2007 Legislative Compendium: Scope of Practice

From the moment the practice of medicine was defined, those with lesser education, differing world views of health care, and/or naiveté toward patient safety concerns have displayed expansionist tendencies into services and treatments long considered and legally defined as the practice of medicine.

With arguments both scientific and political, proponents have attempted to nibble away at the edges of medical practice for their own economic benefit. As a matter of strategy, however, the economic side of the issues generally was downplayed while the righteous aspects of "turf battle" were stressed. Each nonphysician group attempted to present its arguments for expansion as a disagreement between two equally trained - or essentially so, they argued - groups of practitioners.

More often than not, members of the legislature have been placed in the uncomfortable position of having to choose between friends - physicians and those who would challenge the definition of what constituted an act or service encompassed by the practice of medicine. The challenge to each group of nonphysician practitioners was to pursue a single issue. The challenge to physicians and their professional associations has been to defend against all incursions into medical practice while simultaneously pursuing a broad legislative agenda in which scope of practice was but one of many priorities.

With each ensuing battle, the rules of engagement have evolved. For the second session, the Patients First Coalition, representing TMA and the major medical specialty societies in the state, played significant roles. This cooperative approach has created new allies in the debates at just the right time. Today, rather than face multiple single opponents, we also face a coalition of these like-minded groups operating in a coordinated manner, each attempting to buttress both scientific and political arguments for their causes to support expansions.

In 2007, nearly 90 bills were filed that dealt in some ways both major and minor with expansion of scope of practice. No significant proposal impacting medical practice and patient care was passed. Even an agreed-to bill with the acupuncturists failed to move out of committee. In some ways, members exhibited "issue fatigue" and wanted to avoid the confrontational aspects of scope issues. But, an aggressive strategy by the Patients First Coalition also helped to divert some of our adversaries' attention and resources.

Nevertheless, with Sunset review of the Medical Practices Act in 2005 and the Nursing Practices Act in 2007 having been completed for this cycle, the field is open in 2009 for the 81st Texas Legislature to consider a significant amount of scope legislation, primarily in the expansion of practice for advance nurse practitioners.

The Retail Health Clinics issue (covered elsewhere in this compendium) served as a nexus for scope of practice and access to care issues, but it also included economic arguments as well. We expect this to be the tip of the spear on scope issues for the next session.

Scope of Practice Near Misses
House Bill 1117 by Rep. Betty Brown (R-Terrell) would have changed the language of who may file a birth certificate. The bill would have changed the language from "physician, midwife, or person acting as midwife" to "physician or other health care practitioner."

House Bill 3115 by Rep. John Zerwas, MD (R-Richmond), would put in place requirements to better inform patients and the public about the distinction between a physician and others in health care who use the title "doctor ." The bill would have required practitioners, excluding physicians, who use the title of doctor to communicate to a patient orally or in writing, including on a name tag, the type of license, permit, registration, or certificate under which the person is practicing. At least one other state has passed similar legislation. A violation of this requirement would have made the practitioner subject to action by the appropriate oversight board as grounds for revocation or denial of license, permit, registration, or certification. The bill was heard in the House Public Health Committee, but did not have sufficient votes to advance further.

Scope of Practice TMA Staff Team:

Legislative: Dan Finch
Policy/Legal: C.J. Francisco

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