TMA Mobilizes Against Nurse Scope Expansion Bill
By Amy Lynn Sorrel

The Texas Medical Association is mobilizing against a dangerous scope of practice bill set to go before the House Public Health Committee on Monday, April 14, that, if it advances, could erode Texas’ longstanding physician-led care model and patient safety.

House Bill 3794 is among dozens of bills filed this session that chip away at Texas’ scope of practice laws and that for the most part TMA has stopped in their tracks. By contrast HB 3794 opens what TMA President G. Ray Callas, MD, strongly warned is a “floodgate” for independent practice by advanced practice registered nurses (APRNs) without physician supervision.

More specifically, HB 3794 expands the definition of “nursing” for APRNs – which includes nurse practitioners (NPs), nurse midwives, nurse anesthetists, and clinical nurse specialists – to include practicing medicine. The bill gives these nurses full practice authority to:

• Formulate primary and differential medical diagnoses;
• Order and interpret medical tests;
• Prescribe therapies, devices, and medications, including controlled substances in Schedules II through V;
• Treat “actual and potential health problems;” and
• Serve as a patient’s primary care provider of record.

As of this writing, HB 3794 was scheduled to go before the House Public Health Committee in an April 14 hearing set to begin at 8:00 a.m.

Lawmakers have made it a priority this session to bolster access to care across the growing Lone Star State, particularly in rural areas.

HB 3749, however, “will not improve patient access,” Dr. Callas said. “All you will do is increase patient safety issues [by allowing nurses] that are less educated [and] less trained than physicians to care for patients [independently]. And if you do that, you are saying that it's OK to have substandard care throughout the state. That is not what we believe is appropriate.”

Dr. Callas points to a body of supporting research that demonstrates physician-led health care is essential to quality care, patient safety, and lower health care costs. American Medical Association research also shows nurse practitioners do not tend to practice in rural areas and have 5% of the medical and clinical training of physicians, with 60% of NP programs mostly or completely online in 2019.

That does not mean nurses are not an important part of health care in Texas, added Dr. Callas, who oversees certified registered nurse anesthetists in his own practice.  

“We have a team-based, [physician-led] care approach, and we know that is much safer,” he said. “If you have a very good collaboration, the patient is the one benefiting.”

To foster that approach, TMA continues to advocate for viable and proven solutions that incentivize access to care, especially in rural and underserved areas, namely funding for:

• Rural loan repayment programs for physicians and nurses;
• Community-based clerkships and preceptorships for medical students;
• Graduate medical education, particularly for rural residency training and the Joint Admission Medical Program; and
• Expanding telemedicine and Medicaid payments.

If you live in the district of one of the House Public Health Committee members listed below, respond to this ready-made action alert to send a direct message to your representative asking them to oppose HB 3794. 

• Rep. Gary VanDeaver (R-New Boston) 
• Rep. Liz Campos (D-San Antonio) 
• Rep. John Bucy (D-Austin) 
• Rep. Nicole Collier (D-Fort Worth) 
• Rep. Charles Cunningham (R-Humble) 
• Rep. James Frank (R-Wichita Falls) 
• Rep. Ann Johnson (D-Houston) 
• Rep. Jolanda Jones (D-Houston) 
• Rep. Mike Olcott (R-Fort Worth) 
• Rep. Katrina Pierson (R-Rockwall) 
• Rep. Mike Schofield (R-Katy) 
• Rep. Joanne Shofner (R-Nacogdoches) 
• Rep. Lauren Simmons (D-Houston) 

Otherwise, you may electronically submit comments related to the bill without testifying in person until the hearing is adjourned by visiting the House Public Comment portal. The hearing begins this Monday, April 14, at 8 a.m. and can be watched online.  

Either way, Dr. Callas urges physicians to take immediate action.  

“This is for all Texans, to make sure they have … access to physician-led care.”