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Texas is Losing in National Competition for Health Care Workers

AUSTIN – Texans for Healthcare Access today released a short video raising awareness about the state’s overregulation of health care professionals, pointing out that Texas ranks 46th in health profession overregulation, even behind California. While 31 states have changed their laws to attract and retain top health care talent, and many more are currently considering it, Texas is facing an increasing level of competition for health care professionals like advanced practice registered nurses (APRNs), who in Texas are still required to obtain costly, unnecessary contracts before they are allowed to provide care to patients.

“Texas’ formula for economic success over the last two decades has been simple: low taxes and fair regulations equals opportunity,” the video says. “This has helped Texas become the number one place to do business, year after year. Except when it comes to our health care workforce.”

With 31 states, the District of Columbia, all branches of the military, and the U.S. Department of Veterans Affairs no longer requiring these contracts, many Texas-born and Texas-educated nurse practitioners are being forced to consider caring for patients in other states instead of people in their own communities, either moving there or practicing via telemedicine.

Texas’ burdensome and costly regulations are also deterring health care clinics from expanding in areas where they are most needed.

“Convenient care clinics provide much-needed health care to a large number of people, many of whom have no primary care provider. In many cases, our providers are able to detect more serious issues early, including mental health needs, and refer patients to more specialized medical care,” said Nathan Bronstein, Chief Operating Officer, Convenient Care Association. “As we have seen in other parts of the country, states that remove burdensome regulations on APRNs have seen an increase in clinics, including in areas that were previously underserved. Doing so in Texas would increase the ability for more clinics to open in parts of the state where they are needed the most.”

A 2020 Texas Nurse Practitioners member survey found that nearly 80% of nurse practitioners said they would consider practicing telehealth with patients outside of Texas in states that do not have such onerous regulations.

In 2013, Texas lawmakers removed the requirement that APRNs have an on-site supervising physician, yet years later, the state continues to require them to have contracts with physicians before caring for patients. They must maintain these contracts throughout their career.

The law does not require APRNs and physicians to work together or to consult on any cases. In some cases, APRNs are forced to pay thousands and thousands of dollars per month for this contract, which requires the physician to do nothing more than have a single phone call once a month with the APRN.

Further, in response to the COVID-19 crisis, Gov. Greg Abbott waived the regulation temporarily, underscoring the fact these regulations are preventing APRNs from doing the most they can to provide care to the Texans who need it.

More than 7 million Texans live in primary care shortage areas, and with the state’s population growing and more Texans reaching their senior years, the need for primary care will continue to increase drastically. Studies have shown that nurse practitioners tend to have a greater proportion of their practices in rural areas and other regions that are designated health professional shortage areas, and more than 80% of nurse practitioners in Texas specialize in primary care.

When the state of Nebraska removed the contract mandate, more than 25% of counties saw an increase in APRNs.

SB 915 by Chair Kelly Hancock and HB 2029 by Chair Stephanie Klick would remove these outdated, unnecessary mandates and offer an efficient, cost-effective way to enable APRNs to provide care within their current scope of practice to more Texans everywhere.

The newly-released video can be found here.


Texans for Healthcare Access is a coalition of organizations representing consumers, business, and a broad range of health care stakeholders. These groups have joined forces to remove unnecessary barriers to care and allow Advanced Practice Registered Nurses to provide more access and more options for Texas patients. Learn more here.


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