| Perspectives on Texas

For many Texans, finding a doctor to treat even a routine illness can be a challenge. When wait times are too long, or the price tag seems too high, people have a tendency to ignore an injury or illness, increasing the likelihood that a minor issue could worsen into a major one that can require expensive treatments or even hospitalization.

A nurse practitioner for 14 years, I have operated a clinic in Houston for more than a decade, serving a largely indigent population that would struggle to find care without us. Fully seven of every 10 of our patients are on Medicaid, CHIP or Medicare, ranging from newly born to elderly.

I’m proud of the care we give our patients, but we also know many people all across Texas are struggling to find regular health care in the face of a growing shortage of people who can provide even the basic levels of service.

This is why expanding the number of primary care providers is so vital. The good news is that the skill set necessary to provide that care can be readily found in Texas’ nurse practitioners. An NP is a professional with attained a graduate degree — a master’s or doctorate — who has undergone extensive training, including at least 500 hours of hands-on, clinical experience.

NPs focus exclusively on one area of care. In that area of focus, they provide health care services and can guide patients to physicians or specialists in more complex cases. Before they can practice, NPs must attain national board certification and pass a rigorous licensing review by the Texas Board of Nursing.

As a result, NPs like me provide great care. Decades of studies have found that patients of NPs attain outcomes just as good as physicians for the conditions NPs treat. 

The disappointing news, however, is that NPs are currently hindered in their attempts to extend service to underserved areas by an archaic, burdensome Texas law that requires many of them to enter into expensive supervision contracts with physicians. This creates an added layer of bureaucracy and unnecessary expense, with these contracts requiring an average fee of $6,000 annually, and in some cases many times that amount.

It’s important to understand these supervision contracts aren’t really “supervisory” in any way. Nurse practitioners often practice in facilities or clinics where the physician is not on site. And Texas law does not require the supervising physician to see the NP’s patients, sign off on their care or even practice in the same city.

All these contracts drain precious resources away from patient care, to the collective tune of millions of dollars and thousands of hours every year. They are outdated, inefficient and an impediment to patient care.

That’s why nearly half the states — 24 of them so far — have done away with them, along with the District of Columbia, the military and numerous federal agencies. Not one of them has reported a drop in the quality of patient care. Studies have also shown that in states with full practice authority, NPs are 50 percent more likely to practice in rural areas than physicians.

House Bill 1792 by Rep. Stephanie Klick, R-Fort Worth, and Senate Bill 2438 by Sen. José Rodríguez, D-El Paso, would do away with these contracts, replacing them with a one-time, 12-month period of physician supervision, after which an NP is free to practice without a doctor.

This represents a huge step forward in enabling NPs to open clinics like mine where they are needed most. Instead of paying annual fees, NPs can put their resources and time into growing their own practices in underserved areas where Texans need care.