TAFP tells Senate Committee that allowing APRNs to practice independently will not solve Texas’ primary care access problems

The Texas Senate Committee on Health and Human Services held its second interim hearing on September 18, 2024, to address charges from the lieutenant governor’s office in advance of the 89th Texas Legislature. TAFP provided written testimony on the charge to evaluate access to primary and mental health care, and to “examine whether regulatory and licensing flexibilities could improve access to care, particularly in medically underserved areas of Texas.”

As family doctors know, primary care practices provide more than one in three health care visits and often serve as the only source of care for patients, including patients with chronic conditions, such as diabetes, or mental health needs. In Texas as well as across the nation, a shortage of primary care physicians continues to restrict access for patients, leading many lawmakers to push for scope of practice expansion for nonphysician providers and independent practice for nurse practitioners.

“This is a scope of practice discussion,” said committee chair, Lois Kolkhorst, (R-Brenham), as she presented the topic. The next four hours of debate and inquiry left no question that scope of practice will be a huge issue in the legislative session set to begin on January 14, 2025.

In its testimony, TAFP argued that team-based care remains the best model to provide access to high quality primary care.

“Put bluntly, all health care professionals have unique skills and expertise, but APRNs [advanced practice registered nurses] and other providers are not substitutes for physicians. TAFP does not support full independent APRN practice. Rather, TAFP remains ardently in favor of team-based care, where each health care professionals’ unique patient management skills, insight, and expertise come together to strengthen patient safety and outcomes.”

Nationally, 27 states allow APRNs to practice with no physician supervision or collaboration. As of 2023, another dozen states, including Arkansas and Florida, have enacted “transition to practice” requirements that mandate newly graduated APRNs practice under the supervision or mentorship of an experienced clinician for a specified number of hours.

The Academy argued that the lack of standardization among APRN training programs, the proliferation of mostly online training programs, and the limited number of diagnostic training hours required raise serious concerns. These could be addressed through legislation to reform APRN training requirements.

“Enhancing APRN diagnostic skills will improve patient safety and quality — a win for everyone. TAFP supports implementation of innovative strategies to improve APRN diagnostic skills, including enhancing opportunities for experiential learning through nursing preceptorships and residencies.”

As part of its scope discussion, the committee took up the topic of allowing pharmacists to independently prescribe medications to patients following a positive test for maladies like COVID-19, influenza, and strep throat. The Academy joined the Texas Pediatric Society and the Texas Chapter of the American College of Physicians to provide testimony against such expansion.

“Our main concern with allowing pharmacists to independently “test and treat” is patient safety. While pharmacists are trained to ensure the safe, effective, and appropriate use of medications, they have limited training on taking a patient history, performing physical exams, diagnosing patients, interpreting test results or providing primary care services. Additionally, pharmacists frequently lack access to a patient’s full medical record to make informed and appropriate decisions for each individual patient.”

Instead of expanding the scope of practice of nonphysician providers, the Academy proposed the following legislative actions to increase access to high quality, cost-effective primary care to Texans.

• Advance value-based care payment models.
• Create a primary care research fund designed to improve the effectiveness and efficiency of primary care delivery and payment.
• Expand loan forgiveness for those entering primary care.
• Increase primary care GME funding.
• Foster and pay for team-based care.

Stay tuned for more news and analysis from TAFP on what is sure to be an exciting legislative session.