Proposal Would Mark Line Between Pain Doctors, Mid-Level Providers

midlevel2aState lawmakers are weighing a proposal in what some see as a turf war between specialized doctors and mid-level providers like nurse practitioners and physician assistants. WPLN’s Daniel Potter reports on the debate over just who should be allowed to treat pain by injecting medicine near the spine.


The proposal would require direct supervision from a qualified pain doctor before a helper like a nurse practitioner could give spinal injections for pain. Opponents argue it’s a solution without a problem, saying there’s no evidence of harm. Sharon Adkins directs the Tennessee Nurses Association.

“The board of nursing has received no complaints against nurse practitioners who perform these procedures, nor have malpractice insurance rates raised in anyway.”

But that doesn’t mean they’re always doing as good a job as a specialized pain doctor, argues Graf Hilgenhurst, an M.D. who practices in Smyrna.

“There is a small but real risk of doing serious harm to a patient. There is a much greater risk of squandering healthcare dollars and doing no good.”

Tussles like these test the boundaries between doctors and mid-level providers, and could become more common in coming years. That’s as growing patient demand could lead more to physician assistants and nurse practitioners for care.


House Democratic Caucus Chair Mike Turner says each side is looking out for its own interest.

“We also have to decide ‘Is this a turf battle?’ Because most of the time when we see these bills they’re turf battles. And we have to decide is this a turf battle, or is this actually going to help the people of Tennessee?”

And the role of nurse practitioners and physician assistants is only growing, says Republican Matthew Hill, who chairs the House’s general subcommittee on health.

Hill says the federal healthcare overhaul will make Tennessee more reliant on such midlevel providers to offer all kinds of care. He says that means lawmakers have to make sure they’re well trained for the task.

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