TAFP members tell House committee that granting NPs independent practice authority will not solve Texas’ primary care access problem

On April 14, the House Public Health Committee heard hours of testimony on a bill that would grant authority to advanced practice registered nurses to practice independently. The bill, House Bill 3794 by Rep. Drew Darby, R-San Angelo, would give APRNs the authority to:

• make medical diagnoses;
• order and interpret medical tests;
• prescribe therapies, devices, and medications, including controlled substances;
• treat health problems; and
• serve as a patient’s primary care provider of record.

TAFP board member Puja Sehgal, MD, testified against the bill on behalf of the Academy. As the chair of family medicine for Kelsey-Seybold in Houston, she shared her first-hand experience in developing an onboarding program for new advanced practice clinicians — nurse practitioners and physician assistants. She told the committee that while implementing the program, she was alarmed by the significant lack of clinical training among new APRNs.

“Even though I understand APCs are a force multiplier — they really can expand the care — I do not believe we should give them independent authority to practice,” she said.

TMA board member Rodney Young, MD, also testified before the committee, saying that extending independent practice authority to ARPNs is not a good solution to our state’s lack of access to primary care. He is a professor and regional chair of the Department of Family and Community Medicine at the Texas Tech University Health Sciences Center at Amarillo.

“We have always contended that APRNs are important members of the physician-led health care team,” Young said. “But removing physicians from that critical leadership role and allowing APRNs effectively to practice medicine by formulating primary and differential medical diagnoses and prescribing independently, as is proposed in this bill, will not improve patient access to care.”

TAFP also provided written testimony to the committee. “Put bluntly, all health care professionals have unique skills and expertise, but APRNs and other providers are not substitutes for physicians,” the Academy wrote. “TAFP does not support full independent APRN practice. Rather, TAFP remains ardently in favor of team-based care, in which each health care professional's unique patient management skills, insight, and expertise come together to strengthen patient safety and outcomes.”

The bill was left pending by the committee. Stay tuned for more information as the session continues.