Texas is one of 32 states currently that require some form of collaboration between physicians and APRNs. North Dakota and Vermont may have changed their status to “none” since this map was downloaded.
Communicating FamilyMedicine’s Priorities In The82nd Texas Legislature:SCOPE OF PRACTICETexas Academy of Family Physicians
Policy Issue: Scope of PracticeAPRNs in Texas seek independentdiagnosis and prescriptive authority. • Avoiding such an expansion to APRNs is a high priority to our members. • APRN organizations coordinated a strong media campaign, with editorials in all major dailies leading up to lege session, focusing on claims of lower cost, equal quality, and opportunity to address primary care workforce shortage.
From Center to Champion Nursing in America, www.championnursing.org
Texas’ Primary Care Shortage 16,830 primary care physicians in active practice in 2009 68 per 100,000 pop 81:100K is national average 118 of 254 counties are full HPSAs 26 counties had no primary care physicians in 2009
Possible Solution?Advanced Practice Registered Nurses suggestthat if given independent diagnosis andprescriptive authority, they can alleviate Texas’primary care shortage.OUR MESSAGE: The evidence does not supportthis claim, and while the pursuit of this policy maybe politically expedient, the risk outweighs whatmay be a hollow reward.
Framing the Issue Avoid a debate about quality. Anecdotes serve better in personal testimony. No data supports claims about differences in quality between APRNs and physicians. Argue instead for team-based, collaborative model. Turn the question: What should be the minimum standard for who can practice medicine? Refute APRN claims that they can solve the workforce shortage.
Advocacy Materials: Issue BriefsWedeveloped a Compare theseries of 3 Educationissue briefs. Gaps BetweenWe used Primary Carecomm tools Physicians andto distributeto members. Nurse PractitionersLobby teamgave themto keylegislatorsand staff.
Compare the TrainingLittle data exists comparing the quality andcost of care provided by APRNs to that ofprimary care physicians, but the difference intraining is starkly evident.
Compare the Training During their education, nurse practitioners experience between 500 and 1,500 hours of clinical training. At the completion of medical school and residency training, a family physician has experienced between 15,000 and 16,000 clinical hours.
Advocacy Materials: Issue BriefsWedeveloped a Primary Careseries of 3 Physicians Areissue briefs. the Most LikelyWe used Health Carecomm tools Professionalsto distributeto members. to Practice in Rural andLobby teamgave them Underservedto key Areaslegislatorsand staff.
Geographic DistributionIf given independent practice, would nursepractitioners be more likely than familyphysicians to practice in rural andunderserved areas?The data suggests not.
NP to FP Distribution in Texas According to DSHS, in 2009: 5,745 NPs were in active practice Ratio of 25.1:100K pop in metropolitan non-border areas Ratio of 8.3:100K in rural border regions
NP to FP Distribution in States AllowingIndependent Practice In Idaho and Oregon, NPs choose to practice in urban and suburban areas like other health care professionals.
NP to FP Distribution in States AllowingIndependent Practice The story is the same in Arizona and Utah.
Advocacy Materials: Issue BriefsWedeveloped a Collaborationseries of 3 Betweenissue briefs. Physicians andWe used Nursecomm tools Practitionersto distributeto members. Contains Health CareLobby teamgave them Coststo keylegislatorsand staff.
The Fallacy of Cost Savings Proponents of independent practice by APRNs suggest they would save the health care system money, but the data doesn’t support the claim. Research shows any savings gained because NPs earn less than physicians is offset by increased utilization of services. Well-coordinated care provided in a patient- centered medical home has proven to be better quality and lower cost.
Advocacy Materials: TFP FeatureWe collectedanecdotes The featureand horror title helpedstories frommembers reframe theand included question:them in a “What shouldmagazinefeature in the be required tofall 2010 practiceedition of medicine?”Texas FamilyPhysician.
Advocacy Materials: Policy BriefNew Policy Internship James Martin Scholarship through TAFP Foundation funded policy internship 3rd-year FM resident Marie-Elizabeth Ramas authored report We also built a slide deck for her to present the paper, which is available in the backup materials.
Three Policy ConsiderationsThe policy Does the Texas Board of Nursing have thebrief capacity and the expertise to regulate theexpounded practice of medicine by NPs?upon themain themes In the interest of safety and quality, shouldof our issue the state set a minimum standard ofbriefs andposed three education and training to receive an APRNimportant degree and license?policyconsidera- If the Legislature grants NPs the authority totions for practice medicine independently, what willlawmakers. become of the state’s future supply of primary care physicians?
So, What Happened? 6 bills were filed that would grant APRNs independent diagnosis and prescriptive authority. TAFP held a legislative action day, where members armed with our policy documents visited their representatives at the State Capitol. Texas physicians testified before the House Public Health Committee on the so-called “Scope Day,” when the bills were heard.
Success! None of the bills made it to the House floor for debate. We believe our strategy to inform and influence lawmakers through the multifaceted approach of issue briefs, policy briefs, and grassroots advocacy led to our success. Constituent chapters should feel free to use our research and advocacy tools in any way. All the documents should be in the backup materials, but you can also find them at www.tafp.org.
Jonathan Nelsonjnelson@tafp.orgAccess all of these policy tools:www.tafp.org/advocacyTexas Academy of Family Physicians | www.tafp.org