Scope of PracticeFor 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.
Sen. Jon Lundberg (R. - Bristol) and Rep. Bob Ramsey (R. - Maryville) have introduced this bill, which would eliminate the requirement for APRNs to have a formal collaborative relationship with a physician. Currently, Tennessee state laws require APRNs 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 APRNs 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).
Sen. Mike Bell (R. - Riceville) and Rep. Mark Cochran (R. - Englewood) introduced this bill regarding the collaboration requirements for PAs. It has been confirmed that this bill will be amended to provide for independent practice for PAs.
- These bills 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.
- These bills 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.
- Data shows that primary care physicians, APRNs and PAs tend to work in the same geographic areas in Tennessee and other states, regardless of the level of autonomy allowed by state policies. PAs are no more likely to open or maintain rural practices than primary care physicians for the same economic reasons.
- The emergence of telehealth allows for more frequent and effective collaboration between physicians and the rest of the healthcare team despite geographic challenges.
- Patients prefer to have a physician involved in their care and deserve access to safe, high-quality care led by a physician, no matter where the patient lives.
- PAs and APRNs claim that they can fill a healthcare gap in Tennessee communities where hospitals have closed is nonsensical. Primary care offices staffed with PAs or APRNs is not the same as physician-led emergency and specialized care access via hospitals.
- PAs and APRNs will tell you they were allowed to practice without collaborating with a physician during the COVID-19 pandemic. However, Governor Lee’s Executive Order allowing the waiver of the collaboration requirement was only a few weeks and during the same period of time that many practices were shut down as all elected procedures were halted.
- TMA has made numerous offers to modernize oversight rules but the nurses and physician assistants have opposed them.
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.
"Patients at Risk" Video
Watch authors and Drs. Rebekah Bernard, MD, and Niran Al-Agba, MD, discuss the findings in their book, "Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare."
Contact Your Legislators
Reach out to your state senator and urge them to oppose this bill.
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.