Washington International Law Journal


Jeffrey P. Lane


Facing a global physician shortage and high international emigration rates, developing countries are increasingly looking to mid-level health care providers to provide critical primary health care services. Mid-level providers have more training than nurses but less than full physicians and are typically authorized to prescribe medications and perform simple medical procedures. As the demand for health care providers continues to grow, mid-level providers are increasingly being asked to provide a broader array of clinical services. In response to this growing need, mid-level providers are increasingly practicing outside of their licensed scope of practice, which may both compromise patient safety and expose providers to legal liability. To ensure that countries are striking an appropriate balance between the increasing need for health care providers and the need to protect patient safety, the World Health Organization (“WHO”) has called on countries to review their medical licensure laws to ensure that they clearly and appropriately define mid-level providers’ scope of practice, degree of autonomy, initial and continuing educational requirements, and disciplinary mechanisms. One developing country that is utilizing mid-level providers to address its chronic physician shortage and whose licensure laws fail to satisfy the WHO recommendations is the Republic of the Marshall Islands (“Marshall Islands”). The Marshall Islands’ health assistants provide critical primary health care services to the country’s outer island communities. However, the licensure law applying to health assistants does not clearly define their scope of practice, degree of autonomy, or continuing education requirements. As international aid from the United States decreases in the coming years and the outer island health care system likely deteriorates, these health assistants will be faced with increasingly difficult treatment scenarios. To ensure that these providers are adequately trained for these situations, the Marshall Islands should enact a comprehensive health assistant licensure scheme consistent with the WHO recommendations. After analyzing existing medical licensure laws in the Marshall Islands, this Comment will propose a comprehensive health assistant licensure scheme that is consistent with WHO recommendations and modeled on the Marshall Islands’ Nursing Practice Act.

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