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.
In 2013, lawmakers strengthened this model by passing legislation that established a more collaborative, physician-delegated practice among physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs). That 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 and members of the health care team greater flexibility. It also recognizes that independent diagnosing and prescribing is the practice of medicine.
This distinction is important to preserve. Nurse practitioners and PAs are valuable members of the patient care team. They bring valuable patient care skills, including care coordination and patient education essential to improving patient health, but physician training is very different. The typical physician completes between 12,000 and 16,000 hours of clinical training, compared with 500 to 1,500 hours for APRNs and 2,000 hours for PAs. Physicians’ training and education uniquely qualify them to determine if a medical act can be safely delegated to an APRN or PA acting under the physician’s supervision. This is why physician-led team care is integral to improving access to and coordination of quality patient care.
A physician-led, collaborative-care model ensures patients receive safe, cost-effective, and efficient care. Without physician direction and supervision, medical care will become even more uncoordinated and fractured, leading to less effective and duplicative services, higher costs, and lower-quality patient care. Fragmented, uncoordinated care will hamper efforts to improve access to quality care.
Independent diagnosing and prescribing is the practice of medicine, and it must continue to be reserved solely for physicians. Patient safety depends on it.
TMA’s Legislative Recommendations
- Strongly oppose any efforts to expand scope of practice beyond what is safely permitted by nonphysician practitioners’ education, training, and skills.
- Support only those changes to scope-of-practice laws that protect patient safety, are consistent with physician-led team-based care, are based on objective educational standards, and improve patient care with appropriate regulatory oversight by the Texas Medical Board (TMB).
- Require licensure and regulation by TMB for any nonphysician practitioners who are qualified and seek authority to make a medical diagnosis and prescribe medications.
- Reject any attempt to adopt the APRN Compact multistate license, which would replace Texas scope-of-practice law with other states’ laws and authorize patient care independent of a proper supervisory or collaborative relationship with a physician.
- Require structured clinical training for APRN students.
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