[Effective 1/1/2025]

(a) This chapter applies to all graduate physician collaborative practice arrangements. To be eligible to practice as a graduate physician, a licensed graduate physician must enter into a graduate physician collaborative practice arrangement with a licensed physician no later than six (6) months after the date on which the graduate physician obtains initial licensure.
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Terms Used In Tennessee Code 63-20-108

  • Graduate physician: means a medical school graduate who:
    (A) Is a resident and citizen of the United States or a legal resident alien in the United States. See Tennessee Code 63-20-102
  • Graduate physician collaborative practice arrangement: means an agreement between a licensed physician and a graduate physician that meets the requirements of this chapter. See Tennessee Code 63-20-102
  • Primary care services: means medical services in pediatrics, internal medicine, and family medicine. See Tennessee Code 63-20-102
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105
(b) Only a physician licensed pursuant to title 63, chapter 6 or chapter 9 may enter into a graduate physician collaborative practice arrangement with a graduate physician. Graduate physician collaborative practice arrangements must take the form of a written agreement that includes mutually agreed upon protocols and any standing orders for the delivery of primary care services. Graduate physician collaborative practice arrangements may delegate to a graduate physician the authority to administer or dispense drugs and provide treatment, as long as the delivery of the primary care services is within the scope of the graduate physician’s practice and is consistent with the graduate physician’s skill, training, and competence and the skill, training, and competence of the collaborating physician; except that a graduate physician shall not prescribe controlled substances. The collaborating physician must be board-certified in the specialty that the graduate physician is practicing, which must only include pediatrics, internal medicine, or family medicine.
(c) The graduate physician collaborative practice arrangement must contain the following provisions:

(1) Complete names, home and business addresses, and telephone numbers of the collaborating physician and the graduate physician;
(2) A requirement that the graduate physician practice at the same location as the collaborating physician;
(3) A requirement that a prominently displayed disclosure statement informing patients that they may be seen by a graduate physician, and advising patients that the patient has the right to see the collaborating physician, be posted in every office where the graduate physician is authorized to prescribe;
(4) All specialty or board certifications of the collaborating physician and all certifications of the graduate physician;
(5) The manner of collaboration between the collaborating physician and the graduate physician, including how the collaborating physician and the graduate physician will:

(A) Engage in collaborative practice consistent with each professional’s skill, training, education, and competence; and
(B) Maintain geographic proximity. However, the graduate physician collaborative practice arrangement may only allow for geographic proximity to be waived for no more than twenty-eight (28) days per calendar year for rural health clinics, as long as the graduate physician collaborative practice arrangement includes alternative plans as required in subdivision (c)(5)(C). The exception to the geographic proximity requirement applies only to independent rural health clinics, provider-based rural health clinics if the provider is a critical access hospital as provided in 42 U.S.C. § 1395i-4, and provider-based rural health clinics if the primary location of the hospital sponsor is more than twenty-five (25) miles from the clinic. The collaborating physician must maintain documentation related to the geographic proximity requirement and present the documentation to the board of medical examiners upon request;
(6) A requirement that the graduate physician shall not provide patient care during an absence of the collaborating physician for any reason;
(7) A list of all other graduate physician collaborative practice arrangements of the collaborating physician and the graduate physician;
(8) The duration of the graduate physician collaborative practice arrangement between the collaborating physician and the graduate physician;
(9) A provision describing the time and manner of the collaborating physician’s review of the graduate physician’s delivery of primary care services. The provision must require the graduate physician to submit to the collaborating physician a minimum of twenty-five percent (25%) of the charts documenting the graduate physician’s delivery of primary care services for review by the collaborating physician or by any other physician designated in the graduate physician collaborative practice arrangement every fourteen (14) days after the initial observation year. For the first three (3) months of the initial observation year, the collaborating physician shall review one hundred percent (100%) of the charts documenting the graduate physician’s delivery of primary care services. For months four (4) through twelve (12), the collaborating physician shall review seventy-five percent (75%) of the charts documenting the graduate physician’s delivery of primary care services; and
(10) A requirement that a collaborating physician be on premises if the graduate physician performs services in a hospital or emergency department.
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