under the physician’s overall direction, is good for patient care. (TMA strongly supports physician- led teams using several health care professionals, each bringing important skill sets and training to patient care. Team care requires cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. See Section 2 for more on this topic.)
This growth, along with the narrow political interests of a small number of allied health professionals, has spurred calls for Texas to grant them more independent practice. Such an expansion in their scope of practice not only would exacerbate Texas’ physician shortage, but also likely would increase costs and utilization, and could endanger the safety of our patients.
The Texas Medical Practice Act was created more than 130 years ago to protect Texans from people who called themselves “doctor” but did not have the skills, training, or education to warrant such a title. The act, administered by TMB, clearly defines the practice of medicine and the educational qualifications necessary to diagnose, independently prescribe, and direct patient care — and to be held accountable for that care.
In 2011, for example, APNs sought independence to diagnose, prescribe, and order tests and treatments without physician collaboration. Two bills would have allowed APNs to practice medicine without the benefit of a medical education or passing exams that demonstrate medical knowledge and skills. Each would have the Texas Board of Nursing
TMA Recommendations
• Preserve and protect state support for undergraduate medical education and the cultivation of the future generation of Texas physicians, thus ensuring stable access to health care for all Texans.
• Support and develop new graduate medical education programs in the specialties that best reflect the state’s health care needs. Support incentives for hospitals and other community-based agencies to develop residency programs in the specialties most needed.
• Direct the Texas Higher Education Coordinating Board to coordinate the availability of graduate medical education training positions so that Texas can retain our graduates for residency training.
• Sponsor research to identify and promote innovations in training primary care residents for practice in Texas, and to address the factors that influence why few U.S. medical school graduates select this training.
• Adjust the payment system for health care 62 TEXAS MEDICINE July 2012
services to make primary care an attractive career option for those considering a rural practice.
• Reinstate the State Physician Education Loan Repayment Program funds that were slashed during the 2011 legislative session to encourage physicians to practice in rural and medically underserved communities.
• Strongly oppose any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners’ education, training, and skills.
• Support expansions of scope of practice laws that protect patient safety, are consistent with team care, are based on objective educational standards, and improve patient care services.
• Support legislation that strengthens the Texas Medical Board’s regulatory oversight of nonphysician licensees who, by objective educational improvements, are granted authority to perform acts traditionally reserved for and defined as the practice of medicine.
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