A coalition of leaders from the health industry is championing a new policy aimed at alleviating the ongoing shortage of healthcare workers in Texas. This proposed initiative involves permitting qualified out-of-state professionals to practice within Texas by joining existing interstate compacts across various professions. The professions include audiology and speech pathology, cosmetology, occupational therapy, physician assistants, counseling, dentistry, dietetics, respiratory care, and social work. Joining these compacts would enable eligible professionals to obtain a multistate license, functioning similarly to a driver’s license, allowing them to practice across state lines.
At present, legislation is in the works to create compacts specifically for cosmetology, counseling, and dentistry. Bryan Mares, the director of government relations for the Texas chapter of the National Association of Social Workers, emphasized that while it’s premature to predict workforce impacts, these compacts would indeed facilitate easier practice across multiple states. Nearly a dozen professional organizations, including the Texas Academy of Physician Assistants and Texas Counseling Association, have united to form the Interstate Compact Coalition. They claim these compacts could tackle the pervasive workforce shortages that affect nearly every sector of the state’s healthcare industry. Advocates suggest that this initiative could broaden the workforce pool and help traveling professionals—particularly military spouses—avoid the cumbersome process of acquiring multiple state licenses.
Nonetheless, there are opponents who express concerns that such compacts could result in more Texas healthcare workers leaving for other states while simultaneously diluting the rigorous standards enforced by Texas licensing boards. Matt Roberts from the Texas Dental Association highlighted the importance of maintaining existing licensing standards, which might be compromised through compacts. Health workforce shortages are a pressing issue in many states, but Texas faces particularly severe challenges due to its rapid population growth and diversity. The state has an alarming shortage of dental hygienists, ranking last in the nation, at just 37 per 100,000 residents. Additionally, projections indicate that by 2030, Texas could have a social worker deficit of approximately 33,825 positions.
A survey conducted by the Texas Hospital Association revealed that around 64% of hospitals are operating below capacity and providing limited services due to nursing shortages. Rural regions, specifically East Texas, are grappling with a shortage of obstetricians, while inmates in jails may have to wait months for psychiatric treatment due to a lack of available staff at mental health facilities. The shortage of healthcare professionals severely impacts residents in counties along the Texas-Mexico border, resulting in longer travel times and delayed healthcare access.
The rationale behind pursuing interstate compacts is partly linked to families of military service members who frequently relocate, making it challenging for them to maintain their professional licenses across state lines. The U.S. Department of Defense has collaborated with The Council of State Governments to facilitate the establishment of these licensing agreements. Given that Texas hosts 15 active-duty military installations, implementing such compacts could significantly benefit the state.
From a practical standpoint, compact supporters argue that these agreements can streamline administrative processes and enhance efficiency. Mares pointed out that for social workers and similar licensed professionals, interstate compacts represent an effective approach to build a sustainable workforce by allowing qualified practitioners from other states to begin working without delay. These compacts can help eliminate redundant procedures, consequently saving time and resources while ensuring qualified professionals are available to serve the public.
Currently, a licensed social worker seeking employment in Texas must navigate a complex application process, even if they meet the requirements elsewhere. This includes obtaining a jurisprudence exam certificate, verifying clinical supervision, undergoing fingerprinting, and passing an examination by the Association of Social Work Boards, among other requirements. Betsy Cauble, a seasoned social worker and board member at Preferra, a company insuring a vast number of behavioral professionals, noted that interstate compacts could address the issue of access to care for Texans, particularly those living near state lines, by allowing them to continue care with their established providers.
Additionally, Cauble pointed out that Texas lacks workforce diversity and that compacts could pave the way for more multilingual providers to serve the community effectively. She emphasized the difficulties individuals face when trying to articulate personal struggles in a second language and welcomed the prospect of expanding access to Spanish-speaking specialists.
However, apprehensions remain regarding the establishment of interstate compacts, primarily due to concerns over the revenue dependent on licensing fees for state boards that could be impacted. Critics, including John Bielamowicz, who presides over the Texas psychologists’ licensing board, regard the push for compacts as an inadequate solution to Texas’ workforce issues. He suggested that while compacts may facilitate movement, they do not inherently increase the availability of healthcare providers.
The ongoing deficiency of healthcare professionals is particularly pronounced in rural Texas, an aspect that interstate compacts may not effectively address, Roberts cautioned. He proposed that alternative recruitment and retention strategies, such as loan repayment initiatives, boosting Medicaid reimbursements, and incentivizing students to work in rural areas might yield better results. However, these strategies would necessitate ongoing government funding, which has historically been challenging to secure.
While Bielamowicz acknowledges the pressing workforce challenge, he warns that entering into these compacts would cede state authority over licensing, ultimately placing control in the hands of national boards that may not be accountable to Texas state authorities. He expressed concerns that a central organization could impose standards that may not align with the needs of Texans.
In contrast, Mares contended that these licensing compacts would uphold state authority to regulate and enforce rules, stating that states with regulatory frameworks significantly divergent from the compacts, such as New York and California, are less likely to participate. Texas maintains strict regulations related to license revocation for various misconduct, and the compact’s establishment would necessitate negotiations on regulatory enforcement among member states.
The implementation of interstate compacts raises concerns regarding local control in healthcare, as Bielamowicz noted, citing that when constituents face issues, they often turn to local regulators, whereas decisions under compacts may rest with individuals not directly answerable to the state or its citizens.
