According to Tenn. Code Ann. § 63-6-204, a person who treats, or professes to diagnose, treat, operates on or prescribes for any physical ailment of another person shall be considered as practicing medicine. However, administration of family remedies in cases of emergency or the practice of dentistry is exempted from the section. Similarly, the chapter shall not apply to surgeons of the U.S. army, navy, air force or marine hospital service, or to any registered physician or surgeon of other states when called in consultation by a registered physician of Tennessee, or to midwives, veterinary surgeons, osteopathic physicians or chiropractors not giving or using medicine in their practice, or to opticians, optometrists, chiropodists or Christian Scientists[i].
Tennessee law stipulates that no person shall practice medicine without a valid license issued by the medical board. However, persons licensed before July 1, 1947 are exempted from this requirement[ii]. Similarly, visiting medical faculty licensed in a country other than the U.S. and employed full time by a college or university operating an accredited medical school in Tennessee are exempt from the requirement of a license, provided the visiting faculty member is a graduate of a medical school approved by the board, and the practice of the visiting faculty member is limited to and is incidental to the visiting faculty member’s employment at an accredited medical school in Tennessee[iii]. Such person is entitled to engage in private practice if s/he enrolls and satisfactorily participates in a three-year residency program approved by the board. However, such physicians shall not continue private practice after three years unless such person meets all the requirements of licensure set forth in Tenn. Code Ann. § 63-6-207[iv].
Persons violating these provisions are liable for a Class B misdemeanor and each time any person practices medicine or surgery without first obtaining a valid certificate or renewing a certificate, it constitutes a separate offense[v]. Filing or attempting to file, as the person’s own, a diploma or license of another or a forged affidavit of identification is a Class E felony[vi].
Tenn. Code Ann. § 63-6-207 enumerates the qualifications and requirements for obtaining a license. Accordingly, if the applicant is a U.S. or Canadian medical school graduate, s/he shall produce a certificate from a medical school whose curriculum is approved by the American Medical Association or its extant accreditation program for medical education, or its successor and evidence of the satisfactory completion of a one-year United States training program similarly approved by the American Medical Association[vii].
The applicant shall pay the requisite nonrefundable application fee.
The applicant must produce evidence of good moral character and proof of eligibility to live and work in the U.S. if not a citizen of the U.S. or Canada.
If the applicant has graduated from an international medical school, s/he shall produce a certificate from a medical school whose curriculum is judged to be acceptable by the board and a copy of a permanent Educational Commission for Foreign Medical Graduates (E.C.F.M.G.) certificate[viii]. The applicant shall fulfill the requirements of fee and good moral character. In addition, a foreign medical graduate shall produce evidence of completion of a three-year residency program approved by the American Medical Association or its extant accreditation program for medical education, or its successor within three months of completion of the residency program[ix].
As its qualifying examination, the board accepts the Federation Licensing Examination (FLEX) and/or the National Board of Medical Examiners examination and/or the United States Medical Licensing Examination (USMLE) or its successor examination. Applicants shall successfully complete the USMLE within seven years from the date of whichever step of the examination was successfully completed first. An applicant is considered to have successfully completed a step of the examination on the date that the step was taken and not the date on which the passing score was made public by the examination agency; provided, however, that the board is authorized to promulgate rules and regulations creating exceptions that will extend the seven year time frame[x]. In addition, the board reserves the right to write its own state board examination or contract with other national testing organizations.
The board is authorized to issue special training licenses to medical interns, residents and fellows who have met all other qualifications for licensure, with the exception of having completed the necessary residency or training programs and the licensure examination[xi].
It is to be noted that the special training licenses shall be issued only to medical interns, residents, and fellows while participating in a training program of one of the accredited medical schools or of one of such medical school’s affiliated teaching hospitals in Tennessee, and while under the supervision and control of a physician fully licensed to practice medicine in Tennessee. Termination of participation in the training program for which the special license was issued for any reason terminates that license. Further, recipients of the special training license shall not be subject to the occupational tax levied by § 67-4-1702(a)(4)(G).
The board also has power to issue conditional licenses, restricted licenses and special licenses based upon licensure to another state for the limited purpose of authorizing the practice of telemedicine to current applicants or current licensees[xii].
A license shall be renewed biennially on payment of a renewal fees[xiii]. Tenn. Code Ann. § 63-6-211 deals with licensure of out-of-state and international applicants. The section states that the board is authorized to accept the certificates of licensure from other states as long as the applicant’s certificates and qualifications meet or exceed the requirements set forth in Tenn. Code Ann. § 63-6-207.
