SCOPE OF PRACTICE

TMA for years has led 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, team-based healthcare delivery teams are best for patients.

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

OUR PRINCIPLES

  • Today’s quality and value-driven healthcare climate calls for a team-based approach to healthcare delivery. Each team member plays a vital role on the healthcare team and should be able to work to the fullest extend of his or her education and training, but team members are not equivalent or interchangeable. Physicians have more education, training and experience than any other team member(s) and should lead the team in diagnosing and treating complex medical conditions, complications or emergencies.

  • There is an obvious and direct correlation between healthcare collaboration and quality. The physician-led, team-based model is the best way to create much-needed access in underserved areas of the state and contain costs without compromising patient safety or quality of care.

  • Giving midlevel providers independent practice without physician collaboration would create more fragmentation in healthcare delivery and threaten quality of care and patient safety. We need more integrated and coordinated healthcare delivery, not more silos.

NOTABLE ACHIEVEMENTS

2014

  • TMA defeats initial push by nurses to change state laws to allow for fully independent (unsupervised) practice in Tennessee.

2015

  • TMA pushes back against continued advances from nurses in the legislature for independent practice and releases a white paper outlining its vision for team-based healthcare in Tennessee.

2016

  • TMA holds the line on team-based healthcare delivery, again defeating APRNs’ push for independent practice while advancing a bill to support team-based care models in Tennessee. The bill is withdrawn in favor of a legislative task force and TMA negotiates a three-year moratorium on scope bills with nurses.

2017

  • TMA opposes a legislative proposal by physician assistants for a new licensure called Doctor of Medical Science that would effectively grant PAs independent practice in Tennessee and persuades proponents to defer the bill until 2018.

2018

  • TMA remains opposed to the DMS bill and moves its position to neutral during the legislative session after negotiating a number of concessions from bill sponsors, including removing the term “doctor” and requiring PAs to work with physicians in a team-based model, regulated by the Board of Medical Examiners. The bill is withdrawn in committee.

    Following the legislative session, TMA begins to organize a coalition of medical specialty societies to help promote physician-led healthcare delivery in Tennessee and develop a cohesive voice from the medical community. The group makes overtures to the nurses for a possible compromise and begins negotiating rule changes that would improve physician-nurse collaboration.

2019

  • TMA thwarts a pre-session effort by “rogue” APRNs to introduce independent practice legislation in 2019. As a result, no bill is even filed. TMA defeats a resurrected version of the DMS bill that would have given PAs independent practice, and helps defeat a measure that would have given PAs and nurse practitioners the ability to prescribe buprenorphine.

    The moratorium with the Tennessee Nurses Association expired after the 2019 legislative session, and TMA continues working with the coalition for possible solutions to present to the General Assembly in 2020.

 

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. 

Tennessee Academy of Family Physicians 
Tennessee Academy of Ophthalmology 
Tennessee Chapter of the American Academy of Pediatrics 
Tennessee Chapter of the American College of Physicians 
Tennessee Chapter of the American College of Surgeons 
Tennessee Dermatological Society  
Tennessee Group Practice Coalition 
Tennessee Medical Association 
Tennessee Orthopedic Society 
Tennessee Osteopathic Medical Association 
Tennessee Psychiatric Association 
Tennessee Society of Anesthesiologists

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