Communicating Family Medicine’s Priorities In The 82nd Texas Legislature:

SCOPE OF PRACTICETexas Academy of Family Physicians

APRNs in Texas seek independent diagnosis and prescriptive authority.

• Avoiding such an expansion to APRNs is a high priority to our members.

• APRN organizations coordinated a strong media campaign, with editorials in all major dailies leading up to lege session, focusing on claims of lower cost, equal quality, and opportunity to address primary care workforce shortage.

Policy Issue: Scope of Practice

From Center to Champion Nursing in America, www.championnursing.org

Texas’ Primary Care Shortage

16,830 primary care physicians in active practice in 2009 68 per 100,000 pop 81:100K is national

average 118 of 254 counties are

full HPSAs 26 counties had no

primary care physicians in 2009

Possible Solution?

Advanced Practice Registered Nurses suggestthat if given independent diagnosis and prescriptive authority, they can alleviate Texas’ primary care shortage.

OUR MESSAGE: The evidence does not support this claim, and while the pursuit of this policy may be politically expedient, the risk outweighs what may be a hollow reward.

Framing the Issue

Avoid a debate about quality. Anecdotes serve better in personal testimony. No data supports claims about differences in quality

between APRNs and physicians. Argue instead for team-based, collaborative

model. Turn the question: What should be the

minimum standard for who can practice medicine?

Refute APRN claims that they can solve the workforce shortage.

Advocacy Materials: Issue Briefs

We developed a series of 3 issue briefs.

We used comm tools to distribute to members.

Lobby team gave them to key legislators and staff.

Compare the Education Gaps Between Primary Care Physicians and Nurse Practitioners

Little data exists comparing the quality and cost of care provided by APRNs to that of primary care physicians, but the difference in training is starkly evident.

Compare the Training

Compare the Training

Compare the Training

During their education, nurse practitioners experience between 500 and 1,500 hours of clinical training. At the completion of medical school and residency training, a family physician has experienced between 15,000 and 16,000 clinical hours.

Advocacy Materials: Issue Briefs

We developed a series of 3 issue briefs.

We used comm tools to distribute to members.

Lobby team gave them to key legislators and staff.

Primary Care Physicians Are the Most Likely Health Care Professionals to Practice in Rural and Underserved Areas

If given independent practice, would nurse practitioners be more likely than family physicians to practice in rural and underserved areas?

The data suggests not.

Geographic Distribution

NP to FP Distribution in Texas

According to DSHS, in 2009: 5,745 NPs were

in active practice Ratio of

25.1:100K pop in metropolitan non-border areas

Ratio of 8.3:100K in rural border regions

NP to FP Distribution in States Allowing Independent Practice

In Idaho and Oregon, NPs choose to practice in urban and suburban areas like other health care professionals.

NP to FP Distribution in States Allowing Independent Practice

The story is the same in Arizona and Utah.

Advocacy Materials: Issue Briefs

We developed a series of 3 issue briefs.

We used comm tools to distribute to members.

Lobby team gave them to key legislators and staff.

Collaboration Between Physicians and Nurse Practitioners Contains Health Care Costs

The Fallacy of Cost Savings

Proponents of independent practice by APRNs suggest they would save the health care system money, but the data doesn’t support the claim.

Research shows any savings gained because NPs earn less than physicians is offset by increased utilization of services.

Well-coordinated care provided in a patient-centered medical home has proven to be better quality and lower cost.

Advocacy Materials: TFP Feature

We collected anecdotes and horror stories from members and included them in a magazine feature in the fall 2010 edition of Texas Family Physician.

The feature title helped reframe the question:“What should be required to practice medicine?”

Advocacy Materials: Policy Brief

James Martin Scholarship through TAFP Foundation funded policy internship

3rd-year FM resident Marie-Elizabeth Ramas authored report

We also built a slide deck for her to present the paper, which is available in the backup materials.

New Policy Internship

Three Policy Considerations

The policy brief expounded upon the main themes of our issue briefs and posed three important policy considera-tions for lawmakers.

Does the Texas Board of Nursing have the capacity and the expertise to regulate the practice of medicine by NPs?

In the interest of safety and quality, should the state set a minimum standard of education and training to receive an APRN degree and license?

If the Legislature grants NPs the authority to practice medicine independently, what will become of the state’s future supply of primary care physicians?

So, What Happened?

6 bills were filed that would grant APRNs independent diagnosis and prescriptive authority.

TAFP held a legislative action day, where members armed with our policy documents visited their representatives at the State Capitol.

Texas physicians testified before the House Public Health Committee on the so-called “Scope Day,” when the bills were heard.

Success!

None of the bills made it to the House floor for debate.

We believe our strategy to inform and influence lawmakers through the multifaceted approach of issue briefs, policy briefs, and grassroots advocacy led to our success.

Constituent chapters should feel free to use our research and advocacy tools in any way.

All the documents should be in the backup materials, but you can also find them at www.tafp.org.

Jonathan Nelsonjnelson@tafp.org

Access all of these policy tools:www.tafp.org/advocacy

Texas Academy of Family Physicians | www.tafp.org