Editorial: Free nurse practitioners to treat patients independently

FILE - In this April 3, 2013 file photo, family nurse practitioner Ruth Wiley examines Elizabeth Knowles at a Walgreens Take Care Clinic in Indianapolis. Use of nurse practitioners, physician assistants and other “non-physician providers” increased more than 40 percent between 2010 and 2014 at certain physician-owned surgical practices, according to a national survey.

Texas, like the rest of the United States, has a looming doctor shortage. It’s being made worse by uncertainty about the Affordable Care Act, which could soon be repealed before there’s a replacement.

There’s an easy fix here, a bill Texas lawmakers could pass that could help ease the doctor shortage and improve access to care. Let’s allow nurse practitioners to operate without expensive contracts with physicians.

A bill in the House would do just that.

“Texas nurse practitioners are once again seeking independence from costly agreements that require them to sign contracts with doctors in order to treat and write prescriptions for their patients,” the Texas Tribune reports. “State Rep. Stephanie Klick, R-Fort Worth, introduced House Bill 1415 Thursday, saying the bill would get rid of so-called prescriptive authority agreements that require nurse practitioners - who have advanced degrees in a nursing speciality - to pay up to six-figure fees to ‘delegating’ doctors. Currently, nurse practitioners are regulated by both the Texas Board of Nursing and the Texas Medical Board. Under Klick’s bill, nurse practitioners would be regulated solely by the nursing board.”

The Texas Public Policy Foundation studied the matter during the last legislative session, when a similar bill failed.

“Texans like to boast about economic freedom but rarely do we note that Texas has among the most restrictive scope of practice laws in the country,” wrote TPPF’s John Davidson. “That means healthcare providers like nurses and dental hygienists can’t do as many procedures in Texas as they can in many other states. Not because they’re not trained for it but because state law won’t allow it.”

Take dental anesthesia. In 45 states, trained dental hygienists can administer local anesthesia, but not Texas. That undoubtedly makes our dental care more expensive.

“An even more egregious example is the way that Texas restricts nurse practitioners and advanced practice registered nurses, or APRNs,” Davidson noted. “In 20 states, including all of Texas’ neighboring states, APRNs have full practice authority, meaning they have authority to diagnose and refer patients, order tests and write prescriptions.”

New Mexico expanded their scope of practice and then proceeded to poach nurse practitioners from Texas.

“In New Mexico, where APRNs can operate their own primary care clinics, Governor Susana Martinez (in 2014) launched a campaign to entice APRNs from Texas to move to her state and enjoy greater freedom to care for patients and operate their own businesses,” Davidson explained.

There’s a lot of pushback, of course, particularly from the Texas Medical Association.

“Doctors’ groups in Texas have said these nurse-physician contracts are necessary to ensure patient safety, because physicians have more expertise in treating patients,” the Tribune reports. “Primary care physicians must complete four years of medical school and three years of residency training, while nurse practitioners must complete four years of nursing school and usually two years in a graduate-level training program.”

But the vast majority of primary care involves common, day-to-day ailments and injuries that nurse practitioners are fully qualified to treat.

The physician shortage is real. This bill can help solve that problem.

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