Andrea Wirt spends her days at the University of Texas Medical Branch treating patients for dementia, falls, weight loss, high blood pressure and other common ailments that afflict the elderly. 

She has a cadre of patients whom she sees regularly, making sure their golden years are as healthy as can be.

But Wirt doesn’t have an M.D. after her name. Wirt is a nurse practitioner, and she and her colleagues are expected to play a key part in the health care industry of the future.

In a study that could have far-reaching implications for health care in Texas, University of Texas Medical Branch researchers found that as states relax laws concerning nurse practitioners, more patients are using them to supply needed primary care.

“We wanted to look at what happened in states that allowed nurse practitioners more or less authority,” Yong-Fang Kuo, lead author of the study and a professor in the medical school’s preventive medicine and community health department. “As you would expect, it makes a big difference. We can now clearly show that states with fewer regulations means more patients get the primary care they need.”

Many states have turned to nurse practitioners to whittle that gap. Nurse practitioners begin as licensed nurses, then complete an additional one- to three-year master’s degree program. Under Texas law, nurse practitioners can examine, diagnose and treat patients. A nurse practitioner cannot perform invasive procedures, such as surgeries. A doctor must supervise nurse practitioners, who can consult the physicians if needed.

Texas is making it easier for nurse practitioners to play a bigger role in primary care. On Nov. 1, a new law goes into effect increasing the number of advanced practice nurses, such as nurse practitioners, that can work under a doctor’s supervision from four to seven. It also allows doctors to delegate the ability to prescribe medications under certain conditions.

Studies have included dire warnings about the capacity of the health care industry to absorb more people. A 2005 study by the journal Health Affairs predicted that by 2025, the U.S. would be short 35,000 to 44,000 primary care physicians. More and more students in medical school are choosing to entering specialized fields.

As the Affordable Care Act adds millions of people to the health care rolls, nurse practitioners could be used to fill in the gap created by the dwindling number of primary care physicians coming out of medical schools. And the impact will mostly be felt in rural areas, where doctors are few and far between, and in fields such as geriatrics, in which few new doctors are specializing.

Wirt, who has been a nurse practitioner for 18 years, said the new rules are a welcome development.

“It’s definitely a good move, especially in the field of geriatrics, because there a not a lot of geriatricians,” she said. 

The use of nurse practitioners, advanced practice nurses and physicians assistants also has an impact on health care policy. Studies have shown that states with a higher ratio of primary care providers to patients spend less on Medicare and have lower mortality rates.

Utilizing nurse practitioners can also make for the more efficient practice of medical care. 

Tom Hawkins, a 13-year nurse practitioner with 40 years of experience as a nurse, says using more nurse practitioners can allow doctors to focus on patients with more pressing needs. He works at the Galveston County Health District’s Coast Health & Wellness Clinic in Texas City.

“We can see the less complicated patients, while the MDs can deal with the more serious issues,” he said.

Contact reporter Wes Swift at 409-683-5319 or

(1) comment

Shelly Pearl

NP's are not "supervised" by a physician. They work in collaboration,, NP'.s can op0en their own practice and hire a physician to audit a certain number of charts. The only thing not independent from the MD is prescriptive authority. Forms must be filed by the NP and the MD that the MD is granting the authority to the NP.

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