Registration For Assistant Training
Nurse practitioners and registered medical assistant won the first round of a battle to keep the Board of Medical Examiners from imposing rules they say could put many out of business. A bill sponsored by Rep. Gary Odom, D-Nashville, was approved by a House subcommittee and will be heard by the full Health and Human Resources Committee next week.
The bill requires that any rules adopted by the Board of Medical Examiners to govern the practices of registered medical assistant and nurse practitioners also be approved by the Committee of Physician Assistants and the state Board of Nursing, respectively.
Several subcommittee members spoke in favor of the bill and against the rules, claiming they could destroy TennCare by restricting the care that could be provided by nurse practitioners and physician assistants.
The conflict boils down to a difference of opinion between doctors who use the specially trained nurses and those who don't, said Rep. Bob Patton, R- Johnson City. Louise Browning, executive director of the Tennessee Nurses Association, agreed. "Registered medical assistant who lives in the real world know how important this is," she said. TennCare contracts the state signed with managed care organizations require that three providers be used: primary care doctors, physician assistants and nurse practitioners. Dozens of doctors, nurses and others complained about the proposed rules during a public hearing last week. Both daily newspapers in Nashville have published editorials blasting them as unreasonable and unnecessary. Current rules were adopted by the medical examiners' board in the mid-1980s, requiring each doctor to have plans detailing treatments and services nurse practitioners and physician assistants can provide. Those existing rules require supervising doctors to review patient charts each week and to be available for telephone consultation. Under the proposed regulations, doctors would have to be physically present at each clinic one full working day a week. Browning said that would force many satellite clinics in rural counties to close because one doctor may oversee a half dozen clinics. She said few doctors are willing to move to those areas so patients would have no health- care providers. Also, the board proposed that any time new sick patients come in, the doctor would have to examine them before the nurse practitioner or physician assistant could treat them. Oscar McCallum, chairman of the state Board of Medical Examiners, has declined to comment on the proposed legislation until members review it.
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