Improved access to primary care in Texas is within reach

In recognition of National Nurses Week (May 6-12) and the important role that nurses play in the delivery of health care, it’s time to reflect on the constraints that Texas is placing on a profession that is consistently rated the most trusted in America.

But let’s focus on the patient first. Today, more and more Texans are ending up in emergency rooms for the care of chronic conditions and minor illnesses that should be treated in routine office settings. As health care costs continue to balloon, primary care is rightly regarded as the most cost-effective option. Regular visits to a nurse practitioner or physician can prevent expensive complications or emergency room visits down the road. So why is primary care so hard to access and what can be done about it?

The biggest problem is a lack of primary care doctors. This is true in Texas and nationwide, and fewer physicians coming out of medical schools are choosing to work in primary care. The number of primary care doctors is just not keeping pace with population growth.

Texas is also a big, rural state with many small towns. As of 2017, Texas ranked 46th in the United States in the number of physicians practicing in rural areas. Eighty Texas counties have five or fewer physicians, and 35 counties have no physicians at all.  Since fewer doctors are available, primary care is out of reach for residents who can’t drive an hour or more to visit a doctor.

Meanwhile, the workforce of nurses is growing; the number of nurse practitioners has doubled since 2007. Advanced practice registered nurses (APRNS) are registered nurses who have completed a master’s or doctorate and these nurses are trained and ready to provide primary care.

The quality of primary care provided by nurse practitioners is comparable to that of physicians at half the cost. Studies show that health outcomes for patients cared for by nurse practitioners, compared to physicians, were equivalent or better. Because most nurse practitioners are trained in primary care, they are uniquely prepared to manage chronic health problems, long-term illnesses and conditions that affect Americans today.

It’s time to embrace APRNs as an answer to the challenge of access to primary care. On measures of cost, quality and workforce, no other solution comes close. But in Texas, onerous regulations prevent APRNs from operating to the full extent of their training.

Texas requires APRNs to enter into costly contracts with supervising physicians that have little to no effect on the quality of care. This creates a disincentive for APRNs to practice in Texas so they often go to other practice-friendly states.

Good primary care is essential to good health. Texas needs to join the more than 20 states, including Wyoming and Montana, that have modernized their laws and allow nurse practitioners to work to the full scope of their training without a supervisory contract.