Independent Practice for APRNs Bad for Patient Care

TMA Testimony by Gary Floyd, MD

House Public Health Committee
HB 1415 (Klick) OPPOSED

 April 25, 2017

Mister Chairman, members of the committee, I am Dr. Gary Floyd. I am a pediatrician from Fort Worth and a member of the Texas Medical Association Board of Trustees. On behalf of the more than 50,000 members of the TMA, and my 20,000 physician colleagues in primary care, I am testifying AGAINST House Bill 1415.

Members, I have spent a career taking care of kids and educating physicians, nurses, and nurse practitioners to take care of kids. It has been more than rewarding; it’s been more of a calling, and I have a great appreciation for the skills and talents many dedicated practitioners bring to patient care.

I also have spent the better part of the past 10 years laying the foundation for building a better way for physicians and nurse practitioners and physician assistants to collaborate together – as part of a team approach to patient care. I was intimately involved in the work that brought about Senate Bill 406 in 2013, and I am very proud of what we accomplished. I am prouder still that we testified in favor of the bill along with our colleagues representing nurse practitioners and physician assistants in favor of that landmark legislation.

In our opinion, House Bill 1415 would leave those gains behind and the cooperative spirit that led to them, it would fragment care, and it will serve neither patients nor their primary care needs.

By the numbers, the Department of State Health Services reports that there are more than 20,000 primary care physicians practicing in Texas, and slightly more than 14,000 nurse practitioners. 

Nationally, slightly more than 52 percent of APRNs are in primary care, a percentage that has declined since 2004. The challenges of attracting primary care providers – physicians, nurse practitioners, and physician assistants – are consistent across the board.

In Texas, 52.5 percent of APRNs and 51.9 percent of primary care physicians practice in the state’s five biggest counties: Harris, Dallas, Bexar, Travis, and Tarrant. They practice where we practice. And this distribution holds up even in states that allow independent practice like New Mexico, Idaho, and Utah. All have similarly large rural areas with underserved populations.

Lastly, nurse practitioners are valuable members of the patient care team. They bring valuable skills to patient care, but our training is very different. The typical physician completes between 12,000 and 16,000 hours of clinical training, compared to 500 to 1,500 hours for APRNs.

When I first started practice, it would have been usual for a solo physician to work with a nurse and some limited clerical help and take care of a practice of 1,800 patients. Today, it is common for that practice to be a physician, a nurse practitioner, a PA, several nurses, and an entire billing department taking care of 4,000 or 5,000 patients. And it’s not a solo physician; it’s five physicians, 10 physicians.

It is this team approach that lets us expand our reach, extends our care, and has each member of our team practicing up to the highest levels of their education and training.

Mister Chairman, members. Thank you for the opportunity to testify. I am happy to answer your questions.

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Last Updated On

April 26, 2017

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