This would require a patient having access to health care first and foremost, something that in the state of Texas is a significant problem. Texas ranks dead last in access to health care. The primary care physician supply ratio ranks 47th in the nation.

Two groups of practitioners – physical therapists and advanced practice nurse practitioners – have proposed valid solutions to this growing dilemma. If a patient has direct access to appropriate care within these providers’ current scope of practice and education, more patients will have access to necessary care and patients will have choices regarding their care.

In Texas, the 82nd Legislative session is upon us. Health care will almost certainly be an important issue. Once again, direct access to physical therapy will be a topic of discussion amongst legislators. But there is another debate being waged on similar battle grounds - with a common foe.

Lynda Woolbert, a pediatric nurse practitioner, notes that Advanced Practice Nurse Practitioners could be a valuable part of the health care access solution in the state of Texas - “if APRNs are allowed to practice to the full extent of their education and training”.

Sound familiar? If you are a physical therapist in the state of Texas, I would say there is a resounding “yes”. But it is what Woolbert noted next that is perhaps even more important -

“Thus far, associations representing physicians have opposed allowing APRNs to practice to the full extent of their education and training. They often cite patient safety as their prime concern, while describing the issue as a “scope of practice” battle”.

This is the same battle cry that physicians have used against physical therapists for countless years and in far too many states to count.

Before you think that they are truly looking out for the best interests of patients nationwide, consider the following. The American Medical Association sponsors an entity entitled the Scope Of Practice Partnership. This is, for all intents and purposes, a divisive effort to restrict the practice of health care professionals who are not doctors of medicine (MDs) or osteopathy (DOs). As noted by the Coalition for Patients’ Rights, “this effort would limit patients’ abilities to choose their health care providers and limit access to safe, high-quality and cost-effective health care”. The Coalition For Patients’ Rights has strongly urged the AMA to withdraw its efforts.

Intriguing side bar: AMA Resolution 814 - that established the Scope of Practice Partnership in 2006 - was introduced by none other than the Texas Medical Association. And while we’re at it, in the last legislative session in Texas, the TMA spent almost $500,000 on their lobbying efforts. Physical therapists, advanced practice registered nurses, chiropractors, and patients – take note and follow the money trail.

Woolbert reminds us of the true issue that health care providers face:

“The only battle all of us in the health care delivery system should be fighting is pursuing the most efficient means of delivering primary health care services to the residents of this state who want, need and deserve it.”

Patient access to care is truly a simple issue that has cost effective solutions already on the table, but is an issue that is being held up by powers that have nothing to do with patient safety. This issue is no longer about what is right for the patient.  Patients do not truly have choices. A legalized monopoly, however, does exist in the gatekeeper model, cleverly disguised as “patient safety”. The issue of patient safety is a great sound bite, but is it really a rational concern? Or does AMA Resolution 814 simply seek to further entrench the basic tenets of a gatekeeper model and the legalized monopoly that comes with it?

Question: does a patient with an ankle sprain really need to see a family physician, then an orthopedist, then have an MRI, then get a brace, then perhaps actually see a physical therapist? I highly doubt it. In the vast majority of cases, that is what the insurance companies would call over-utilization of services. The vast majority of patients would consider it a waste of time and money.

In order for patients to truly attain access to appropriate care, and subsequently decrease the cost of care, some harsh realities will need to be assessed. Lawmakers will need to make the decision – between special interest lobbyist dollars and the rights and care of their constituents.

Photo credit: mtsofan