Tennessee Legislature Passes Law Allowing Podiatrists to Supervise Physician Assistants

By John Williams
TPMA Lobbyist

The Tennessee legislature has passed legislation allowing a licensed podiatrist to serve as the supervising physician of a physician assistant (PA).  This new law is Chapter 946 of the Public Acts of 2016.  Prior to passage of this bill, only MDs or DOs could serve as supervising physicians of PAs.

Chapter 946 amends the PA practice act and the Podiatrist practice act.  Podiatrists who supervise PAs must comply with all supervision requirements that apply to MDs and DOs (e.g., protocols, chart signature, etc.).  PAs that are supervised by a podiatrist may not provide any “services that are outside of the scope of practice of a podiatrist” and may “prescribe only drugs that are rational to the practice of podiatry.”

The bill was sponsored by Sen. Rusty Crowe of Johnson City and Rep. Matthew Hill of Jonesborough, both of whom have sponsored legislation for TAPA in past years.  The bill was an initiative of the Tennessee Podiatric Medical Association.  Both the Tennessee Academy of Physician Assistants and the Tennessee Medical Association stated in writing their support for the bill.

The bill was signed into law by Governor Haslam on April 27, 2016, and is effective immediately.

Tennessee is the 8th state to allow podiatrists to supervise PAs.  The others are California, Colorado, Michigan, Ohio, Rhode Island, Virginia, and West Virginia.

Before a podiatrist hires a PA to work in his or her practice, it is essential that the podiatrist familiarize himself or herself with all the supervision requirements of Tennessee law.  Following is the key Supervision rule adopted by the Board of Medical Examiners:

 

0880-02-.18 SUPERVISION OF PHYSICIAN ASSISTANTS.

The following requirements apply to a supervising physician who supervises one or more physician assistants:

(1) A supervising physician or a substitute supervising physician must possess a current, unencumbered license to practice in the state of Tennessee.

(2) Supervision does not require the continuous and constant presence of the supervising physician; however, the supervising physician must be available for consultation at all times or shall make arrangements for a substitute physician to be available.

(3) A supervising physician and/or substitute supervising physician shall have experience and/or expertise in the same area of medicine as the physician assistant.

(4) Physician assistants who hold temporary licenses pursuant to T.C.A. § 63-19-105(a)(2) (those waiting to take the licensure examination) may not provide services unless a supervising physician is on site while the services are being provided.

(5) Protocols are required and:

(a) shall be jointly developed and approved by the supervising physician and physician assistant;

(b) shall outline and cover the applicable standard of care;

(c) shall be reviewed and updated biennially;

(d) shall be maintained at the practice site;

(e) shall account for all protocol drugs by appropriate formulary;

(f) shall be specific to the population seen;

(g) shall be dated and signed; and

(h) shall be made available upon request for inspection by the board or committee.

(6) The supervising physician shall be responsible for ensuring compliance with the applicable standard of care under (5). Additionally, the supervising physician shall develop protocols in collaboration with the physician assistant to include a method for documenting consultation and referral.

(7) Within ten (10) business days after the physician assistant has examined a patient who falls in one of the following categories, the supervising physician shall make a personal review of the historical, physical, and therapeutic data gathered by the physician assistant on that patient and shall so certify in the patient's chart within thirty (30) days:

(a) when medically indicated;

(b) when requested by the patient;

(c) when prescriptions written by the physician assistant fall outside the protocols;

(d) when prescriptions are written by a physician assistant who possesses a temporary license; and

(e) when a controlled drug has been prescribed.

(8) In any event, a supervising physician shall personally review at least twenty percent (20%) of charts monitored or written by the physician assistant every thirty (30) days.

(9) The supervising physician shall be required to visit any remote site at least once every thirty (30) days.

(10) If more than one physician supervises a physician assistant in a practice setting (such as in a hospital emergency room), one protocol may be developed for that practice setting.

(11) If a physician assistant and the same supervising physician work in more than one practice setting, one protocol may be developed which covers all these practice settings.

(12) The number of physician assistants for whom a physician may serve as the supervising physician shall be determined by the physician at the practice level, consistent with good medical practice.

(13) The supervising physician may delegate to a physician assistant working under the physician's supervision the authority to issue prescriptions or medication orders for legend drugs and controlled substances listed in Schedules II, III, IV, and V of Tennessee Code Annotated, Title 39, Chapter 17, Part 4 in accordance with written protocols which are mutually developed and agreed upon by the physician assistant and the supervising physician.

(14) A licensed physician who supervises the services of a physician assistant in a manner that is inconsistent with the Tennessee Medical Practice Act or these rules shall be subject to disciplinary action.