TMA’s “Battle This Session” Begins: Fighting Scope Creep
By Emma Freer

As expected, several scope-of-practice expansion attempts have crept their way into the more than 800 bills the Texas Medical Association is already tracking so far this legislative session, underscoring why fighting scope creep is medicine’s top priority.  

“This is our battle this session,” Clayton Stewart, TMA’s chief lobbyist, told an audience of member physicians during TMA’s Winter Conference in Austin on Jan. 28. “We’re going to fight, and we’re going to fight hard.” 

If interim hearings were any indication, advanced practice registered nurses are expected to pursue full independent practice and prescribing authority, and TMA is on guard for such legislation.  

Mr. Stewart said nurses are arguing they are the solution to Texas’ physician workforce shortage, especially in rural areas. But TMA has balked at this claim, citing studies showing physicians and nonphysician practitioners tend to practice in the same areas, regardless of state scope laws.  

Among the scope bills filed so far:  

  • House Bill 1105 by Rep. Four Price (R-Amarillo) would allow pharmacists to administer childhood vaccines; and 
  • House Bill 1767 by Rep. Stephanie Klick (R-Fort Worth) would allow podiatrists to access hospital privileges.  

Although TMA has defeated most scope expansion legislation in the past, Mr. Stewart emphasized the association must be successful 100% of the time to preserve patients’ access to the highest level of care. 

“Do not take this for granted,” he said. “They are fighting hard on this.” 

TMA President Gary Floyd, MD, who helped secure compromise legislation in the past with a landmark team-based care bill, recently told Texas Medicine all health care professionals play a critical role. But he stressed only physicians have the education, training, and experience necessary to lead that team. 

TMA Board Trustee John Carlo, MD, added Texas shouldn’t accept a lower standard of care because of workforce shortages. As a public health physician who cares for patients in medically underserved areas, “that’s where you often see very complex cases, and that’s the last place you’d want to place undertrained nonphysician practitioners,” he said. 

Instead, Mr. Stewart said the real fix – and TMA’s advocacy focus – is to train more physicians by bolstering graduate medical education (GME) funding, loan forgiveness programs, and rural training tracks. 

Early budget bills from both the House and the Senate increase GME residency positions. But Mr. Stewart said more needs to be done on loan forgiveness programs, especially those geared toward physicians who train in rural areas.  

TMA member physicians can help win this fight by participating in First Tuesdays at the Capitol, TMA’s signature lobbying event during which physicians, medical students, and TMA Alliance members meet with their representatives in Austin to discuss health care policy issues. Scope of practice is the focus of this session’s first event on Feb. 7.  

Last Updated On

March 16, 2023

Originally Published On

February 06, 2023

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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