About 140 bills related to scope of practice were presented to the Texas legislature during its last session. Of those bills, not one measure expanding nonphysicians’ scope of practice was enacted into law.
"The threat of scope creep has never been higher in the state of Texas," AMA member G. Ray Callas, MD, an anesthesiologist and president of the Texas Medical Association, said during an episode of “AMA Update” about stopping scope creep in medicine.
“We have everyone from every angle trying to be doctors without really having a license,” said Dr. Callas, of Beaumont, Texas. For example, advanced practice registered nurses, physician assistants, chiropractors, optometrists, dentists and even unlicensed people.
“These groups want to do everything from open med spas to start IV clinics to perform surgery when they don't even have any training, much less experience and the oversight to do these kinds of procedures," he added.
Dr. Callas discussed the Texas Medical Association’s fight against scope creep and how it has benefited from the AMA’s help.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.
Working with AMA to fight scope creep
One of the most significant legislative efforts to expand scope of practice was Senate Bill 1700, the Healthcare Expanded and Accessed Locally for Texans Act. That bill, which would have allowed nurse practitioners and certified registered nurse anesthetists to practice without physician supervision, ultimately did not advance out of the Senate Health and Human Services Committee.
State Sen. César Blanco, who authored the bill, argued that the measure would help provide care to rural areas where there were not enough physicians.
Notably, research from the AMA—backed up by others’ studies—shows that regardless of scope of practice laws nurse practitioners tend to practice in the same areas as physicians.
Dr. Callas heard from legislators representing rural areas in Texas that expanding scope of practice would decrease the quality of care their constituents received.
"This is very powerful, and it motivates me to continue to fight … to make sure all Texans are treated the same, period," Dr. Callas said.
The Texas Medical Association is one of more than 100 national, state and specialty medical associations that form the AMA Scope of Practice Partnership. The Texas Medical Association also is a two-time recipient of grants from the partnership, allowing the association to retain a designated contract lobbyist focused on scope of practice.
"The generosity of the AMA Scope of Practice Partnership has been key to our success," Dr. Callas said. "And when I'm saying ‘key’—I cannot thank AMA enough for this."
Dr. Callas, a delegate for the Texas Medical Association in the AMA House of Delegates, also credited the AMA for providing valuable resources about scope of practice to its members.
“One thing that has also been really helpful in its effort is the data that AMA continues to provide for us on why scope expansion is not the answer to underserved areas," he said. "From the heat maps to the VA emergency department study, these are all hard data points that show it's not [in] the patient's best interest to allow any scope of expansion."
Despite his excitement over the Texas Medical Association's prevention of scope of practice expansion to date, Dr. Callas said he knows the battle will continue. But he believes that partnerships such as the one between the Texas Medical Association and the AMA are the only way to continue to fight scope expansion.
“Working together is the key for us to be successful in the great United States of America," Dr. Callas said. "In all 50 states, we might not agree on all legislation, but we should all agree” on the need for physician-led care.
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