Darby Defends Nurse Practitioners in Push for Rural Health Reform

“These folks in white coats—I don’t know what they think is going to happen here. Blood in the committee room?” Darby quipped during closing remarks. “What I didn’t hear today is one of them saying they’d go practice in rural Texas.”

Darby argued that most physicians opposing the bill work in large urban hospital groups, often backed by private equity, and have little interest in rural care.

“What we’re doing now isn’t working,” he said. “We don’t have doctors moving to rural Texas. But we do have highly trained, qualified nurse practitioners who are already there—providing care—and paying over $100,000 a year for a piece of paper.”

He described these arrangements as “phantom doctor” agreements that typically involve a monthly phone call and chart review. One of his constituents, he noted, runs a clinic alone within an hour of San Angelo and pays a physician six figures annually despite minimal contact.

“She could use that money to buy equipment, hire staff, and treat more patients,” Darby said.

He stressed that the future of rural Texas depends on improving healthcare access.

“If we don’t have quality healthcare in rural communities, nobody will live there,” he said. “There are 27 counties where you can’t even deliver a baby. What are we doing about that?”

Darby said the committee could consider adding residency or geographic restrictions on APRNs seeking independent practice but urged lawmakers to weigh the need for accessible healthcare over entrenched regulatory burdens.

HB 3794 remains pending before the House Public Health Committee, chaired by Rep. Gary VanDeaver.