Licensure Process - Graduate Physician

To practice as a graduate physician in Tennessee a person must possess a lawfully issued license from the Board. The Board in its discretion may issue licensure according to the following criteria, process, and qualifications: (1) Definitions. In addition to the definitions contained in T.C.A. § 63-20-102, the following terms, are applicable to graduate physicians: (a) “Collaborating physician” means a physician who holds an unencumbered license issued pursuant to Title 63, Chapter 6 or Chapter 9 with no disciplinary history, who is actively practicing in Tennessee, has entered into a graduate collaborative arrangement with a graduate physician licensee, and is board-certified in the specialty in which the graduate physician licensee is practicing. (b) “Medically underserved rural area of the state” means: 1. An area or population group in this state designated by the United States Department of Health and Human Services as an area with a shortage of health care services; or GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE 2. An area that the Tennessee Department of Health considers to be medically underserved based on relevant demographic, geographic, and environmental factors. (c) “Supervision” means overseeing the activities of and accepting responsibility for the primary care services rendered by the graduate physician licensee. Supervision of each graduate physician licensee by the collaborating physician shall be continuous and require the physical presence of the collaborating physician at the place where primary care services are rendered except as provided in T.C.A. § 63-20-108(c)(5)(B). (2) Qualifications for licensure. To practice medicine as a graduate physician licensee in Tennessee a person must possess a lawfully issued graduate physician license from the Board of Medical Examiners or Board of Osteopathic Examination. The procedure for obtaining such a license is as follows: (a) An applicant shall obtain an application form from the Board Administrative Office or from the Board’s website, respond truthfully and completely to every question or request for information contained in the form, and submit it along with all documentation and fees required by the form and this rule to the Board’s Administrative Office. (b) An applicant shall cause FCVS to release the applicant’s physician information profile to the Board. (c) An applicant shall submit proof of United States citizenship or of being lawfully present in the United States pursuant to T.C.A. § 4-58-103. (d) An applicant shall submit a clear and recognizable, recently taken, bust photograph which shows the full head, face forward from at least the top of the shoulders up. (e) All applicants shall cause to be submitted a certificate of successful completion of Step 1 and Step 2 of the U.S.M.L.E., or Level 1 and Level 2 of the COMLEX-USA, or a combination of examinations approved by the Board of Medical Examiners or Board of Osteopathic Examination if not included in the FCVS physician information profile. Successful completion must have occurred within the two-year period immediately preceding the date of application for licensure, but not more than three years after graduation from a medical school or osteopathic school. (f) An applicant shall pay the applicable application fee and state regulatory fee as provided in 0880-02-.02. (g) An applicant shall cause the result of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials. (h) Application review and licensure shall be governed by Rule 0880-02-.07. (i) An applicant shall submit any other documents as specifically requested by the Board of Medical Examiners or Board of Osteopathic Examination. (3) In addition to the other requirements of this rule, graduates from any allopathic or osteopathic school outside of the United States shall submit the following: GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (a) An E.C.F.M.G. certification status report if not included in the FCVS physician information profile. (b) All documents required to be submitted by this rule shall be translated into English and such translation certified along with the original document as to authenticity by the issuing source. (4) Issuance of the graduate physician license: (a) If a graduate physician license is granted, the following shall apply: 1. The graduate physician license is restricted, though not disciplinary, to allow the practice of primary care services in the practice settings set forth in T.C.A. § 63- 20-103. 2. The graduate physician license shall be of a duration of two (2) years from the date of issuance. 3. The graduate physician license shall be nonrenewable and cannot be converted to a full and unrestricted license. 4. A graduate physician licensee may not serve as a supervising or collaborating physician to an advanced practice registered nurse or physician assistant. 5. A graduate physician licensee is subject to the same disciplinary proceedings as a full and unrestricted license under T.C.A. § 63-6-214 and T.C.A. § 63-9-111. (b) Notification of intent to practice. Prior to practicing as a graduate physician, a licensed graduate physician must enter into a graduate physician collaborative practice arrangement, (“Collaborative arrangement”) with a collaborating physician no later than six (6) months after initial licensure and in accordance with T.C.A. §§ 63-20-101, et seq. Failure to enter into a collaborative arrangement with a collaborating physician within this timeframe shall invalidate the license. Any attempt to practice medicine on the invalidated license will constitute the unlicensed practice of medicine. A graduate physician licensee in this state must submit on forms provided by the Board of Medical Examiners and Board of Osteopathic Examination verification of a collaborative arrangement. This notification form shall include but is not limited to the following: 1. The name, license number, business address, email address, telephone number, and specialty in which board certification of the collaborating physician; and 2. The name, license number, business address, email address, telephone number, and the specialty in which the graduate physician is practicing. 3. An attestation by both the graduate physician licensee and the collaborative physician that they have entered into a collaborative arrangement, have accepted the responsibilities of that arrangement, and have read and understand the rules and statutes that govern the practice of graduate physicians in Tennessee. 