Legislative Priority #1: Scope of Practice Encroachments, Graduate Medical Education Funding
By Amy Lynn Sorrel

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Goal: Protect independent medical diagnosing, treatment, and prescribing as the practice of medicine; address workforce shortages in a way that ensures all patients have access to the same standard of care and keeps pace with Texas’ outsized population growth 

Impact: Unsurprisingly, the Texas Medical Association expects another contentious session when it comes to defending against scope-of-practice expansions by nonphysician practitioners. If interim hearings were any indication, advanced practice registered nurses will be looking for full independent practice and prescribing authority, and physician assistants (PAs) will challenge the physician delegation requirement, citing state access-to-care shortages as justification. Pharmacists are expected to file bills allowing them to administer the spectrum of childhood vaccines, and to make permanent federal emergency regulations permitting pharmacists to treat patients after testing them for COVID-19.  

As with every session, the list goes on with various specialty-specific attacks, says TMA lobbyist Michelle Romero. But also in every session, TMA has been able to stop most of these efforts.  

TMA President Gary Floyd, MD, who helped secure compromise legislation in the past with a landmark team-based care bill, says all health care professionals play a critical role as part of that team. But not all health care professionals have the skill sets that match the education, training, and experience of a physician, who should be leading the team.  

On top of college, physicians complete four years of medical school, plus three to eight years of residency, including more than 10,000 hours of clinical training, Dr. Floyd said. Compare that with nurse and PA training of just two to four years of graduate level education, no residency, and well below 1,000 hours of clinical training.   

Nonphysicians’ equation of their classroom learning with medical school not only falls short, “but residency is where I learned to take care of my patients, not medical school,” Dr. Floyd said. “That’s where you operate in not just one or several clinics, but in hospitals and ICUs caring for significantly ill and critical patients. Typical clinical experience does not place nurse practitioners in such situations where there are really sick and critically ill or injured patients. 

“The public trusts the state to not allow people to operate beyond what they know how to do, so [expanding nonphysicians’ scope of practice] is unleashing a much lesser trained group of providers on a very unsuspecting public who makes an appointment, shows up, and has something severe that gets missed because [that practitioner] never had the experience to take care of it.”  

Nor should Texas be offering a lower standard of care as a quick fix to fill workforce shortages, says TMA Board Trustee and past Council on Legislation Chair John Carlo, MD. As a public health physician who cares for patients in medically underserved areas, “that’s where you often see very complex cases, and that’s the last place you’d want to place undertrained nonphysician practitioners,” he said.  

TMA leaders also point to a recent study from the Hattiesburg Clinic in Mississippi that found allowing nurse practitioners and physician assistants to function independently in a primary care setting resulted in higher costs and utilization, and lower quality of care.  

The real fix: train more physicians by bolstering graduate medical education funding, loan forgiveness programs, and rural training tracks, Ms. Romero says. “There is no other training as rigorous and standardized as medical education.”  

Those efforts will be especially important to match the high-speed train that Texas’ population growth is on: Texas led all states in numerical population growth for 2020 and 2021, according to the U.S. Census Bureau. That meant an average of 850 new people arrived each day.