Scope of Practice

Physicians and nonphysician practitioners work together as a team every day to provide high-quality patient care. However, nonphysician practitioners are limited by their education, training, and skills as to the level of care they can provide safely. Only physicians have the clinical expertise and training to exercise independent medical judgment and serve as the trusted leader of the health care team.

In virtually every legislative session, one or more groups of nonphysician health care practitioners try to expand their scope of practice. Issues likely to surface in 2009 include efforts by advanced practice nurses to obtain independent practice and prescription authority, by optometrists to perform laser and other surgeries on the eye, and by chiropractors to have explicit authority to perform preparticipation sports physicals. Numerous other possibilities exist.

TMA and 12 state medical specialty societies formed the PatientsFIRST Coalition in 2005. The purpose of the coalition is to protect the safety of Texas patients and ensure they receive the best medical care by the best person trained to deliver that care.

Medicine's 2009 Agenda

  • Prevent any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners' education, training, and skills. 
  • Defend the definition of medical practice, the physician's role as leader of the health care team, and the physician's right to delegate and supervise medical services while remaining responsible for patient care. 
  • Support licensure efforts by nonphysician practitioners when it benefits patient care, when the practitioners are trained adequately and supervised properly, and when licensure is linked to the Texas Medical Board for regulatory oversight of potential scope expansions not explicitly authorized by the Texas Legislature. 

Medicine's Message

  • There should be one, high standard for patient 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 is neither a good solution nor good public policy for improving Texans' access to quality health care. 
  • Nonphysician practitioners do not have the training to know what they don't know. 
  • Maintaining the integrity of the health care team under the physician's overall responsibility is good for patient care, and is efficient and sound public policy.

A majority of Texas voters oppose allowing limited-license practitioners to diagnose illness, prescribe medications, or perform procedures such as laser surgery on the eye or laser hair removal, even if it reduces health care costs.