State legislators in Tennessee have withdrawn a proposal to allow some physician assistants (PAs) to practice with limited physician supervision after the AAFP pointed out the "grave danger" such a move would create for patients.
The Tennessee House and Senate were considering legislation that would have given more leeway to physician assistants who complete a new "doctor of medical science" (DMS) degree. Lincoln Memorial University-DeBusk College of Osteopathic Medicine in Harrogate, Tenn., created the degree program for PAs with master's-level training and three years of clinical experience in primary care, emergency care or general internal medicine. The curriculum includes 50 hours of credits over two years, most of which would be obtained online.
The New Healthcare Practitioner Act(wapp.capitol.tn.gov) was unclear about the exact role these new medical professionals would play, and it did not outline how they would work with physicians on patient care.
"The proposal creates grave danger for patients," the AAFP said in a March 13 letter(3 page PDF) that urged legislators on the Tennessee House Health Committee to not put patients at risk.
"All patients deserve to have their health care delivered by a fully trained and licensed physician," the AAFP said in the letter, which was signed by Board Chair John Meigs, M.D., of Centreville, Ala.
Allowing professionals with insufficient medical training to diagnose and supervise care under limited oversight would confuse patients and compromise their safety, the AAFP pointed out. Creating a new ill-defined profession would lead only to greater fragmentation of care.
"We are also troubled by the precedent the legislation would establish by allowing such changes in a profession's role and responsibility, especially when it is not a widely accepted practice," the letter stated.
The letter described the rigorous medical education that physicians must receive before they can become licensed and the continuing education they undertake to maintain their status. In contrast, there is no existing regulatory body or licensing agency that could hold those who receive a DMS degree accountable.
"Since these individuals are not recognized under applicable federal law, it is doubtful that they would be allowed to provide care to patients in public health care programs," the letter stated. "No licensing board exists for this new provider, and the legislation does not address the critical absence of a governing body to ensure patient safety."
The AAFP recognizes the need for more primary care, especially in rural and medically underserved areas, but this proposed change to medical standards would not solve the problem. Instead, the AAFP advised legislators to increase funding for graduate medical education, expand primary care training and provide medical school debt relief.
"We face a severe primary care workforce shortage in the United States, but creating shortcuts for mid-level professionals is not the answer," the letter stated.
The House Health Committee removed the bill from its calendar on March 20.