4. Proof of the collaborating physician completing a certification course that meets the requirements set forth in this rule. (c) A graduate physician licensee shall notify the Board of Medical Examiners or Board of Osteopathic Examination of any additions or changes, including termination of a GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE collaborative arrangement, with a collaborating physician within thirty (30) calendar days of such occurrence. (5) Scope of practice. A graduate physician licensee is limited to only performing primary care services under the supervision of a collaborating physician in the practice settings specified in T.C.A. § 63-20-103. (a) A graduate physician licensee shall not provide patient care during the absence of the collaborating physician. (b) A graduate physician licensee may perform those duties and responsibilities delegated by the collaborative arrangement, including the prescribing, administering, and dispensing of drugs and providing treatment as long as the primary care services are within the scope of the graduate physician licensee’s practice and is consistent with the graduate physician licensee’s skill, training, and competence and the skill, training, and competence of the collaborating physician. (6) Collaborative arrangements. A written collaborative arrangement must be in place prior to the practice of medicine by a graduate physician licensee and it must comply with all provisions of T.C.A. §§ 63-20-101, et seq. along with the following additional requirements: (a) The collaborative arrangement shall be signed and dated by the collaborating physician and the graduate physician licensee signifying that both parties are aware of its contents and agree to be subject to the terms of the collaborative arrangement. (b) The collaborative arrangement shall contain mutually agreed upon protocols and any standing orders for the delivery of primary care services. (c) The collaborative arrangement shall identify the graduate physician licensee’s scope of practice. (d) The collaborative arrangement shall establish the relationship and access to the collaborating physician such that guidelines for consultation and referral to the collaborating physician or designated health care facility for services or emergency care that is beyond the education, training, competence, or scope of practice of the graduate physician licensee are developed. (e) The collaborative arrangement shall outline how the graduate physician licensee will provide charts to the collaborating physician for review. (f) The collaborative arrangement shall not allow a graduate physician licensee to see patients through telemedicine. The graduate physician licensee must treat all patients in person. (g) The collaborative arrangement shall create written, measurable, and objective performance goals for evaluating the quality of care provided to patients by the graduate physician licensee. (h) The collaborative arrangement shall require that all prescriptions and orders issued by the graduate physician licensee identify their collaborating physician and conform to all applicable state and federal statutes, rules, or regulations. (i) The collaborative arrangement shall indicate the process for modification or termination of the arrangement by either party. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (j) The collaborative arrangement shall be reviewed annually and revised as needed by the collaborating physician and the graduate physician licensee. Documentation of the annual review shall be maintained as part of the collaborative arrangement and shall be made available upon request to the Board of Medical Examiners or Board of Osteopathic Examination. (k) The collaborative arrangement and any subsequent addendum, modification or termination of the collaborative arrangement shall be in writing, signed and dated by the parties, and shall be maintained by the collaborating parties. The collaborating parties shall produce a copy of the collaborative arrangement, including any addendum, modification, or termination upon request by the Board of Medical Examiners or Board of Osteopathic Examination. (l) Physicians shall report to the Board of Medical Examiners or Board of Osteopathic Examination the name of each graduate physician licensee with whom the physician has entered into an arrangement within thirty (30) days of entering into the arrangement, and also within thirty (30) days of the termination of any arrangement. (7) Collaborating physician. In addition to the collaboration requirements and restrictions contained in T.C.A. §§ 63-20-101, et seq., the following requirements, are applicable to the collaborating physician: (a) The collaborating physician must possess a current, unencumbered license to practice in the state of Tennessee. (b) The collaborating physician must be board-certified in the specialty in which the graduate physician licensee is practicing and is limited to pediatrics, internal medicine, and family medicine. (c) The collaborating physician shall not enter into a collaborative arrangement with more than three (3) graduate physician licensees at the same time. (d) The collaborating physician must conduct a personal review of one hundred percent (100%) of the charts documenting the graduate physician licensee’s delivery of primary care services every day for the first month and every other day for months two (2) and three (3). For months four (4) through twelve (12), the collaborating physician must conduct a weekly personal review of seventy-five (75%) of the primary care services delivered by the graduate physician licensee. For months thirteen (13) through twenty- four (24), the collaborating physician shall conduct a personal review of twenty-five (25%) of the charts documenting the graduate physician licensee’s delivery of primary care services every fourteen (14) days. The graduate physician licensee is responsible for the submission of the charts to the collaborating physician. The documentation submission may be accomplished in person or by other electronic means. (e) The collaborating physician shall complete a certification course prior to the practice of medicine by the graduate physician. Such course shall include at a minimum instruction on ethics, supervision principles, review and/or assessment, and risk management and must be at least six (6) hours in length. If the collaborating physician is on the faculty at an accredited medical or osteopathic school, proof of career development courses regarding education and supervising of healthcare trainees may satisfy this requirement. If these hours meet acceptable continuing education requirements, they may also be used to satisfy continuing medical education hours required for state licensure. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (f) The collaborating physician shall consider the level of skill, training, and competence of the graduate physician licensee and ensure that the delegated responsibilities are consistent with that level of skill, training, and competence and are within the collaborating physician’s level of competence.