Perryman Report: Good Media on Use of APNS

The Perryman Report generated some wonderful media coverage on greater utilization of APRNs in Texas.  The press event created some positive buzz as we headed to the House Public Health Committee hearing in Houston Tuesday.

The hearing offered some real surprises as the committee was determined that physicians and physician educators answer questions as to whether APRN practice regulations are outdated and unnecessary.  Almost to a person  the answer was YES , but some had caveats attached.  The TMB even noted that the current regulatory maze is complicated and nearly impossible  for the doctors to manage and understand.   TMBs executive director stated the doctors count on an administrative staff person to make sure they are in compliance.  

The physician educators made it clear that Texas will continue to lose med students  to other states so long as we don't increase residency slots, which forces students to finish their training in other states.  In an effort to close the gap, the committee asked if APRNs are qualified and capable of providing high-quality care and if the state should create a better regulatory environment to better utilize this already existing workforce.  The answer was yes.

 There was no discussion on safety, only one comment on APRNs providing service in underserved areas and a discussion on prescriptive authority led to the executive director of TMB returning to the table to state Schedule 2 drugs are not the problem with pill mills because they are so heavily regulated.   It was as if the physicians were  almost  reading from our script.  This provided us with a real opportunity to drive home the point and lay out our proposal.  James Dickens, an APRN and senior program officer for the Office of the Assistant Secretary for Health in theDallas Regional Office represented the Texas Team.  Marty Strong, a pediatric nurse practitioner and private practice owner represented TNP and CNAP.  Our witnesses did a fine job delivering their testimony.  Marty's supervising physician recently passed away the Sunday following her meeting with him to sign charts and his impending retirement.  James described the Texas Team and the proposed collaborative practice model crafted in the APRN Roundtable.  

Our witnesses did fine until the committee began  asking questions about details in our proposal.   Since we have not formulated details of the proposal, our witnesses had a difficult time .  One of the answers given was factually incorrect.  The bulk of the questions were directed to James as he was the one that laid out the proposal.   James was asked by Dr. Schwertner, a House member on the committee, if our proposal would finally offer relief to the doctors on liability and the response was "no".  The witness mistakes that were made are very common.  It is very nerve wracking to be peppered with questions and the reaction is to answer everything rather than leave something hanging.  But it showed us that we have to be more diligent in our pre-training to emphasis that the best answer is always "I am not sure about that, but will get the answer to you as soon as possible" rather than risk a wrong answer.

In the end, the overall hearing was good but our portion actually opened more questions that we will need to answer sooner rather than later.   Dr. Schwertner asked if it would be possible under our proposal for a doctor to oversee 10,000 APRNs and if each and every collaboration agreement would be different.  He was left with the impression that the collaboration agreements will have no structure and will be hard for the TMB to oversee.  Rep. Kolkhorst concluded that we would need to do something to prevent the "corporate dentistry issues" from being recreated with APRNs.  Our team will need to clean up the inaccuracies and get legislators pointed again in the right direction.  Representative Kolkhorst did say that she would be creating working groups with legislators and stakeholders to begin working together to find real solutions to better utilize APRNs in primary care settings.