Legislature fails to make sensible fixes


The Texas Legislature has a couple more days to go in the session, but the bulk of its work is done. And what's just as significant as what has been done is what has been left undone.

Lawmakers failed to enact common-sense reforms that would allow nurse practitioners to take on more of the duties now assigned to doctors — duties they're more than qualified to perform.

"There will be no form of a nurse-practitioner bill making it this session," says John Davidson of the Texas Public Policy Foundation. "And that's entirely because of the intractability of the Texas Medical Association. It acts as a cartel, protecting doctors at the expense of the health of Texans."

Meanwhile, he notes, the list of other states that have made these reforms continues to grow.

Just last March, Nebraska became one.

"Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor's oversight," the New York Times reports. "Maryland's governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners."

That's important — particularly in light of existing and worsening doctor shortages.

"The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas," the Times explains. "About a third of Nebraska's 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away."

Texas, too, has a doctor shortage. The Affordable Care Act only makes it worse. The federal government estimates that by the year 2020, the United States could see a physician shortage of greater than 90,000. Five years after that, the shortage is estimated to be 130,000 doctors.

Davidson notes that about half of Texas counties don't have enough primary care physicians, and the state has nearly 300 "Medically Underserved Areas" — more than any other state in the country.

"The future of health care lies in diversified models of care that utilize non-physician providers like nurse practitioners to a much greater degree," he wrote last fall. "The research on these policy reforms is clear: the quality, safety and effectiveness of primary care provided by (advanced practice registered nurses) is comparable to that provided by physicians. And patient satisfaction surveys have consistently shown that patients are pleased with the quality of care and attention they get from APRNs. It's not an unsafe experiment, it's not unprecedented, and it's not new."

Of course, some doctors' groups disagree.

"Groups representing doctors, including the American Medical Association, are fighting the laws," the Times pointed out. "They say nurses lack the knowledge and skills to diagnose complex illnesses by themselves. Dr. Robert M. Wah, the president of the AMA, said nurses practicing independently would ‘further compartmentalize and fragment health care.'"

It's fragmented now. That's why the Legislature's failure to approve this common-sense reform is so disappointing.

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