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Legislature should free these qualified providers, allowing us to move into rural and underserved areas that desperately need primary care services.” But there are only 12,000 APNs and 7,500 PAs in Texas, compared with more than 60,000 physicians, Dr. Floyd says.

“We don’t have enough of any of them. Nor are they flocking to rural Texas.”

TMA is willing to work on more flexible supervision rules,

for example, to help relieve unnecessary barriers to care, he says. “But things like diagnosing and prescribing remain the practice of medicine. And the legislature has established the medical board to oversee the practice of medicine. We are not willing to budge on that.”

Nor will TMA let up in defending physicians’ clinical au- tonomy from interference by hospitals’ or other entities’ eco- nomic interests. In 2011, TMA preserved the state’s ban on the corporate practice of medicine with protections for employed physicians, whether they work in hospital-run health care corporations, rural or urban hospitals, or health care collaboratives. From credentialing to utilization, by keeping clinical mat- ters in the hands of physicians and physician governance structures, “what we’ve done is protected doctors’ indepen- dent medical judgment and the patient-physician relationship. That’s where our focus is,” Mr. Finch says.


Doctors will see TMA go on the offensive when it comes to public health initiatives.

TMA continues to work with the Texas Public Health Co- alition on measures that aim to discourage tobacco use and increase cessation through legislation and evidence-based pro- grams; target obesity by using educational and community- based efforts; promote immunizations and disease prevention; and prevent cancer. TMA also will keep tabs on forthcoming revisions to the state mental health code and likely weigh in with the Texas Society of Psychiatric Physicians, Dr. Secrest added. Mental health funding saw no cuts last session, and TMA wants to keep it that way. However, the association’s public health agenda could once again run up against the budget and proposed 10-percent re- ductions to DSHS’ 2014–15 funding. And convincing lawmak- ers that prevention now means savings down the road is no easy task when the legislature’s only required duty is to come up with a two-year budget, TMA leaders say. More revenues, however, might create an opportunity for the association to mitigate the tax that family physicians and pediatricians must pay out of pocket to buy and stock vaccines, not knowing if they will be used. The typical vaccine costs around $15, but physicians may deduct only the expense of administering it. The 1-percent tax means even if health insurance companies reimburse enough to cover the purchase price of the vaccine, doctors still lose money. And yet the service is critical to overall public health.

26 TEXAS MEDICINE January 2013

TMA would like to see legislation supporting a tax deduc- tion for the actual cost of the vaccine. “We have some hope that with a better financial situation, this might be an issue the legislature would go for,” Mr. White- hurst said. n

Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by tele- phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at

All articles in Texas Medicine that mention Texas Medical Association’s stance on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. That law requires disclosure of the name and address of the person who contracts with the printer to publish the legislative advertising in Texas Medicine: Louis J. Goodman, PhD, Executive Vice President, TMA, 401 W. 15th St., Austin, TX 78701.

The Texas Medical Association Political Action Committee (TEXPAC) is a bipartisan political action committee of TMA and affiliated with the American Medical Association Political Action Committee (AMPAC) for congressional contribution purposes only. Its goal is to support and elect pro-medicine candidates on both the federal and state level. Voluntary contributions by individuals to TEXPAC should be written on personal checks. Funds attributed to individuals or professional associations (PAs) that would exceed legal contribution limits will be placed in the TEXPAC administrative account to support political education activities. Contributions are not limited to the suggested amounts. TEXPAC will not favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions are subject to the prohibitions and limitations of the Federal Election Campaign Act. Contributions or gifts to TEXPAC or any CMS PAC are not deductible as charitable contributions or business expenses for federal income tax purposes. Federal law requires us to use our best efforts to collect and report

the name, mailing address, occupation, and name of the employer of individuals whose contributions exceed $200 in a calendar year. To satisfy this regulation, include your occupation and employer information. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, call TEXPAC at (512) 370-1361.

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