Health care
BY HANNAH NORTON
Texas nurse practitioners call for end of ‘pay-to-play’ rules
Texas faces an ongoing primary care provider shortage as the state’s population grows—and nurse practitioners say cutting a major regulation would help solve the problem. The federal government classi es communities with fewer than one primary care provider for every 3,500 residents as health professional shortage areas. Of Texas’ 254 counties, just 30—most of which are in metropolitan areas—do not have provider shortages, according to the Rural Health Informa- tion Hub. The details Texas nurse practitioners must sign an annual contract and pay a fee to a supervising physician, who oversees patient care through in-person or virtual meetings at least once a month. Ten other states have similar laws, according to the American Association of Nurse Practitioners. Erin Pérez, president of the professional organi- zation Texas Nurse Practitioners, said some nurse practitioners who graduate from Texas universities choose to work in telemedicine or move to other states to avoid the “regulatory burden,” contributing to the health care workforce shortage. Over 72% of nurse practitioners in Texas are licensed in primary care, according to a 2022 report from TNP. “[This regulation] takes from patients’ nances because somebody’s having to pay for it. So even if they’re in the hospital, or they’re in a nursing home, or they’re in a rehab, ... somebody is paying that physician signature fee that does not improve their care,” Pérez said. Nurse practitioners must receive a master’s or doctoral degree, undergo clinical training and get a national board certi cation before they can begin
Erin Pérez, president of Texas Nurse Practitioners, speaks at the professional organization’s annual conference on Sept. 30.
COURTESY TEXAS NURSE PRACTITIONERS
caring for patients. However, they do not have to complete a multiyear residency program, which is required for physicians. TNP has advocated for independent practice legislation for several legislative sessions, with bipartisan support from lawmakers. On the other side, the Texas Medical Association has defended the current regulations, arguing physician-led teams are essential to protect patients. “I never want to stop a nurse practitioner from graduating and performing at the highest level of their license,” TMA President Dr. Ray Callas said. Zooming in Texas has 8.8% of the U.S. population and 7.3% of
active U.S. physicians, the TMA reported in 2022. Shortages are particularly dire in rural areas, where hospitals sometimes close due to a lack of employees. According to the TMA report, 32 Texas counties had no primary care physicians in 2022. Callas said decreasing the amount of time physi- cians spend in school and recruiting doctors from other countries could help reduce the strain. “We want to make sure that we have internet ... throughout the state of Texas,” Callas said. “That would help tremendously—if people have broadband access to the internet, we might be able to make access easier from the telemedicine standpoint.”
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