This page contains a Flash digital edition of a book.
may not even be possible in an emergency situation. Past ef- forts also sought to require indefinite treatment. “These are medical procedures, and the question is, do we

treat them any differently than any other medical procedure? There will be bills filed on end-of-life issues, and we will have to figure out how to separate situations involving DNR orders from those involving the withdrawal of care,” Dr. Secrest said, adding that the two are distinct issues. Dr. Floyd anticipates another showdown with advanced practice nurses (APNs) over independent practice and inde- pendent prescribing, despite their lack of education and train- ing to do so. TMA expects similar scope-of-practice expansion activities by optometrists, podiatrists, and chiropractors. TMA and TAFP, through a

joint workgroup, established core principles to help guide their negotiations with APNs and hopefully move toward collaborative practice agree- ments. Physician assistants (PAs), rather than seek inde- pendent practice, have champi- oned with doctors a physician- led, team-based model of care. Midlevel practitioners “are an important part of our health care team. But it is a health care team, and we are resolved that that team should be led by a physician, who has much more training and experience,” Dr. Floyd said. At the same time, the work-

group seeks common ground with PAs and APNs to resolve what both sides agree are con- fusing layers of rules governing where and when physicians may delegate their prescriptive authority and the degree of physician supervision needed in various practice sites. Different sets of rules exist for midlevel practitioners in rural settings and in hospitals for how much time a physician must spend on site and for how many practitioners a physician can supervise. “We could go a long way

toward standardizing [those rules] and removing variation,” Dr. Floyd said. “In an electron- ic age, much can be accom- plished through telemedicine

to be more efficient, and for both sides, face time might be better spent discussing things like deviations from protocols” and how to improve care. Such modifications will require legislative and regulatory

change, and TMA hopes to reach an agreement with nurse practitioners going into the session, Mr. Finch says. But similar talks stalled in the past when the group said it wanted nothing short of independent practice. In a Sept. 13, 2012, column in the Fort Worth Star-Telegram, Sandy McCoy, president of the Texas Nurse Practitioners lobby group, said APNs can fill the gap created by primary care phy- sician shortages and that diagnosing and prescribing “are well within the bounds of our education and training. The Texas


TMA outlines its strategic roadmap for state and federal advocacy initia- tives for the remainder of the decade in Healthy Vision 2020, a compre- hensive plan for improving health care and maintaining the viability of physician practices in Texas. Based entirely on existing TMA policy, Healthy Vision 2020 was re-

viewed and improved by TMA’s policy councils and the TMA Board of Trustees. Healthy Vision makes eight key recommendations. They are:

• Ensure an adequate health care workforce; • Protect physicians’ independent medical judgment; • Promote efficient and effective new models of care; • Repeal harmful and onerous state and federal regulations; • Invest in prevention; • Protect and promote a fair civil justice system; • Provide appropriate state and federal funding for physician services; and

• Establish fair and transparent insurance markets for patients, employ- ers, taxpayers, and physicians.

TMA member physicians can read and comment on the plan on the

TMA website at You may also order a printed copy from the TMA Knowledge Center by calling (800) 880- 7955 or emailing Texas Medicine has been publishing a section of Healthy Vision each month since July. Section 7, Provide Appropriate State and Federal Funding for Physician Services, is in this issue.

January 2013 TEXAS MEDICINE 25

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