TAFP to Legislature: Support collaborative care model, maintain scope of practice

posted 11.02.10

The Primary Care Coalition has released its latest advocacy resource: a set of three policy briefing papers describing the rationale to support team-based care led by a primary care physician and protect against changes to scope of practice laws in Texas. TAFP encourages family physicians to use the briefs when speaking to their state senator and representative to help educate legislators on the appropriate role of nurse practitioners.

The first brief, “Compare the Education Requirements of Primary Care Physicians and Nurse Practitioners,” focuses on the differences in years and intensity of training between physicians and advanced practice nurses. Standard medical training prepares doctors for complex differential diagnoses, the development of treatment plans across multiple organ systems, and the ordering and interpreting of tests within the context of the patient’s overall health condition.

“Because primary care physicians throughout the United States follow the same highly structured educational path, complete the same coursework, and pass the same licensure examination, you know what you’re getting with a physician,” the authors state in the brief. “There is no such standard to achieve nurse practitioner certification, as their educational requirements vary from program to program and from state to state.”

One of three charts on the brief displays the gap in clinical training hours. When a nurse practitioner finishes education, he or she has equivalent clinical experience to a third-year medical student. After this point, physicians go on to complete an additional year in medical school and a three-year residency program at minimum. The training gap is further described through studies showing deficiencies in education and preparation for practice of newly graduated nurses.

The second brief, “Primary Care Physicians Are the Most Likely Health Care Professionals to Practice in Rural and Underserved Areas,” disputes the argument that nurse practitioners will fill the physician workforce shortage by opening practices in rural and undeserved areas.

It features a large map of Texas on the front, illustrating practice-mapping data from the American Medical Association. With color-coded counties for full Health Professional Shortage Area counties and partial HPSAs, the map shows that the state of Texas relies more on primary care physicians to provide health care to patients in rural, underserved areas.

This is further illustrated through four state maps on the back of the brief. The four states—Idaho, Oregon, Arizona, and Utah—each allow nurse practitioners to diagnose and prescribe without any physician collaboration, and they also feature metropolitan areas and large, rural areas like Texas. They show that even in states that allow independent practice, nurse practitioners follow the same practice patterns as their colleagues in states that require collaboration: they gather in large, metropolitan, non-border areas, not in rural, underserved communities as their professional organizations claim.

An important conclusion the authors draw in the brief is that the economic environment that discourages family physicians from opening and maintaining a rural medical practice will discourage and has discouraged nurse practitioners from these areas as well.

The third brief, “Collaboration Between Physicians and Nurse Practitioners Contains Health Care Costs,” explores the goal of reducing health care costs through implementation of the patient-centered medical home rather through relaxed scope of practice laws.

“Contrary to the claims of nurse practitioner organizations, independent practice by nurse practitioners would not lead to more efficient or cost-effective care; in fact, studies show the opposite would be the likely outcome,” the authors state in the brief.

The brief refutes the claim by citing a study on utilization of medical services such as diagnostic tests, hospital admissions, and specialty referrals, all of which increased in the nurse practitioner group and all of which lead to increased cost of care. Coordinated care provided in a patient-centered medical home, on the other hand, has proven to be better quality and lower cost, and the brief provides five settings where this has been the case.

“Allowing nurse practitioners to diagnose, treat, and prescribe without any physician collaboration will only serve to further fragment the chaotic and poorly coordinated health care delivery system Texans encounter,” the authors state in the brief.

The brief’s end message is that both nurse practitioners and physicians have the same goal: to keep Texans healthy and productive, and to ensure that when they need it, patients have access to safe, high-quality medical care. Advanced practice nurses are a vital part of Texas’ health care workforce, and physicians and APN provide the highest quality health care when they work together. This team should be supported and kept together by state policies that have the best interests of the patient in mind.

The Primary Care Coalition is a partnership comprised of the Texas Academy of Family Physicians, the Texas Pediatric Society, and the Texas Chapter of the American College of Physicians, collectively representing more than 14,000 physicians across the state. To access these and other advocacy resources, go to www.tafp.org/advocacy/resources.