A physician-led team approach to care, with each member of the health care team providing care based on his or her education and training, is key to ensuring that patients receive high-quality care. Maintaining the integrity of the health care team, under the physician’s overall direction, is good for patient care. TMA strongly supports physician-led teams utilizing a number of health care professionals, each bringing important skill sets and training to patient care. Team care requires cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources.

In the 2011 Texas Legislature, advanced practice nurses (APNs) sought the independence to diagnose, prescribe, and order tests and treatments without physician collaboration. Two bills would have allowed APNs to practice medicine without the benefit of a medical education and without passing the exams necessary to demonstrate medical knowledge and skills. And each would have the Texas Board of Nursing responsible for the regulation of APNs who would be practicing medicine.

The Texas Legislature, wisely, rejected those bills. Granting independent practice to APNs will not increase the health care workforce, nor has experience in other states shown that they are likely to locate in medically underserved and rural areas. Further, APN independent practice will not lower costs. Research found utilization rates for medical services, referrals to specialists, and hospitalizations for patients were higher for APNs versus physicians or resident physicians.

On the other hand, some scope expansions are consistent with team care, based on objective educational standards, and would improve patient care services. These should be carefully weighed and ultimately involve some supervision and regulatory oversight by the Texas Medical Board.