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Pushing for Care, High-Speed Internet for Rural Texans

Nursing home staff and resident

Natalie Bachynsky, a highly trained family nurse practitioner, decided in early 2020 that the only way she could keep helping people get or stay healthy in rural Houston County was to open her own practice. 

“The clinic I was working for shut down four times,” she recalls, noting that larger organizations would come in and buy it only to leave a year or so later after failing to make it profitable.  

Before Bachynsky could open a clinic, she had to sign an agreement with a licensed doctor to be her supervising physician. State law requires nurse practitioners to maintain often expensive contracts with such doctors, even when the doctors don’t actually see patients at their clinics.  

AARP Texas is part of Texans for Healthcare Access, a coalition of nearly 40 organizations urging state lawmakers to end the contractual requirement. It’s among several issues affecting rural residents, including expanding access to high-speed internet, that AARP is advocating for during this year’s legislative session, which runs through May 29.  

Proponents of ending the requirement say it would make it easier for advanced practice registered nurses, who have graduate-level degrees, to provide care, particularly in rural areas where health care provider shortages are most acute. Twenty-six states and the District of Columbia don’t require such nurses to be sponsored by a physician. 

Not having such a requirement has been tried and tested, says Erin Cusack, director of government affairs at Texas Nurse Practitioners, a group that provides support to and advocates on behalf of them. “The military has done this for the past three decades.”  

The National Academy of Medicine notes in a 2021 report that studies have found “little to no difference in the quality of care received by patients from NPs and physicians.” 

Texas doctors have opposed previous legislation aimed at doing away with the requirement, arguing their supervision and more advanced education helps ensure patient safety. Cusack disagrees, saying nurse practitioners are trained to provide basic primary care. 

Expanding high-street internet

The push to end the contractual obligation for advanced practice registered nurses comes amid a national health care provider shortage—fueled in part by burnout and an aging population.  

Nearly 7.5 million Texans live in areas with a shortage of primary care health professionals, lacking at least one provider for every 3,500 residents, according to the nonprofit Kaiser Family Foundation. The state would need an additional 1,038 primary care physicians to remove the shortage designation in all areas, Kaiser estimates. 

AARP Texas is also pushing for lawmakers to increase access to medical services via telehealth by speeding up the expansion of high-speed internet in rural areas. 

“High-speed internet is a basic need for Texans,” says Kathy Green, AARP Texas director of state and federal strategy. 

AARP supports additional funding for the Texas Broadband Development Office, which awards grants and low-interest loans to internet service providers that expand to underserved areas. Established by the Legislature in 2021, the office received $5 million in the 2022–2023 state budget. It’s asking lawmakers for additional funding to hire more staff.

Thomas Korosec is a writer living in Dallas. 

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