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. 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 overall direction and coordination in the hands of physicians.
In 2013, lawmakers bolstered this model by passing legislation that set up a more collaborative, delegated practice among physicians and advanced practice registered nurses (APRNs) or physician assistants (PAs). The new law reinforces the importance of physician-led medical care teams, recognizes the skills all practitioners bring to patient care, and allows the delegating/supervising physician greater flexibility to improve access to care and maintain quality of care. The new law recognizes that independent diagnosis and prescribing are the practice of medicine. Physicians may delegate, but they must supervise.
TMA believes that a physician-led team approach to care, with each member of the health care team providing care based on his or her education and training, is critical to ensuring that more Texans receive high-quality care. Team care requires cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources.
A small number of allied health professionals have spurred calls for Texas to grant them independent practice. Such an expansion in their scope of practice would likely increase costs and utilization, and could endanger the safety of our patients. The Texas Medical Practice Act was passed more than 130 years ago to protect Texans from people who called themselves “doctor” but who did not have the skills, training, or education to warrant such a title. The act, administered by the Texas Medical Board (TMB), clearly defines the practice of medicine and the educational qualifications necessary to diagnose, independently prescribe, and direct patient care — and to be held accountable for that care.
In the coming decade, integrating the talents of a diverse medical team under physician leadership will be one of the key challenges. Without physician direction, supervision, management, and coordination, medical care will trend toward even more fractured care, higher-than-necessary utilization, and creeping inefficiencies. This will lead to even higher costs, duplications of services, and lower-quality patient care. These inefficiencies in turn will hamper efforts to improve access to care.
On the other hand, some scope expansions are consistent with team care, are based on objective educational standards, and would improve patient care services. These should be carefully weighed and likely will involve regulatory oversight by TMB.
TMA’s 2015 Legislative Recommendations
- Stop any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners’ education, training, and skills.
- Enact only those changes to scope of practice laws that are based on objective educational standards, improve patient care services, protect patient safety, preserve the physician-led medical home, are consistent with team care, and have appropriate regulatory oversight by the TMB.
- Pass legislation that strengthens TMB’s regulatory oversight of nonphysician licensees who, by specific educational achievement, are granted authority to perform acts traditionally reserved for and defined as the practice of medicine.
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