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Texas Medical Board Attempting to Limit Scope of Practice

NP   (856 Views 11 Comments)
by Dodongo Dodongo, APRN, NP (Member)

Dodongo has 7 years experience as a APRN, NP.

57 Likes; 2 Followers; 10,099 Visitors; 675 Posts

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I think we should all be aware of proposed rules by the Texas Medical Board, as published in the Texas Register on January 25, 2019.  The proposed rules are found on this website, under the hyperlink "Proposed Rules": https://www.sos.state.tx.us/texreg/pdf/currview/index.shtml

In short, Section 193.21(d) states that there are certain acts that cannot be delegated to a "mid-level provider" (their words): "The reading and interpreting of radiological studies, and rendering a diagnosis based upon radiological studies".  

This has the potential to adversely impact the practice of NPs in Texas.  Further, if legislation like this is passed, it endangers the future practice of NPs in other states as well.

The Texas Medical Board is currently soliciting public comment on these proposed rules and have provided an email address for contact.  Texas Medical Board: rules.development@tmb.state.tx.us.  You can also send a formal letter to the following address:

Texas Medical Board
ATTN: Rita Chapin
PO Box 2018
Austin, TX 78768-2018

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MikeFNPC works as a FNP.

14 Likes; 5,277 Visitors; 172 Posts

The problem we have here in Texas is with the occupation code.  

https://statutes.capitol.texas.gov/Docs/SDocs/OCCUPATIONSCODE.pdf

In chapter 151, it says that to practice medicine in Texas you have to have gone to medical school.  Therefore, NP's cannot practice medicine in Texas.  And now, it would seem, that the TMB is saying in the same section that you quoted, that reading xrays and making a diagnosis is practicing medicine.  

https://www.sos.texas.gov/texreg/pdf/backview/0125/0125is.pdf

What I think should happen is we need to change the occupation code to include APRN's in being able to practice medicine.  

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MikeFNPC works as a FNP.

14 Likes; 5,277 Visitors; 172 Posts

I think that the TMB may be shooting themselves in the foot with this one.  I just don't see how this rule can pass.  There are too many independent NP clinics doing xrays.  How many patients would suffer and even die waiting for an MD/DO to read an xray?  

I agree with the TMB when it works to get along with APRN's, not when they aggressively attack. 

The rural clinic I work at has two providers, myself and an MD, each of us have a panel.  We have xray and use it frequently.  Sometimes the MD is off for 2 weeks at a time or more.  We don't have anywhere close by for patients to go for imaging.  I wonder how many lives it would take for the TMB to wake up, or do they even care.  

Hey Texas Docs, it really isn't about the money, it's about the patient.  

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MikeFNPC works as a FNP.

14 Likes; 5,277 Visitors; 172 Posts

2 hours ago, Dodongo said:

 

 

Another interesting item.  In the report from the Texas Register, it also says, "Any physician authorizing standing delegation orders or standing medical orders which authorize the exercise of independent medical judgment or treatment shall be subject to having his or her license to practice medicine in the State of Texas revoked or suspended under §§164.001, 164.052, and 164.053 of the Act."

So, the TMB isn't just attacking NP's they're attacking other MD/DO's who are willing to sign delegation agreements with NP's.  Thanks to the OP for bringing this to light, Texas, take notice of the kind of care that the TMB is proposing for the general public.  

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1 Like; 9,233 Visitors; 302 Posts

Those of us in TX have got to make our voices heard by the TMB. We can't take steps back, we're already behind. We need to write them and get them to see the light.

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1,755 Likes; 4 Followers; 17,078 Visitors; 2,548 Posts

This will hamstring all of your flight programs as well. 

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I don't mean to be the debby-downer of our profession but I would always wait for the reading of a radiologist for a proper/official diagnosis. I might have some background and knowledge to say to the patient "I don't think you have a fracture, or pneumonia, etc. but I am still waiting on the radiologist's read to confirm it." I think it's fair for them to put it out there and I understand where they're coming from. I believe this is better for our profession if anything because one NP might have had formal training when it comes to radiology but I'm 100% sure most of the programs don't. This is potentially saving our profession the way I see it.

What's not clear on that short section is the Section 193.21(d) number 2 where it states "rendering a diagnosis based on the radiological studies." can't be delegated. Do they mean even after the radiologist has read and interpreted it, we still can't diagnose a patient? Now that's different. But in any event, I don't find it offensive, but that's just me.

