Legislative Hotline: Independent Prescribing for APRNs: A Bad Idea
By Joey Berlin


The main event of this session’s troublesome scope of practice bills was scheduled to come before the Texas House Public Health Committee today. So the house of medicine sent a handful of its advocates into the ring to stop this year’s effort to give advanced practice registered nurses (APRNs) more authority to perform medical acts without physician supervision.

House Bill 2029 by Rep. Stephanie Klick (R-Fort Worth) would allow APRNs – without any collaboration with a physician – to independently:

  • Prescribe medications;
  • Prescribe durable medical equipment; and
  • Evaluate diagnostic testing.

The Texas Medical Association sent four physicians to explain TMA’s opposition to the bill: Sugar Land family physician Troy Fiesinger, MD, a member of TMA’s Council on Legislation; Austin oncologist Debra Patt, MD, chair of that council; Houston internist Cynthia Peacock, MD; and Round Rock family physician Tina Philip, DO.

TMA’s objections to HB 2029 – as well as similar legislation offered in previous sessions to expand APRNs’ scope – are rooted in a long list of points. Among those:

  • While physicians are trained to provide complex differential diagnoses, order and interpret tests, and develop treatment plans, nurse practitioners are specifically trained to treat patients after a diagnosis and implement chronic disease management protocols.
  • Members of the health care team aren’t interchangeable, and the clinical hours APRNs must complete in their training aren’t enough to prepare them for independent practice. Physician education is standardized by state medical boards; APRN training isn’t.
  • TMA strongly supports improving access to care and lowering health care costs, but HB 2029 won’t achieve that. Health care costs have not decreased in the 30 states that have expanded APRNs’ scope of practice, and states with permissive licensing have shown no evidence of improved access to primary care.

TMA maintains that APRNs are an important part of a clinically integrated, team-based approach to care, but that team must be physician-led.

Testimony on HB 2029 is expected to occur this afternoon. You can join the Public Health Committee hearing in progress on the Texas House’s video broadcast page.

TMA has created a legislative toolkit to arm you with the information you need to join us in stopping scope of practice expansion in Texas. The toolkit includes messages, research and polling data, social media graphics and posts, short videos, and more to help you get the word to Texas lawmakers that health care must be physician-led and team-based.

TMA Needs Your Expert Help 

The 2021 legislative session is about to enter its final two months, and the opportunities to stop bad bills and promote good ones are mounting. Time-sensitive Action Alerts are an effective and an efficient way for you to share your messages of concern and support with legislators from the convenience of your desk or mobile phone. Action Alerts arrive by email and have a pre-written response, to which we strongly encourage you to add a personalized story or anecdote about how the proposed legislation will affect you, your patients, and your practice. You can access Action Alerts from the email you receive, our Grassroots Action Center, or the VoterVoice mobile app. Just click the link and go. Easy Ways to Get Involved in TMA Advocacy 

Your participation is a vital component of our legislative success. Join our advocacy efforts today.

Stay up to date on bills TMA is following closely. And take advantage of other opportunities to get involved with our advocacy efforts.

Last Updated On

March 24, 2021

Originally Published On

March 24, 2021

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