Scope of Practice Legislative Brief

Physicians and nonphysician practitioners work together as a team to provide high-quality patient care every day. They are trained together; they practice together. Physicians serve as the leader of the team because they have clinical expertise and training to exercise independent medical judgment. Nonphysician practitioners work with physicians and should be able to provide care based on their level of education, training, and skill.   

However, in every legislative session, one or more groups of nonphysician practitioners seek to expand their scope of practice beyond their training and attempt to practice medicine without graduating from medical school. In 2011, advanced practices nurses will seek diagnosis and prescribing privileges — essentially the practice of medicine — without physician supervision; physical therapists will seek direct access to patients without a physician’s referral; and podiatrists will seek authority to work above the foot. Other groups will likely seek similar expansions, all based on the claim of improving access to care.

Expanding this authority will not enhance access or ensure better care to patients. All patients deserve high-quality care by practitioners who are well trained, operate in an efficient team, and properly supervised by physicians who answer to the regulatory body responsible for medical care in Texas, the Texas Medical Board (TMB).

Medicine’s 2011 Agenda

  • Prevent any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners’ education, training, and skills.
  • Defend a single standard of care, the physician’s role as leader of the health care team, and the physician’s ability to delegate and responsibility to supervise medical care for patients.
  • Support licensure efforts by nonphysician practitioners when it improves patient care, when the practitioners are appropriately trained, and when there is appropriate linkage to the TMB for regulatory oversight.  

Medicine’s Message

  • There should be a single standard of medical care for all practitioners. Physicians embrace their role as both providers and supervisors of care and understand the responsibility and accountability they bear for properly delegated medical acts.
  • Lowering the standard of care does not improve access to health care services for Texans.
  • Nonphysician practitioners should practice to the highest level of their training and skills but not beyond.
  • Maintaining the integrity of the health care team, under the physician’s overall direction, is good for patient care.

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