In a Sept. 14 opinion column, Sandy McCoy, a Plano nurse practitioner and president of their state association, fashioned a plea for increased scope of practice for her profession.She made several correct statements worth repeating. Texas is low compared to other states in availability of primary care physicians; it is undoubtedly going to get worse; there are not enough Texas residency slots to further the training of Texas medical school graduates; and, in her words, "nurses are crucial to the future of healthcare in our state." (See: "Nurse practitioners are an underused resource")She also quoted one of several economic models that show a positive economic impact to fully actuating primary care in the state.However, she made one statement that is more arguable. She asked for significantly increased ability to diagnose and prescribe -- duties traditionally held by doctors -- and stated that such is "well within the bounds of [their] education and training." She is welcome to make that plea, but not every stakeholder within healthcare would agree.She also fails to note that the shortage in access to healthcare is primarily rural and there is a chronic and recurring shortage of nurses functioning in their traditional role. Her solution would not address the first issue and would tend to aggravate the second.Nurses are an indispensable part of the healthcare team. If you are a hospital inpatient, in a post-anesthesia recovery room or in an ICU, you are there because you need access to a nurse. Healthcare as we know it cannot exist without nurses.Nurse practitioners are a valuable part of the delivery of care, and I enjoy their input every day. However, converting our current APRNs to proto-physicians by allowing an expanded unsupervised role in diagnosis and prescription is not the best solution to the problem McCoy describes.We need to balance funding for residency programs so Texas medical graduates can stay here to train. We need to allow loan repayment programs so graduates with six-figure education debts can get relief by practicing in rural areas (the 185 of 254 counties that McCoy mentions). And we need to adequately pay for and respect nurses in their current role as members of the healthcare team. Anything else can compromise quality of care and patient safety.Stephen L. Brotherton, a physician in Fort Worth, is president-elect of the Texas Medical Association.