By Lindsay Street, contributing writer | Giving more autonomy to nurse practitioners will help cut health care costs and improve access to health care, particularly in rural areas, say proponents of a Senate bill pushing for changes. Others say it’s just not that simple.
In South Carolina, nurse practitioners are licensed primary care professionals who operate under the supervision of a medical doctor. The new legislation, S.C. Senate bill 345, would still require a doctor’s supervision of a nurse’s practice, but would allow doctors to supervise more than three nurse practitioners at a time, remove a geographical radius tied to the doctor’s location and allow nurse practitioners to prescribe drugs. The legislation would expand autonomy of certified nurse midwives as well.
The doctors weigh in
While more than 30 other states have done something similar to increase health care access and limit unnecessary emergency room visits, some of South Carolina’s doctors are pushing against the proposed changes.
During testimony in a Senate Medical Affairs subcommittee this week, representatives of the S.C. Medical Association reaffirmed its stance that all medical care in the state should be “physician-led.”
“If this bill passes, are nurses going to come to the Statehouse to take the Hippocratic oath?” Dr. March Seabrook of Lexington asked rhetorically during his subcommittee testimony. “This is about education and training, not lobbying.”
But not all doctors agreed with the association’s stance. Bucking their peers, two doctors, Dr. Keith Guest of Beaufort and Dr. Elwood Owens of Florence, spoke to the subcommittee in favor of loosening regulations.
“We’re not talking about throwing everything out. We’re talking about amending laws,” Guest said in his testimony. “I support the bill as written … it doesn’t give (nurse practitioners) complete autonomy.”
Championing the bill is Sen. Tom Davis, a Beaufort Republican who leads the subcommittee. Davis said he expected the full Senate Medical Affairs Committee to take up a vote on S. 345 in the coming weeks.
“South Carolina, in relation to other states, heavily regulates nurse practitioners,” Davis told Statehouse Report. He added the new legislation would allow nurse practitioners “to render the health care services for which they are trained” and that this could increase health care access in the state and potentially lower costs.
During Wednesday’s subcommittee, Davis pushed back against the testimony of fourth-year medical student Daniel Young of Charleston, who has a nursing education and worked under nurse practitioners. Young said that while many of the nurses are “excellent clinicians,” he did not “recognize them as having an education equal to my own.” Young said he has more hours of training than nurse practitioners and still has more education ahead of him.
“There are simply not enough of qualified physicians to go around,” Davis said. “(We should allow) nurse practitioners the latitude to provide a limited amount of care for which they are trained.”
Davis’s premise for sponsoring the legislation is rooted in the senator’s assertion that more medical professionals in the state would increase access and drive down costs — a simple supply-and-demand model.
“It’s like any other commodity of supply and demand,” Davis told Statehouse Report. “If the number of providers is expanded, the costs go down.”
Davis penned an opinion piece last spring saying Medicaid expansion wasn’t needed but loosening regulations on nurse practitioners could fill the void, making health care more accessible and affordable.
But according to Wednesday’s testimony from medical practitioners, that’s not exactly how it will work, though it could end up saving the state some money. Doctors supportive of relaxing regulations said, if anything, it will keep taxpayer costs down by keeping low-income patients out of the emergency room by giving them access to rural-based nurses.
“If you have more and more practitioners and if they see those patients at the home office and keep them out of the emergency room, then you will have a dramatic difference in costs,” Owens said. “One-on-one patient care at the office, nurse practitioners can greatly reduce the frequency of emergency room visits at the nearby hospital.”
Expanding rural care
Nurse practitioner Jackie Baer also gave testimony at the subcommittee. She currently sees patients on Johns Island. She said her supervising doctor is 71. Baer said she was afraid that if the doctor retired or died, her clinic might have to close because she wouldn’t be able to find another physician within the legal geographical radius to supervise her practice.
“The law is outdated and I ask why,” she said during her testimony. In a later interview, Baer expressed frustration that the wheels of legislation have not moved faster on the issue: “They just need to take a vote and do something. They need to be legislators.”
During the subcommittee, Sen. Tom Corbin, R-Greenville, challenged the assertion that nurse practitioners will venture further into the rural areas and serve a greater population. Owens responded that they will and have in other states.
“You need somebody to go into the hinterland and treat those sparsely populated patients,” Owens said.
Baer said nurse practitioners’ low student loans and low overhead mean they can afford to serve fewer patients per day in the rural areas, whereas a doctor may need to see many more in an urban area.
“It’s not worthwhile for them to be out there,” Baer told Statehouse Report. She added that where she practices, there hasn’t been a physician who has stayed for the long term in the 15 years she’s served the area. “It’s not a financial win for them and I can see why they leave … We’re much more cost effective.”
Baer said that if the physician-led model being pushed by the S.C. Medical Association worked as is, then there wouldn’t be such a void in the rural area.
“We’re losing this game and we need a different plan. What they’ve been doing for 30 years is not working … It’s nice to have physician to lead the team but they’re not out here,” Baer said. “Let the people who are out here do it.”
Dr. Gerald Wilson, a past president of the S.C. Medical Association who practices in Columbia, said during the subcommittee meeting that serving rural parts of the state should depend on recruiting doctors from that area. And that starts with education, he said.
- Have a comment? Send it to: email@example.com.
Editor’s Note, 3/14/17: Online comments to this news story have been closed. We thank the 39 people who provided their opinions.