The doctor shortage is here. But good policy decisions can help alleviate it — such as allowing nurse practitioners to bear more of the burden of primary care. Texas lawmakers can help by expanding the scope of practice for these valuable health care workers, and Texas residents will benefit.
“Along with much of the nation, Texas suffers from a scarcity of primary care physicians,” notes the Texas Public Policy Foundation. “The shortage is worse in Texas than it is in most other states, and particularly bad in rural areas. According to the U.S. Department of Health and Human Services, 126 of Texas’ 254 counties have been designated Health Professional Shortage Areas, defined as areas with a doctor-patient ratio of roughly one to 3,000.”
Other states have the same problem, and they’ve found some solutions — which have recently come at the expense of Texas.
“In November 2013, New Mexico Gov. Susana Martinez launched a campaign to actively recruit nurse practitioners (NPs) to her state as part of a broad effort to deal with a shortage of primary care physicians,” explained John Davidson of the TPPF in a recent report. “Because NPs in New Mexico are allowed independent practice and prescriptive authority, Gov. Martinez highlighted neighboring states with more restrictive scope of practice laws, including Texas, where NPs are not allowed to run their own clinics or practice without physician oversight.”
In fact, Texas has a restrictive policy regarding nurse practitioners shared by only a few other states. The Legislature took a good first step in loosening those restrictions in 2013, with Senate Bill 406, but too many restrictions remain in place.
“To meet the needs of a growing and aging population in Texas, a more robust approach to reform is required,” Davidson contended.
The good news is that Texas lawmakers have a history of addressing doctor shortages with smart reforms. In the mid-1980s, Texas found itself losing physicians, largely because of the risk of lawsuits and diminishing returns.
“Doctors were caught between rising medical malpractice insurance costs and lower compensation from insurance-provided benefit contracts and low Medicare/Medicaid reimbursement levels,” explains former state Rep. Joseph Nixon. “Combined with increasing hassles and demands to appear in court or in depositions, doctors were choosing to retire or leave Texas. In doctor-per-citizen ratio, Texas ranked 49th out of 50 states.”
Of the state’s 254 counties, more than 150 had no obstetrician in 2003, and more than 120 had no pediatrician.
But lawsuit reform was a driving force in the general elections of 2002. And when lawmakers gathered with a new Republican majority, lawsuit reform was a top priority — culminating in the 96-page House Bill 4.
At the same time, the Legislature crafted a constitutional amendment, Proposition 12, to allow a cap on non-economic damages. Voters approved it on Sept. 13, 2003.
Doctors began coming to Texas by the thousands — in fact, more than 7,000 in the first five years following the passage of Prop. 12.
Lawmakers have an opportunity to repeat this success, by allowing nurse practitioners to expand their scope of practice.