Physician assistants want deregulation due to doctor shortage

Tennessee’s physician assistants want state lawmakers to loosen regulations on their practices, essentially allowing them to be independent of the doctors who have traditionally supervised them and, the argument goes, help ease the state’s shortage of medical practitioners.

The proposal comes as states are increasingly expanding the role of nurses, physician assistants, pharmacists and telehealth services to ease the continuing shortage of health care providers. This trend accelerated during the COVID-19 pandemic when states, including Tennessee, eased medical practice rules to allow patients more access to health care.

North Dakota, Utah and Wyoming have already approved similar measures.

But physician groups, including the Tennessee Medical Association, say that permanently ending such regulations would allow physician assistants to practice as doctors without having attended medical school or gone through supervised residency programs.

This, doctors say, could lead to poorer health outcomes for patients.

Two bills are now before the General Assembly to expand the authority of physician assistants’ practice. And, last week, several hundred physician assistants and PAS in training in white coats showed up at the state Capitol to lobby on their behalf.

Seth Weathersby, a physician assistant who owns three urgent care centers in Murfreesboro, was among them. He argues that PAS are well-trained and are ready to fill the many gaps in the state’s medical care, without all of the “red tape” that’s currently required of them.

“Everyone hears all the time about how underserved we are from a primary care (medicine) perspective, from an internal medicine perspective and how it takes forever to get in to see your doctor, and everybody has a great relationship

with urgent care now,” Weathersby said. “But preventative medicine has fallen so far off people’s radar because access to care is so incredibly limited.”

Yarnell Beatty, the Tennessee Medical Association’s senior vice president and general counsel, said the existing regulations help prevent overprescribing of opioids and “over-utilization of health care resources” by PAS.

“Changing state laws to allow PAS to sever collaborative 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) without having attended medical school or undergone a supervised residency program,” Beatty wrote in an email. “Tennessee needs more integration in health care, not less.”

Existing law versus the proposed changes

Tennessee law requires physician assistants to work in partnership with a supervising or, as the law puts it, “collaborating” licensed physician and to notify the state of who that person is. Prescriptions provided by physician assistants must be monitored by the state’s board of medical examiners and board of physician assistants, including site visits.

The law also requires collaborating physicians to visit sites at least once a month. Their co-signatures are required for at least 20% of patient medical charts each month. Doctors are not required to constantly be on-site but must be available for consultation or make arrangements for a replacement doctor for any such needs, the law further states.

The proposed change would take doctors out of the equation altogether for Pa-owned practices. Staff would answer directly to clinic owners. Medical reviews of practices and prescribing would be under the direct jurisdiction of the board of physician assistants.

Tennessee law already allows physician assistants to prescribe Schedule II through V drugs. Schedule II and III drugs (which include addictive painkillers) are usually limited to a 30-day supply. Physician assistants are not proposing to change that.

Will this help the physician shortages?

The United States faces a projected shortage of up to 124,000 physicians in the next 12 years, according to the American Medical Association. While the AMA calls for more funding for physician training, physician assistants say cutting red tape is one easy solution.

“In some areas, it’s hard to find someone to collaborate with,” said Marie Patterson, director of Middle Tennessee State University’s Physician Assistant Studies program. “So, if you want to go to a rural area and open up a clinic, you technically can’t do that if you can’t find a physician to collaborate with you.” She noted that this was the same system that was in place during the COVID-19 emergency: “We did not see this exponential amount of malpractice cases come before us.”

The Tennessee Medical Association isn’t buying that argument. It and the American Medical Association argues that there’s little evidence that physician assistants are any more likely to set up shop in rural areas than doctors.

“Expansion of charity medical care, increased graduate medical education funding, and telehealth are starting to address access to care in rural communities,” Beatty said. “In other states where nurses and PAS were given socalled ‘independent’ practice, those providers have not moved to rural areas any more than physicians.”

Physician Assistants and Nurse Practitioners - What are they?

A physician assistant is similar to the now-familiar nurse practitioner and also has a high level of medical training, though neither has the same level of schooling as full-fledged physicians.

Physician assistants have master’s degrees in medical education and sometimes doctorates. Nurse practitioners are registered nurses. In Tennessee, they must have graduate degrees in a nursing specialty area, threequarter hours of pharmacology, national certification and evidence of specialized practitioner skills.

The pay is roughly the same between the two specialties.

According to the Bureau of Labor Statistics, the median salary for a physician assistant is more than $121,500. Nurse practitioners earn a median of $123,780. Physicians and surgeons, by comparison, earn a median of $208,000.

Both medical specialties can prescribe a variety of medications. Nurses may assist doctors with surgeries. Physician assistants may perform some invasive procedures themselves.

“If a patient is doing very poorly after a surgery and is dying, I have the ability as a PA, with my training, to open up their chest to put my hands in there and help with their heartbeat,” said Jennifer Orozco, president of the American Academy of Physician Associates.

Frank Gluck is a reporter for The Tennessean. He can be reached at fgluck@tennessean.com. Follow him on Twitter at @Frankgluck.