Scope of Practice

Protect Patient Safety With Physician-Led Health Care Teams - 01/20/2021

Texas needs more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. But the real gains in improving access to and coordination of patient care will come largely from solidifying and expanding the use of physician-led teams. Physician-led team-based care capitalizes on the efficiencies of having the right professional providing the right services to the right patient at the right time, with physicians managing the overall direction and coordination.


Buried in Paperwork - 01/14/2021

The Texas Medical Association reached a landmark agreement with advanced practice nurses and physician assistants on legislation to improve patients' access to care through an improved delegated model for team-based health care. The bill helps establish a more flexible and collaborative practice model that improves on current site-based restrictions.


VA Waives State Scope Laws for Nonphysician Practitioners - 11/11/2020

The U.S. Department of Veterans Affairs (VA) is waiving state scope-of-practice laws in an interim rule that takes effect Thursday, effectively allowing VA nonphysician practitioners to practice across state lines at VA facilities without physician overs


TMA Opposes Bill Defining Clinical Psychologists as Physicians in Medicare - 09/28/2020

A broad swath of organized medicine, including the Texas Medical Association, is asking congressional leadership to oppose a bill that legally would consider clinical psychologists to be physicians within Medicare, saying it “inappropriately” expands psychologists’ scope of practice.


Docs Must Supervise Delegation to CRNAs, TMA Tells Attorney General - 09/21/2020

Texas Attorney General Ken Paxton should state that certified registered nurse anesthetists (CRNAs) require physician supervision when a physician delegates medical acts to them, the Texas Medical Association told the attorney general in response to a request for opinion.


Some Clarity, Some Fog: AG Opines on Physician-Optometrist Relationship - 07/01/2020

An opinion by the Texas attorney general will keep the Texas Optometry Board (TOB) from exerting influence over the practice of medicine – to a certain point.


I Won’t Take the Nurse Practitioners’ Bait - 04/09/2020

The American Association of Nurse Practitioners (AANP) is obviously intent on picking a fight with physicians. No thanks. We’ll take the high road, fully aware of the dangers of their plans, and stick with what we know is best for our patients: the physician-led health care team.


TMA Opposes Attempts to Expand Audiologists’ Scope - 02/14/2020

Proposed federal laws that would give audiologists unlimited access to Medicare patients without a physician referral could lead to lasting, and expensive, harm to patients, medicine once again told U.S. Senate and House leadership this week.


TMA to Trump: Do Not Expand NPPs’ Scope of Practice - 02/12/2020

When President Donald Trump released an executive order earlier this month that would, in part, expand the scope of practice of nonphysician practitioners, the Texas Medical Association vowed to keep physicians at the head of the health care team. On Monday, TMA President David Fleeger, MD, took a major step to do that, urging President Trump and Health and Human Services (HHS) Secretary Alex Azar to remove that language entirely.


Physicians Must Lead Care Teams, Medicine Tells Feds - 01/24/2020

The Texas Medical Association, and 99 other medical societies, are making it clear to Medicare that physicians are the nation’s most highly trained health care professionals – and the government shouldn’t weaken or eliminate their supervision of nonphysicians.


TMA Says “No” to Federal Scope Expansion Under President’s Medicare Executive Order - 01/23/2020

At least one piece of President Donald Trump’s recent executive order on Medicare will meet strong opposition from the Texas Medical Association. “Know this: TMA will stand up for our profession and our patients to prevent this totally unwarranted scope-of-practice expansion from becoming reality,” said TMA President David C. Fleeger, MD.


CRNAs Can’t Administer Anesthesia Unless Physician Delegates It, AG Rules - 09/12/2019

The state attorney general has agreed with the Texas Medical Association in an official opinion that keeps certified registered nurse anesthetists (CRNAs) from administering anesthesia without physician delegation.


Respecting the Roles: TMA Battles Another Round of Scope of Practice Bills - 08/02/2019

When nonmedical professionals ask the Texas Legislature for the authority to practice medicine, TMA mounts a full-court press, letting lawmakers know why there are some roles only physicians can fill.


Scope of Practice: Shot Down - 08/02/2019

When it comes to shooting down dangerous attempts to expand non-medical practitioners’ scope of practice, TMA’s advocacy army once again proved to be expert marksmen in 2019. Medicine trained its scope on bills that would have allowed nurse practitioners, chiropractors, and optometrists, among others, to wade into the practice of medicine.


