Physicians tell House committee: Independent practice for nurse practitioners is the wrong answer for Texas primary care shortage

Tags: HB1415, Dr. Briggs, Emily Briggs, Public Health Committee

By Jonathan Nelson

The House Public Health Committee took up several bills that would expand the scope of practice of nurse practitioners on a long day of business on Tuesday, April 25. The hearing had stretched into the evening before TAFP member Emily Briggs, MD, of New Braunfels was called to the podium to speak against House Bill 3395 by Rep. Four Price (R-Amarillo). The bill would grant nurse practitioners independent authority if they practice in a rural area that doesn’t currently have a physician.

“I’m a family physician in Comal County, which means I see patients in my office,” Briggs told the committee. “I also take care of them in the hospital, I deliver their babies, I take care of their babies after delivering them and I also take care of the rest of their family.”

She told the committee that while she supports the bill’s goal to expand access to care in rural communities, granting nurse practitioners the authority to independently diagnose and prescribe is not the solution. Out in rural practice, physicians encounter a wide range of cases that require significant expertise and training.

“In a rural practice, a clinician needs a breadth of experience to care for the complex chronic patient. Primary care is more than coughs and colds, more than disease prevention and counseling. Physicians and providers practicing in rural areas really need a higher level of training to address the breadth of those problems. Patients with chest pain, lacerations, burns, broken bones, or a woman in labor.”

Even fully trained physicians often feel underqualified to practice medicine in rural areas, she said. “If we want to improve access to care in rural areas, we should strengthen our efforts to recruit physicians from rural communities to medicine. We need to continue to provide loan repayment as recruitment strategy, and we need competitive reimbursement for our Medicaid patients.” The bill was left pending.

A much more dangerous bill came under consideration earlier in the day. H.B. 1415 by Rep. Stephanie Klick (R-Fort Worth) would grant advanced practice registered nurses, or APRNs, full independent practice authority. They could essentially practice medicine without any interaction or collaboration with a physician and their licensure and oversight would be the responsibility of the Texas Nursing Board rather than the Texas Medical Board.

Gary Floyd, MD, a pediatrician from Keller and a member of the TMA Board of Trustees, spoke against the bill. “Nurse practitioners are valuable members of the patient care team,” Floyd said. “They bring valuable skills to patient care, but our training is very different. They are trained in care and comfort and we are trained in diagnosis and treatment.”

By the time primary care physicians begin treating patients independently, they have completed four years of medical school and three to four years of specialty training. They have logged between 12,000 and 16,000 hours of patient care under the tutelage of supervising physicians. When nurse practitioners complete their training, they have acquired 500 to 1,500 hours of clinical training.

“It’s a team approach; it’s a collaborative approach; it’s meant to be interactive. I think that’s best for our citizens and I’d urge this committee to stand against House Bill 1415,” Floyd said. The bill was left pending.



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