Scope of Practice

For years, TMA has lead advocacy efforts to keep Tennessee physicians supervising patient care and prevent inappropriate scope of practice expansion for midlevel healthcare providers. Advance practice nurses and physician assistants have been unsuccessful in their attempts to change state laws to achieve independent practice in Tennessee because of TMA's influence with lawmakers and regulators who understand that physician-led healthcare delivery teams are best for patients.

TMA remains steadfast in advocating for policies that improve and strengthen interprofessional relationships, not weaken them. We also aim to ensure Tennessee's physician oversight structure is working as intended. 

SB0176 / HB0184

Sen. Jon Lundberg (R. - Bristol) and Rep. Bob Ramsey (R. - Maryville) have introduced bill SB0176 / HB0184, which would eliminate the requirement for physician assistants to have a formal collaborative relationship with a physician. Currently, Tennessee state laws require PAs to collaborate with physicians because doctors have more education, training and experience. Each team member plays a vital role and should be able to work to the fullest extent of his or her education and training, but team members are not equivalent or interchangeable. Changing state laws to allow PAs to sever professional relationships with physicians and practice beyond the scope of their education, training and experience would essentially be giving them licenses to practice medicine (do what doctors do).

• This bill would threaten patient safety and quality of care and create the risk for missed diagnoses, increased opioid prescriptions, and/or overutilization of services (redundant tests, unnecessary visits and referrals, etc.), which increase overall healthcare costs.
• This bill would create more fragmentation in healthcare when the entire industry is moving in the opposite direction. We need more integrated and coordinated healthcare delivery in Tennessee, not more silos.

Patient-centered, physician-led care is the best way to increase healthcare access without compromising patient safety or quality of care.

NOTABLE ACHIEVEMENTS

2020

• TMA entered session with scope of practice as its top legislative priority and, after unsuccessfully attempting to reach common ground with nurses and physician assistants prior to the start of session, filed a placeholder caption bill that gave legislators an alternative to APRN independent practice and a more reasonable solution for addressing healthcare access without compromising patient safety or quality of care.

• The Tennessee Nurses Association wasted no time filing a bill for independent practice (SB 2110 / HB 2203).

• TMA and the Coalition for Collaborative Care were united in opposing the bill, and our deep collaborative work with legislators and other partners killed the Nurses' association bill. This helped keep Tennessee physicians supervising patient care and prevent inappropriate scope of practice expansion by mid-level healthcare providers.

• The nurse independent practice bill was one of several bills that would expand scope of practice for mid-level healthcare providers. Learn about the other bills in this brief video.

2014 - 2019 Achievements

We need to see things from your view.

 As we work with lawmakers to explain why abolishing the collaborative relationship between APRNs and physicians is bad for patient care, we need real life examples to help them better understand.

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Coalition for Collaborative Care
In 2018, TMA organized a coalition of the state’s largest medical specialty societies to identify and promote best practices for physician-led, team-based healthcare delivery in Tennessee and develop a solution(s) to increase access across the state. The group is examining collaboration rules to identify how the state might improve the regulatory environment to support more efficient primary care, particularly in rural, underserved areas of the state, as an alternative to nurse independent practice.