Scope of Practice

Scope of practice in Texas: How the Texas Medical Association and AMA stop scope creep in medicine [Podcast]


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AMA Update

Scope of practice in Texas

May 31, 2024

How to manage scope creep in medicine: What is the Texas scope of practice? What is mid level creep in medicine? What determines the scope of practice for healthcare practitioners?

Our guest is Texas Medical Association President G. Ray Callas, MD. AMA Chief Experience Officer Todd Unger hosts.


  • G. Ray Callas, MD, president, Texas Medical Association

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about how Texas is successfully fighting scope creep and the role the AMA has played in those efforts. Our guest today is the new president of the Texas Medical Association, Dr. Ray Callas, in Beaumont, Texas. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Callas, it's an honor to meet you.

Dr. Callas: Todd, thank you for having me. And I look forward to talking with you today.

Unger: Well, when you became president of the Texas Medical Association, you listed fighting scope creep as one of your top priorities. Let's start with having an overview from you about what this issue looks like right now in Texas.

Dr. Callas: The threat of scope creep has never been higher in the state of Texas. We have everyone from every angle trying to be doctors without really having a license, like APRNs, PAs, chiropractors, optometrists, dentists and even unlicensed people. These groups want to do everything from open med spas to start IV clinics to perform surgery. They don't even have any training, much less experience and the oversight to do these kind of procedures.

Last session, we roughly fought 140 bills related to scope of practice where we worked hard. And I think the newest trend that we're very concerned about, Todd, is we're seeing legislation, that interstate compacts, where a state outside the state of Texas grants someone from outside the state, their law originating from their original state to come across our borders and practice independently like they do in their own state. So we have full scope in our home state. We are very well concerned that this could be a big threat this year.

Unger: Well, unfortunately, the concerns that you're facing right now are not unique to the state of Texas. We're hearing that from all over the country but seems particularly acute for what you're facing. And I want to talk to you a little bit about your last legislative session where you had a number of important wins. Dr. Callas, can you tell us about some of the scope bills that you defeated and how you did it?

Dr. Callas: Yeah, Todd. I'm proud to say that out of those 140 scope of practice bills, not one expanded scope of practice, not one. I will say the first—and I'm very proud of this—is that the largest bill was an independent practice bill, that the chairman of Health Service Committee was a nurse. She couldn't even get that bill out of her own committee. We didn't even let it get heard.

We also did some other things. We had a one bill that slipped through our cracks a little bit. But what we used, we used on the floor techniques with our Scope of Practice Partnership lobbyist. We were able to listen and learn, and make sure we utilized every niche and cranny of oversight with our lobbyists at AMA helped us have that oversaw all scope of practice. And we were able to kill it on the floor with a vote of 96 over 45.

And how we did that, we used strategic lobby contacts. We also followed up. We followed up. We followed up. We made sure our physicians called their friends. And we got it killed, 96 to 45. So those are just some of the things that we did. And like I said, Todd, I want to be very clear. We had zero scope of practice creep on the state of Texas.

Unger: Well, what an excellent legislative session. Of course, it continues. You've got a new one that starts in January. You've got a few months to prepare for that. But I'm curious how you're going to be using this time to get ready for what is probably another wave of scope bills.

Dr. Callas: Yes, sir. I'm glad you asked that question. Our Senate will be having interim hearing on September 18 regarding expansion of scope of practice. Our goal with this hearing is to use the opportunity to crush any type of scope expansion that we might even see before the beginning of next session.

One thing that has also been really helpful in its effort to the data that AMA continues to provide for us on why scope expansion is not the answer to underserved areas. From the heat maps to the VA emergency department study, these are all hard data points that show it's not the patient's best interest to allow any scope of expansion. And that's what we will be using. Every time that we turn around and we think we're protecting patients, we end up with another scope creep and it never fails.

Unger: Well, I'm curious, when you talk to policymakers in Texas about the risks of scope of practice expansion, what do you hear from them?

Dr. Callas: Well, that's a really mixed bag, Todd. On one end, we have those who know what it means to be professionally licensed individual who have gone through the educational channel to get licensed and feel. That same should be true in medicine, like the attorneys, like the engineers. Then we have those that feel some level of care is better than no care for rural and underserved areas.

However, hear me out on this. What I found most interesting is those elected officials that live in underserved, lower socioeconomic areas, they feel that expanding scope of practice decreases the level of care that these Texans deserve, meaning that they will be treated at much less standard than the regular Texans because they live in a lower socioeconomic or rural area. This is very powerful. And it motivates me to continue fight hard because if legislators feel that way, that's what makes me drive to make sure all Texans are treated the same, period.

Unger: That's an amazing point. The AMA is, of course, proud to support your scope of practice efforts in any way that we can. You mentioned the Scope of Practice Partnership as an example. Can you share a few of the stories about how the AMA has been working with the TMA on this issue?

Dr. Callas: Sure can, Todd. I have to say the generosity of the AMA Scope of Practice Partnership has been key to our success. And when I'm saying key, I cannot thank AMA enough for this. TMA is now a two-time recipient of this grant, and it allows us to retain a designated contract lobbyist to focus primarily on scope of practice for the AMA.

We have tracked over 2,000 pieces of legislation. And we also have means to use a lobbyist that just focuses on that to kill or to warn us of these bills that will be coming. I will tell you, it is proactive measures that the AMA partner with the TMA that allows us to take on scope creep and to keep it put to bed, so to speak.

Unger: Well, our voice, of course, is so much stronger when we all work together, especially on big issues like scope of practice. When you look ahead at the coming year, whether it's this next legislative session or in the future, what other ways do you envision us working together?

Dr. Callas: I really do think there's one big thing we need to continue to do, Todd. I couldn't say it any better. Working together is the key for us to be successful in the great United States of America. But the biggest key is scope of practice. There's not another profession that can do what we do. We are the only trained professionals in the United States that we need to continue to work together.

In all 50 states, we might not agree on all legislation, but we should all agree that scope of practice needs to be led by physicians. We also need to make sure that people that want to be physicians can practice to the highest level of their license. But they got to go to medical school if they want to take charge or be the captain of that ship.

I also feel very strongly that the only way we're going to continue to grow and be very boisterous and be safer for the United States, for all Americans, is to join the AMA and to fight with TMA. I think we should all—all 50 states should be included in fighting scope of practice creep. We should work together as one unit and make it work together because all Americans deserve protections.

Unger: And what I hear from so many health care leaders, this is an issue that is present at each of those 50 states. And it's from leaders like you that we can learn about approaches that are successful and making sure that patients get the right care. Dr. Callas, thank you so much for joining us today and sharing your work with us. We're really looking forward to supporting you and the TMA in the year ahead.

Dr. Callas: Thank you very much, Todd. It is very important that TMA and the AMA work hard together. And thank you for your time today to talk. And I really do appreciate it, Todd.

Unger: Absolutely. And of course, fighting scope creep is one of the top priorities of the AMA. You can support our work. Like Dr. Callas said, become an AMA member, That wraps up today's episode. And we'll be back soon with another AMA Update. Be sure to subscribe for all of our new episodes and podcasts at Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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