By TCCRI Staff. Mar. 24, 2020
The onset and spread of the coronavirus has highlighted the heroic efforts of frontline healthcare workers who continue to selflessly put their own needs and fears aside to care not only for those with COVID-19, but also their regular patients with strep throat, appendicitis, broken limbs, cancer, and all of the other maladies they fight on a daily basis. However, these trying times have also underscored a significant healthcare provider shortage- an issue that we in Texas have experienced for years and is only exacerbated by current circumstances.
As discussed in TCCRI’s 2019 Health Care & Human Services Task Force Report, over two million Texans live in counties that are served by only 2.5 percent of the state’s physician workforce, with the majority of our counties federally classified as “health professional shortage areas,” or HPSAs. At the time of this writing the Texas Department of State Health Services’ website reported that 199 “whole” counties are considered HPSAs, while an additional 14 counties have “partial” designations. Given these grim statistics, it is little wonder that many Texans can find themselves waiting weeks or months to see a doctor in some areas of the state. With almost 30 percent of Texas doctors over the age of 60, this trend doesn’t appear to be changing anytime in the near future. And this situation was present before the additional stressors placed on our already teeming system by the coronavirus.
While some are quick to offer Medicaid or Medicare coverage expansions, this myopic approach fails to understand the basic premise that coverage does not equal access to care. Even if government programs were expanded to cover every person in Texas, this imprudent act would do absolutely nothing to ensure that anyone could actually be treated.
Understanding these dynamics, Governor Abbott has taken swift and decisive action. From making it easier for out-of-state health care providers in good standing to obtain a Texas license and opening up the pipeline for qualified nursing students to enter the workforce, to easing telehealth and pharmacy regulations, the Governor’s leadership will help mitigate the effects of the current public health crisis on Texas’ own health care system.
However, the Governor can only temporarily waive current laws in times of disaster, and, once the current disaster declaration has expired, we will revert back to the statutes and regulations currently on the books. As our own Russell Withers posited in last week’s blog post, disasters offer a unique opportunity to strip away the politics and truly examine whether these waived laws and regulations should be there in the first place. And nowhere is this opportunity greater than in addressing Texas’ provider shortage.
While not all laws waived during times of disaster should be made permanent, state lawmakers should follow Governor Abbott’s example and give serious consideration to which of those could become permanent policy solutions in the 87th Legislative Session. In addition to easing the burden for out-of-state health care professionals to become licensed in Texas and allowing a physician-patient relationship to be established via telemedicine- actions taken within the last two weeks- lawmakers should also look to increase the autonomy and use of non-physician providers, such as advanced practice registered nurses (APRNs) and physician assistants (PAs), and to better-utilize pharmacists in playing a larger role in primary and preventive care.
The strain on our current health care infrastructure won’t go away with the eventual downturn of coronavirus cases. With the postponement of less critical medical services and procedures until at least April 22nd, our system will be playing catch-up for the foreseeable future, and our need for a growing health care workforce will only continue to increase. As state leaders begin to reconfigure and navigate what the next session is going to look like post-coronavirus, we should take this important opportunity to build upon Governor Abbott’s work and carve out a legislative agenda aimed at comprehensively addressing Texas’ health care provider shortage.