Proposed Legislation Seeks to Allow APRN Independent Practice

We are members of the Coalition for Collaborative Care, a group of Tennessee physicians and professional physician associations representing multiple specialties dedicated to promoting best practices for, and increasing access to, optimal medical care for all Tennesseans. 

As multiple training pathways have emerged for non-physician medical providers, it has become increasingly difficult for patients to understand the titles and roles these different providers have on the medical team. Physicians (MDs and DOs) receive the highest level of medical training, both in classroom studies and clinical training. Physician training usually requires 15,000-20,000 hours of clinical experience. On average, physician assistants (PAs) train for about 2,000 clinical hours and nurse practitioners (NPs) can train for as few as 500 clinical hours. Given their level of training, physicians are uniquely qualified to manage, coordinate, and supervise patient care by medical teams. For this reason, current law in Tennessee requires physician oversight for both NPs and PAs.

As healthcare professionals know, this pandemic has stressed Tennessee’s medical system and strained capacity to provide bedside care and staff our hospitals. Certainly, non-physician clinicians are valuable members of healthcare teams and have played an important role providing needed care during this unprecedented crisis in collaboration with physicians.

As we move past the current healthcare crisis, we will continue to face physician shortages in many rural, medically underserved areas of our state. Some suggest that PAs can help fill this rural healthcare gap by practicing independently without physician oversight. Practicing in rural areas where the nearest support, specialist, or tertiary care center may be hours away, is one of the most difficult parts of serving in an underserved rural community.

The health of Tennesseans is best served not by giving complete independent responsibility to non-physician clinicians, but by working together as a supportive team that maximizes the value and training of each member. This physician-led, team-based model provides the highest quality patient care. This model is also the best way to increase access to healthcare across our state.

The emergence of telehealth allows for more frequent and effective collaboration between physicians and the rest of the healthcare team despite geographic challenges. Governor Lee has committed to expanding broadband internet services across Tennessee. Advances in telehealth should only improve and strengthen a medical team’s ability to collaborate in patient care.

Finally, patients prefer and deserve to have a physician involved in their care, regardless of their geographical location. Increased graduate medical education funding, in addition to telehealth expansion, will help to increase patient access to physicians in rural communities. Medicine works best with a team-based approach with experienced physicians collaborating directly with non-physician providers. When providers with less education and experience work separately in silos, patient care suffers.  When all members of the medical community work collaboratively, everyone benefits from the knowledge and experience of all members of the team. 

Howard Herrell, MD – Chairman – Coalition of Collaborative Care

Ty Webb, MD – Tennessee Academy of Family Physicians

Rebecca Taylor, MD – Tennessee Academy of Ophthalmology

Hunter Butler, MD – Tennessee Chapter of the American Academy of Pediatrics

Sudave Mendiratta, MD – Tennessee Chapter of the American College of Emergency Physicians

Tracey Doering, MD -Tennessee Chapter of the American College of Physicians

Robert Maxwell, MD – Tennessee Chapter of the American College of Surgeons

Pezhman Shoureshi, MD -Tennessee Dermatology Society

Mike Carrigan, MD -Tennessee Group Practice Coalition

Kevin Smith, MD – Tennessee Medical Association 

Jeffery Lawrence, MD – Tennessee Orthopedic Society

J. Michael Wieting, DO -Tennessee Osteopathic Medical Association

Christopher Young, MD – Tennessee Society of Anesthesiologists