In Texas, however, both sides worked together to craft legislation to increase healthcare access that they all could live with. The new law, signed by Gov. Rick Perry on June 14, loosens physician supervision requirements for NPs and physician assistants, increases from four to seven the number of NPs or PAs a doctor to whom can delegate prescriptive authority, and allows physicians to delegate Schedule II controlled-substance prescribing in hospital and hospice settings.
The Texas Medical Association called it “a landmark bill” that establishes physician-led teams and “creates a more collaborative, delegated practice among physicians and advanced practice registered nurses or physician assistants."
“Diagnosing and prescribing remain the practice of medicine, which only physicians are trained and authorized to do by Texas law,” Dr. Stephen Brotherton, president of the TMA, said in a news release. “But the good news is that by working together as a team—doctors, nurses and physician assistants—we can take care of more patients and do a better job of it.”
Sandy McCoy, president of Texas Nurse Practitioners, said in an interview that both sides were motivated by a CMS listing that ranked Texas 47th in the nation for access to primary care.
“Everyone came to the table and realized that we had a problem,” said McCoy, a bariatric nurse practitioner with the Baylor University Medical Center in Dallas. “We realized we had to make some compromises—deeper compromises than we had made in the past.”
She said state restrictions on NP practices had led to some providers in El Paso and the western edge of the state to set up shop in New Mexico where they could practice more freely.
McCoy cited estimates that healthcare reform may eventually add as many as 6 million Texans to the ranks of the insured. That prompted everyone to seek compromise. “Eventually, we'd like to see full prescriptive authority (for NPs),” she said. “Eventually, we will come back and ask for more.”