2. Policy Issue: Scope of Practice
APRNs in Texas seek independent
diagnosis 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.
3. From Center to Champion Nursing in America, www.championnursing.org
4. 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
5. Possible Solution?
Advanced Practice Registered Nurses suggest
that if given independent diagnosis and
prescriptive authority, they can alleviate Texas’
primary care shortage.
OUR MESSAGE: The evidence does not support
this claim, and while the pursuit of this policy may
be politically expedient, the risk outweighs what
may be a hollow reward.
6. 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.
7. Advocacy Materials: Issue Briefs
We
developed a Compare the
series of 3 Education
issue briefs.
Gaps Between
We used Primary Care
comm tools
Physicians and
to distribute
to members. Nurse
Practitioners
Lobby team
gave them
to key
legislators
and staff.
8. Compare the Training
Little data exists comparing the quality and
cost of care provided by APRNs to that of
primary care physicians, but the difference in
training is starkly evident.
10. 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.
11. Advocacy Materials: Issue Briefs
We
developed a Primary Care
series of 3 Physicians Are
issue briefs.
the Most Likely
We used Health Care
comm tools
Professionals
to distribute
to members. to Practice in
Rural and
Lobby team
gave them Underserved
to key Areas
legislators
and staff.
12. Geographic Distribution
If given independent practice, would nurse
practitioners be more likely than family
physicians to practice in rural and
underserved areas?
The data suggests not.
13. 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
14. NP to FP Distribution in States Allowing
Independent Practice
In Idaho and Oregon, NPs choose to
practice in urban and suburban areas
like other health care professionals.
15. NP to FP Distribution in States Allowing
Independent Practice
The story is the same in Arizona
and Utah.
16. Advocacy Materials: Issue Briefs
We
developed a Collaboration
series of 3 Between
issue briefs.
Physicians and
We used Nurse
comm tools
Practitioners
to distribute
to members. Contains
Health Care
Lobby team
gave them Costs
to key
legislators
and staff.
17. 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.
18. Advocacy Materials: TFP Feature
We collected
anecdotes The feature
and horror title helped
stories from
members
reframe the
and included question:
them in a “What should
magazine
feature in the
be required to
fall 2010 practice
edition of medicine?”
Texas Family
Physician.
19. Advocacy Materials: Policy Brief
New 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.
20. Three Policy Considerations
The policy Does the Texas Board of Nursing have the
brief capacity and the expertise to regulate the
expounded
practice of medicine by NPs?
upon the
main themes In the interest of safety and quality, should
of our issue
the state set a minimum standard of
briefs and
posed three education and training to receive an APRN
important degree and license?
policy
considera- If the Legislature grants NPs the authority to
tions for practice medicine independently, what will
lawmakers. become of the state’s future supply of
primary care physicians?
21. 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.
22. 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.
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.
