Texas boasts about freedom. Despite its economic freedoms and well to do fiscal policies, Texas remains a less than free state when it comes to personal and occupational freedoms. The latter of which Texas ranks dead last. Texas still requires a lifelong contract with a physician, regardless of how long a Nurse Practitioner has practiced. This means underserved areas will remain underserved where NP’s could bring much needed health care. Also, as a result of this restrictive environment, fewer NP’s want to practice in Texas. For more data pertaining to this topic please see the link to the report provided by the CATO Institute. https://www.freedominthe50states.org/occupational/texas