Many Texans think they live in the most economically free state in the country. The absence of state income tax certainly provides more freedom to keep and use their money than residents of almost any 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 more than half of 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 for seeking 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 are experiencing 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, to 190,000.


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States that grant nurse practitioners and their patients more freedom and privilege attract more such practitioners, and this increase has helped offset the much slower growth of primary care physicians. In Texas, partly due to harsh government regulations, this has not been the case.

Nurse practitioners are registered nurses who have advanced degrees. Their training includes graduate courses as well as clinical hours seeing patients. They are qualified to provide routine medical care and do so at a lower cost than doctors. Texas politicians should expand their availability, not restrict it.

Unlike most other states, Texas law requires nurse practitioners to have a supervising physician to diagnose and treat patients or prescribe medications. This physician must take the time to review nurse practitioner records, which alienates them from their own patients. Texas law also requires nurse practitioners to register with a physician monthly. Physicians can cancel these agreements at any time, which means nurse practitioners and their patients could be left in limbo, unable to practice or receive treatment until they find a replacement. This has a chilling effect on opening up 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 medications, and treat people without the supervision of a nurse. doctor. This makes doctors and nurse practitioners more efficient. It also gives their patients better access to healthcare.

Research shows that in states that restrict the work of nurse practitioners, such as Texas does, their salaries tend to be lower and therefore they are less likely to practice there. Research also shows that nurse practitioners do as good a job as doctors in some settings and improve health outcomes for children at lower cost. This is especially important for low-income patients.

With the influx of people moving to Texas from other states, the need for health care providers continues to grow. By discouraging nurse practitioners from locating here, Texas politicians are exacerbating the provider shortage. The Texas legislature is now considering legislation to allow free nurse practitioners to practice in the state.

Fortunately, although most health care policy reforms are costly, changing scope of practice laws doesn’t cost taxpayers a penny. In fact, allowing nurse practitioners to work independently actually saves money due to lower healthcare costs. This is mainly because nurse practitioners cost less than doctors, and by increasing the availability of primary care, they save money by detecting and treating medical issues earlier. In a state that prides itself on being free, it doesn’t take a brain surgeon to see that freeing nurses is a given.

Dean Stansel is an economist and associate research professor at the Bridwell Institute for Economic Freedom at 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.

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