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T.L.L. Temple Foundation-Funded Report Finds Allowing APRNs to Practice Without State-Mandated Contract Requirements Will Improve Access to High-Quality Care Across Texas
AUSTIN – A public health study and data analysis funded by the T.L.L. Temple Foundation found that Texas can alleviate the primary care provider shortage in Texas by 32% by removing a state mandate on Advanced Practice Registered Nurses (APRN), like nurse practitioners, that requires them to obtain and maintain a contract with a physician in order to practice. The study also found that removing the restrictions would generate thousands of new jobs and save the state of Texas up to $47.7 million in the first biennium alone.

“Making this simple, cost-saving, and important legislative change will significantly improve access to care, improve quality, and significantly increase access to care in rural and underserved areas where Texas’ need for care providers is critical,” the report says.

Texas’ unmet need for healthcare services is projected to worsen over the next several decades, notably in primary and psychiatric care. Already, 228 counties are designated as Primary Care Health Professional Shortage Areas. The study determined modernizing Texas’ law would alleviate the primary care provider shortage by 2,376 providers, or 32%, and reduce the psychiatric provider shortage by 13%.

Under current law, a nurse practitioner must obtain an often-costly contract with a physician before they can see patients, even though the law does not require direct supervision or even require they practice in the same city as the contracting physician. It only requires a phone call with the physician once a month. This presents a significant barrier to nurse practitioners who want to open primary care clinics in the areas that need them the most. Texas has not required direct, on-site supervision of APRNs for 10 years and nurse practitioners have been shown to be more likely to practice in rural and other underserved areas.

More than half the states, the Department of Veteran Affairs, and all branches of the U.S. military have already done away with these types of lifetime mandates.

“This study demonstrates what a growing number of other states have realized: that APRNs provide high-quality care and that removing these outdated, unnecessary barriers will expand access to and options for patient care across the state,” said Texas Nurse Practitioner Foundation President Jan Zdanuk. “This is a no-cost, no-risk way to effectively address the growing shortage of primary care providers in Texas.”

The study also found:

• Care from Advanced Practice Registered Nurses is effective and safe. APRNs represent just 2% of all medical malpractice claims, both in Texas and nationally.

• Removing practice restrictions on APRNs will result in an estimated cost savings for the state of Texas of up to $47.7 million in the first biennium when examining Texas Medicaid and Teacher Retirement System of Texas.

• Loosening current restrictions will generate more than 4,000 new jobs in Texas and add nearly $500 million to the Texas GDP in the first year. The GDP gains jump to $2.3 billion after five years and $4.6 billion after 10.

The team of researchers who conducted the study include: Dr. Jane Bolin, Deputy Director of the Southwest Rural Health Research Center at Texas A&M, Senior Regents Professor at the Texas A&M School of Public Health, Department of Health Policy and Management, and Associate Dean of Research at Texas A&M College of Nursing; Lisa Carruth, former Chief Financial Officer at the Texas Health and Human Services Commission; and Dr. Kayla Cline, a Clinical Assistant Professor in the James Benjamin Department of Accounting at Texas A&M Mays Business School.

The full report can be found here.

Texas Senator Cesar Blanco has filed the HEAL Texans Act (SB 1700) to modernize state law, remove the contract requirement on APRNs, and help alleviate our state’s healthcare workforce shortage by expanding quality, local healthcare options for patients.


Texas Nurse Practitioners Foundation is a 501(c)(3) organization formed for charitable, educational, and scientific purposes. TNPF raises and awards funds to support the nurse practitioner educational and workforce pipeline, advance clinical research on nurse practitioners in the healthcare system, and foster community projects dedicated to promoting and improving access to healthcare for all Texans. To learn more visit