The board is likewise authorized to accept certificates of license from other states or countries and grant licenses to practice medicine in Tennessee to individuals who, qualify as distinguished faculty members at a rank of full professor. The minimum criteria required for such licensure are that the applicant shall possess a degree of doctor of medicine or its equivalent, have a full-time appointment at professorial rank at an accredited college of medicine in Tennessee, have current membership in good standing in medical specialty societies that have restricted and selective membership and have been invited to be a lecturer or visiting professor at medical educational institutions either abroad or within the United States. In addition, the applicant must have delivered scholarly medical papers before national or international meetings and possess letters of support from the dean of the appointing college of medicine and its appropriate department chairs, as well as from academic colleagues from outside of Tennessee attesting to the individual’s distinguished status[xiv].
Tenn. Code Ann. § 63-6-214 enumerates the grounds for denial, suspension or revocation of license. Accordingly, the board has the power to deny, withhold issuance or suspend, limit or restrict a previously issued license or reprimand an applicant or licensee. The board is empowered to discipline a licensee through informal settlements, private censures and warnings. The board can also permanently revoke a license.
The grounds upon which the board shall exercise disciplinary power include:
- Unprofessional, dishonorable or unethical conduct;
- Violation or attempted violation, or assisting in or abetting the violation of, or conspiring to violate license requirements, any lawful order of the board, or any criminal statute of the state of Tennessee;
- Making false statements or representations, being guilty of fraud or deceit in obtaining admission to practice, or being guilty of fraud or deceit in the practice of medicine;
- Gross malpractice, or a pattern of continued or repeated malpractice, ignorance, negligence or incompetence in the course of medical practice;
- Habitual intoxication or drug abuse in such manner as to adversely affect the person’s ability to practice medicine;
- Violation of the laws governing abortion;
- Willfully betraying a professional secret;
- Fraudulent advertising of medical business and willful violation of the rules and regulations promulgated by the board;
- Conviction of a felony, conviction of any offense under state or federal drug laws, or conviction of any offense involving moral turpitude;
- Making or signing in one’s professional capacity any certificate that is known to be false at the time one makes or signs such certificate;
- Dispensing, prescribing or otherwise distributing any controlled substance or any other drug not in the course of professional practice, or not in good faith to relieve pain and suffering, or not to cure an ailment, physical infirmity or disease, or in amounts and/or for durations not medically necessary, advisable or justified for a diagnosed condition;
- Offering, undertaking or agreeing to cure or treat a disease, injury, ailment or infirmity by a secret means, method, device or instrumentality;
- Giving or receiving, or aiding or abetting the giving or receiving, of rebates, either directly or indirectly;
- Engaging in the practice of medicine under a false or assumed name, or the impersonation of another practitioner, or a like, similar or different name;
- Engaging in the practice of medicine when mentally or physically unable to safely do so;
- Using radiation in the treatment of any noncancerous disease, disorder or condition of the skin without first adequately warning the patient of the extent of any known risk of cancer associated with such treatment or repetition of such treatment. Receipt of such advance warning shall be acknowledged by signature of the patient or, in the case of a minor, the patient’s parent or guardian and shall be retained by the physician for the period prescribed by the board; and
- Disciplinary action against a person licensed to practice medicine by another state or territory of the U.S. for any acts or omissions that would constitute grounds for discipline of a person licensed in Tennessee;
- Transferring of patient medical information to a person in another state who is not licensed to practice medicine or osteopathy in the state of Tennessee using any electronic, telephonic or fiber optic means or by any other method if such information is employed to diagnose and/or treat persons physically located within the state of Tennessee. However, such a transfer is not illegal if it is used for a second opinion requested by a Tennessee licensed medical doctor or osteopathic physician.
- Illegal referrals to laboratories[xv].
Also, it is an offense for any licensed physician to divide or to agree to divide any fee or compensation of any sort received or charged in the practice of medicine or surgery with any person. However, it is not illegal for a physician to compensate any independent contractor that provides goods or services to the physician on the basis of a percentage of the physician’s fees generated in the practice of medicine[xvi].
Disciplinary proceedings by the board are governed by the Administrative Procedures Act[xvii]. A physician whose license has been revoked shall not thereafter practice medicine or surgery in Tennessee, and for each and every instance of such practice the person commits a Class B misdemeanor. [xviii]
[i] Tenn. Code Ann. § 63-6-204.
[ii] Tenn. Code Ann. § 63-6-201.
[v] Tenn. Code Ann. § 63-6-203.
[vii] Tenn. Code Ann. § 63-6-207.
[xi]Tenn. Code Ann. § 63-6-207 (d).
[xii] Tenn. Code Ann. § 63-6-209.
[xiii] Tenn. Code Ann. § 63-6-210.
[xiv] Tenn. Code Ann. § 63-6-211.
[xv] Tenn. Code Ann. § 63-6-214.
[xvi] Tenn. Code Ann. § 63-6-225.
[xvii] Tenn. Code Ann. § 63-6-216.
[xviii] Tenn. Code Ann. § 63-6-217.