A legislative decision means it will be at least another year before Tennessee’s physician assistants — known as “PAs” — could get restrictions lifted on their scope of practice.

There are currently about 2,800 PAs across the state, and that number has been growing fast. PAs are clinicians with graduate-level training who do many of the same tasks as doctors: conducting exams, making treatment plans, writing prescriptions and performing many procedures.

Their state trade group, the Tennessee Academy of Physician Assistants (TAPA), has been part of a national push to expand the scope of practice of PAs. Current restrictions on their role date to 1999, and some were temporarily lifted during COVID. The academy would like to see those pandemic-related allowances made permanent. And there’s widespread agreement that the limitations are due for some amount of update — though exactly how much has triggered debate.

Right now, a PA in Tennessee needs to work with a “collaborating” physician. This means that a PA’s license is tied to a doctor who must review and sign off on 20% of the PA’s charts, as well as visiting where the PA practices at least once a month.

TAPA supports a bill that was proposed in the Tennessee General Assembly in January to update restrictions on PAs.

“We’re trying to give hospitals and physician-owned practices more flexibility with how they utilize PAs on their team,” says Katherine Moffat, executive director for TAPA.

The proposal would loosen the rules, giving individual practices and hospital systems control over their own PA oversight. For example, the quantity of chart reviews could vary.

“Maybe [a hospital system wants] to do 100% for new grads and 50% for people that have been there for 5 years and taper it down. They would have that flexibility at the practice level,” Moffat says.

Seth Weathersby, a PA in Murfreesboro, runs four urgent cares, including Gateway Urgent Care.

Seth Weathersby, a PA in Murfreesboro who runs four urgent cares, would welcome the changes. He also questions the impact of the current regulations, like the mandatory monthly physician site visits. “It is really more of just kind of a check in, to meet some new people, to make sure paperwork is in order. There is not a whole lot of patient care that really is impacted by his actual site visit,” he says.

The Tennessee Medical Association (TMA), which represents doctors in the state, has opposed the bill.

The main sticking point: PAs who have logged 6,000 clinical hours — or about 3 years — would no longer need to have physician oversight.

“We want to preserve that collaborative relationship,” says Yarnell Beatty, senior VP and general counsel for the TMA. “If they’re not associating with a physician or assisting a physician, then they’re really practicing medicine without going to medical school.”

This spring, the bill was postponed to the legislature’s 2024 agenda. If passed, Tennessee would join North Dakota, Utah and Wyoming in allowing PAs to practice with the greatest flexibility in the nation.

This week, PAs from across the country are gathering in Nashville for their national conference, and they’ll be talking strategy about legislative changes.