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Dodongo has 7 years experience as a APRN, NP.

57 Likes; 2 Followers; 10,099 Visitors; 675 Posts

1 hour ago, Eydyey said:

I don't mean to be the debby-downer of our profession but I would always wait for the reading of a radiologist for a proper/official diagnosis. I might have some background and knowledge to say to the patient "I don't think you have a fracture, or pneumonia, etc. but I am still waiting on the radiologist's read to confirm it." I think it's fair for them to put it out there and I understand where they're coming from. I believe this is better for our profession if anything because one NP might have had formal training when it comes to radiology but I'm 100% sure most of the programs don't. This is potentially saving our profession the way I see it.

What's not clear on that short section is the Section 193.21(d) number 2 where it states "rendering a diagnosis based on the radiological studies." can't be delegated. Do they mean even after the radiologist has read and interpreted it, we still can't diagnose a patient? Now that's different. But in any event, I don't find it offensive, but that's just me.

Do you practice in a hospital?  I make diagnosis and treatment decisions all the time based on a wet read that can't wait for the radiologist to post their final reading.  

 

Further, you think restricting our practice is the answer? Rather than NPs in Texas spamming the CCNE with proposals like this and demanding that radiologic interpretation being included in all NP programs?  It's better to just stay ignorant and be forever under the thumb of physicians.

 

Don't for a second think this will be the last we'll see of proposed legislation such as this.  

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I also get where you're coming from. I understand that not all the situation fits it and have the resources available for them and this blanket policy potentially adversely affecting practice for NPs/PAs practicing at your level. You might be perfectly capable of doing that yourself but what about the thousand others who are entry-level into their careers as NPs. Oh no, I didn't say anything about restricting our practice at all. I'm all about collaboration for safer care to my patients, and IN THIS PARTICULAR situation, I would prefer to OFFICIALLY get a read from someone who does this better than I do. As I said, I often tell my patients, "I don't think you have this, so I'll treat you for this, but If I miss anything that the radiologist see, I'll give you a call." Also, don't get me wrong I am all about standardizing and improving education for NP programs. I will go out of my way to contribute to making the NP education better, but that's completely another topic which I think we both are on the same page about. But this does not solve the CURRENT issue, and the CURRENT issue is that most NPs who are in school and have recently graduated were not trained like MDs/radiologists. I am all for the progression of our profession, but I think we should not compromise patient safety in the process because of our ego. It is only my opinion though for this CERTAIN issue. Now, If It was any other issue such as EKG interpretation or any other ridiculous issue proposed against our profession then I'd be against it.  I don't mean to attack/offend anybody. I apologize if I have. At the end of the day, I'll do what's safe for my patient, if it means not waiting for the radiologist and relying on my wet read, then so be it, but I'd be the first to call the patient if they see anything I didn't.

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MikeFNPC works as a FNP.

14 Likes; 5,277 Visitors; 172 Posts

I hope doing what's safe for the patient is what we all strive for.  This has nothing to do with the patient.  It has everything to do with control.  If we stand by and allow the door to open for medical boards to control NP's that door will be impossible to close.  I find it hard to believe that this topic has only attracted the attention of a few of us.  I've sent messages to the Texas Board of Nursing, and several elected officials expressing my opposition to this rule with logical and practical examples of how this rule is part of the problem with access to care, not part of the solution.  My question to NP's of every state is, should we do something, or nothing?

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LibraSunCNM has 10 years experience and works as a CNM.

83 Likes; 24,386 Visitors; 1,069 Posts

18 hours ago, MikeFNPC said:

I hope doing what's safe for the patient is what we all strive for.  This has nothing to do with the patient.  It has everything to do with control.  If we stand by and allow the door to open for medical boards to control NP's that door will be impossible to close.  I find it hard to believe that this topic has only attracted the attention of a few of us.  I've sent messages to the Texas Board of Nursing, and several elected officials expressing my opposition to this rule with logical and practical examples of how this rule is part of the problem with access to care, not part of the solution.  My question to NP's of every state is, should we do something, or nothing?

As a midwife who has dealt a little in lobbying for APRN-friendly laws, and whose profession in general is plagued with turf wars with physicians, you're absolutely right.  This has nothing to do with actual patient safety, it is an effort to exert a little extra control over NPs.  Grant this law, then there will be another one coming down the pike revoking prescriptive privileges, or something to that effect.  It SUCKS to have to spend time and money lobbying, but it's a necessary evil in our professions.

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