be in the clinic, but he/she must be within 50 miles. But if that doctor decides to pull the plug, the assistant physician is left without a way to practice.

"Maybe the collaborator passes away, or wakes up and decides that he doesn't want to do this, or he retires," Derges said. "All these patients were thrilled to have a doctor, and now, that day, you have to lock your doors and say, 'sorry for you.'"

Right now, there's no way for assistant physicians to move past that designation without completing a residency program. Dr. Derges is working to craft another bill, to make three years of work as an assistant physician, the same as a three-year residency. 

But not everyone is on board. 

Dr. David Barbe, a Missouri native, and the president of the American Medical Association, released this statement to 41 Action News: 

"The AMA appreciates that the intent of this law is to bridge critical gaps in the health care workforce, particularly those due to limited residency positions. However, we encourage states to pursue more practical workforce solutions, such as increasing the number of state-funded residency positions."

The American Academy of Physician Assistants also voiced opposition to the law, telling 41 Action News: 

“AAPA understands the Missouri General Assembly’s interest in addressing the healthcare workforce shortage in the state. However, there are well-tested solutions that meet the same goal, such as increasing state funding for medical residency slots, providing incentives for the existing workforce to practice in rural and underserved areas, and decreasing barriers for other healthcare professionals, including PAs, to practice to the full extent of their education and experience.  To solve Missouri’s healthcare access problem, legislators must maximize the use of PAs – a profession which has existed for 50 years – and other established healthcare professionals.”

Dr. Wael Mourad works with Dr. Mustafa, and a few other assistant physicians, as the doctor required to partner with them. 

"As their collaborating physician, I review everything that they do," Mourad said.

Mourad knows about the opposition to the law and has some of his own reservations. But he says the number of people who aren't getting medical care, is just too high. 

"I feel that the assistant physician law is conducive to expanding our healthcare team, so we can see more patients on a charitable basis," Mourad said. 

Mustafa agrees.

"The other day I saw a patient that hasn't been to a doctor in 5 or 6 years, and I asked him why, and he just said, 'I don't have the money,'" Mustafa said.

Mourad said more conversations have to happen statewide before these assistant physicians graduate to seeing more than patients who otherwise couldn't afford it. 

Missouri was the first to enact a law like this, but it's no longer alone. In Kansas, special permits can be granted to medical school graduates, with most of the same rules as the Missouri law. But in Kansas, the doctor must be a graduate of the University of Kansas Medical School.