Court Sides With TMA in Final Ruling on Chiropractic Scope of Practice Lawsuit - 06/26/2019

We won! In a final judgment by Travis County District Court Judge Rhonda Hurley, TMA prevailed in its long-held declaration that the Texas Board of Chiropractic Examiners' (TBCE's) rules permitting chiropractors to make medical diagnoses and perform other medical procedures exceed the chiropractic scope of practice.  


TMA Opposes Dental Board's Sleep Apnea Treatment Rules - 06/26/2019

TMA is fighting the Texas State Board of Dental Examiners' (TSBDE's) proposed rule changes for dental treatment of obstructive sleep apnea. The association told TSBDE in a letter TMA "strongly opposes any attempt to expand the dentists' scope of practice through the promulgation of rules that TMA contends not only lack support in, but also conflict with, the applicable law passed by the Texas Legislature. Unfortunately, this opposition extends to the rules adopted to be effective on June 11, 2014, and the new March 18, 2016, rule proposal."


Victory! Marriage and Family Therapists Can't Diagnose - 06/26/2019

In a scope-of-practice victory for medicine, the Supreme Court of Texas upheld the Third Court of Appeals' decision that the Texas State Board of Examiners of Marriage and Family Therapists' (MFT's) diagnostic assessment rule exceeds the scope of marriage and family therapy.


Houston Judge Changes Course, Says DOs Can File Commitment Papers - 06/26/2019

Physicians across Texas are breathing a sigh of relief — at least for now — thanks to Harris County Probate Judge Rory Olsen's decision to allow doctors of osteopathy (DOs) to file Certificates of Medical Examinations needed for mental health commitments. TMA and a host of other physician organizations have been fighting the judge's initial ruling, which prohibited DOs from signing the commitment papers.


Legislative Top 10: Lawmakers Say No to Expanding Scope of Practice - 06/10/2019

Every legislative session, allied health professionals ask lawmakers to broaden their scope of practice to some form of health care only physicians are trained and authorized to provide. Today's TMA Legislative News Hotline video reports that lawmakers passed no such Texas Medical Association-opposed bills this term.


Prohibit Chiropractors From Practicing Neurology - 04/29/2019

The current statutory definition of chiropractic references its focus on the musculoskeletal system. SB 1867 would add “neuro” to its definition. We find this an unwarranted expansion, contrary to patient health care, and unsupported by chiropractors’ education and training.


Chiropractors Are NOT Neurologists – Don’t Expand Their Scope - 04/03/2019

Simply alleging that the basis of this proposal is the impossibility of treating conditions related to the “musculoskeletal” system without a neurological connection is misleading, oversimplified, and potentially dangerous. Adding the term “neuro” is not merely the addition of the nerves that may connect muscle tissue or bones. It is the addition of the entire neurological system that includes the brain, the spinal cord, and the regulation of many bodily functions – all well beyond chiropractors’ education and training.


Stop APRN Scope Expansion - 04/03/2019

Medical school was a very humbling experience as I learned the depth of what I did not know as a nurse practitioner. Many times I realized I had inadvertently provided improper treatment for a patient simply out of ignorance. I came to realize, for example, the reason I struggled to understand how to interpret lab data as a nurse practitioner was that I hadn’t gained the in-depth knowledge of normal physiology and abnormal pathophysiology required to understand the “why” behind the lab tests.


Pharmacy Board Nixes Proposal That Could’ve Broadened Pharmacists’ Scope - 03/14/2019

Medicine’s objections were strong, and the state’s draft rules allowing pharmacists to perform medication therapy management services aren’t going to make it after all.


Healthy Vision 2025 Calls for Teamwork, not Scope Expansion - 02/07/2019

The sentence has appeared in every edition of the Texas Medical Association’s Healthy Vision series since the first Healthy Vision 2010 was published 14 years ago: “TMA opposes any efforts to expand any health professionals’ scope of practice beyond what is safely permitted by their education, training, and skills.” That focus on safety remains an integral part of  Healthy Vision 2025 , published last week. And that sentence remains, verbatim.    


Help TMA Fight Independent Practice For APRNs - 02/07/2019

Please contact your state lawmakers today through the new TMA Grassroots Action Center. Let them know you support physician-led, team-based care. Tell them how much you learned in your years of medical school, residency, and beyond. Tell them why APRNs are NOT the answer to Texas’ physician shortage. Ask them to say “No” to the APRNs and to help the Texas Medical Association stop them.