Shortage of primary care providers: Nurse practitioners can fill the gaps

In order to expand access to primary care, the foundation of a healthy population, the Texas Legislature should allow medical professionals to practice to the fullest extent of their licensure. 

The shortage of primary care providers in Texas, particularly rural Texas, is pervasive. 

There are 435 Health Professional Shortage Areas in our state, where an insufficient number of physicians are available to care for the population. That’s 224 entire counties within Texas are classified as shortage areas, with a total population of over 15 million people. 

Despite the daunting scope of the system-wide problem, many Health Professional Shortage Areas need as few as one provider to address the shortage in their area. These figures should give us hope that addressing care shortages is a solvable problem. 

Let’s empower nurse practitioners to fill those gaps. 

Nurse practitioners have graduate level degrees, hundreds of hours of clinical training and practice primary care at a far greater rate than physicians. However, they are hamstrung by inefficient occupational licensing laws. 

Texas is one of a handful of states that require nurse practitioners to cede much of their authority to a physician. These supervisory relationships can cost nurse practitioners thousands of dollars annually, and may dissuade them from practicing in Texas altogether. By removing this contractual requirement, nurse practitioners can provide cost-effective care in underserved areas within the boundaries of their licenses. 

Opponents of full practice authority say that nurse practitioners are not clinically equipped to treat patients. But a study conducted in V.A. hospitals, where they have full practice authority, showed that patients assigned to nurse practitioners were “less likely to use primary care and specialty care services and incurred fewer total and ambulatory care sensitive hospitalizations” than patients assigned to M.D.s. Costs and clinical outcomes between the two groups of patients were similar. 

Additionally, there is some suggestion that some populations may prefer the care of a nurse practitioner to that of a physician.

Participants in focus groups conducted by Texas 2036 as part of its research into its “Who are the uninsured in Texas” study report that they feel that nurse practitioners spend more time trying to understand their problems and care more for them on an individual level than physicians. 

Twenty six states have released nurse practitioners from the administratively and financially burdensome obligations of physician delegation authority, and none have returned to the limited practice model. The state of Texas should include nurse practitioners in an “all hands on deck” approach to solving the primary care crisis.