April 15, Dean Stansel, an economics professor at the Bridwell Institute for Economic Freedom in the Cox Schooll of Business at SMU Dallas and co-author David Mitchell (Ball State University professor), for an op-ed that warning Texas leaders that strict guidelines for nurse practitioners frustrate their ability to care for Texans. Published in the Dallas Morning News under the heading Free nurse practitioners: https://tinyurl.com/hf3dwmbn
Many Texans believe they live in the most economically free state in the country. Having no state income tax certainly provides more freedom to keep and make use of their money more than residents in almost every other state.
However, when it comes to using that money for something as necessary as affordable routine medical care, Texans are less free than residents of over half of the other states. As of this year, 30 states and the District of Columbia allow patients to receive routine medical care from a nurse practitioner without undue restrictions on that patient-provider relationship. Texas does not.
Heavy-handed restrictions are costing Texans money and better health
By Dean Stansel and David Mitchell
Many Texans believe they live in the most economically free state in the country. Having no state income tax certainly provide more freedom to keep and make use of their money more than residents in almost every other state.
However, when it comes to using that money for something as necessary as affordable routine medical care, Texans are less free than residents of over half of the other states. As of this year, 30 states and the District of Columbia allow patients to receive routine medical care from a nurse practitioner without undue restrictions on that patient-provider relationship. Texas does not.
As a result, Texans have fewer options to obtain routine medical care. In fact, Texas has 437 designated Health Professional Shortage Areas, a reference to an area where there are not enough primary care physicians to meet population needs. According to the Texas Department of State Health Services, 224 of the state’s 254 counties have such a shortage.
Across the country, the number of primary care physicians is growing too slowly, creating a shortage of primary care providers — especially in rural areas. But the number of nurse practitioners nationwide more than doubled from 2010 to 2017, up to 190,000.
States giving nurse practitioners and their patients more freedom and privileges attract more such practitioners, and that increase has helped to offset the much slower growth of primary care physicians. In Texas, in part due to heavy-handed government regulations, that hasn’t been the case.
Nurse practitioners are registered nurses who have advanced degrees. Their training includes graduate coursework as well as clinical hours seeing patients. They are qualified to provide routine medical care and to do so for a lower price than doctors. Texas politicians should be expanding their availability, not restricting it.
Unlike most other states, Texas law requires nurse practitioners to have a supervising physician in order to diagnose and treat patients or prescribe medication. That physician must take the time to review the nurse practitioners’ charts — which takes them away from their own patients. Texas law also requires nurse practitioners to check in monthly with a physician. Physicians may cancel these agreements at any time, meaning the nurse practitioners and their patients could be left in limbo, unable to practice or receive treatment until they find a replacement. This is a deterrent to opening new health care practices and providing more care in Texas.
In contrast, more than half of the states and the District of Columbia have laws allowing nurse practitioners to “fully practice,” meaning they can diagnose patients, prescribe medicine and treat people without physician oversight. That makes both physicians and nurse practitioners more effective. It also gives their patients greater access to health care.
Research shows that in states that restrict nurse practitioners’ work, like Texas does, their wages tend to be lower and thus they are less likely to practice there. Research also shows that nurse practitioners do just as good a job as physiciansin some settings, and improve children’s health outcomes at a lower cost. This is especially important for patients with lower incomes.
With the influx of people moving to Texas from other states, the need for health care providers is ever growing. By discouraging nurse practitioners from moving here, Texas politicians are exacerbating the shortage of providers. The Texas Legislature is considering legislation now to free nurse practitioners to practice in the state.
Fortunately, while most health care policy reforms are expensive, changing scope of practice laws doesn’t cost the taxpayers a dime. In fact, allowing nurse practitioners to work independently actually saves money due to lower health care costs. That’s primarily because nurse practitioners are less costly than doctors, and, by increasing the availability of primary care, they help save money by detecting and treating medical problems early. In a state that prides itself on being free, it doesn’t take a brain surgeon to see that freeing the nurses is a no-brainer.
Dean Stansel is an economist and research associate professor at the Bridwell Institute for Economic Freedom at the Southern Methodist University Cox School of Business. David Mitchell is the distinguished professor of political economy and director of the Institute for the Study of Political Economy at Ball State University. They wrote this column for The Dallas Morning News.