Remarks on S. 345, a bill to increase the scope of practice for nurse practitioners:

Act 234 of 2018, a bill authored by me to increase the scope of practice for advanced nurse practitioners in South Carolina, has now passed both the House and the Senate and is being sent to Gov. McMaster for his signature, which he has said he will promptly do. Printed below is a transcript of the remarks I made to my colleagues in the Legislature in the successful effort to get this bill across the finish line:

There are not enough health-care providers in South Carolina to meet the needs of its residents. In order to truly improve access to health care, there must be an increase in the supply of providers.

South Carolina, with its estimated 3,600 primary-care physicians, ranks 40th among the states with just 77.5 physicians per 100,000 residents (nationally, the number is 90.1 per 100,000). Moreover, there is a strong bias in the distribution of those physicians to urban or suburban areas, and 42 of our 46 counties are medically underserved. One county (Lee) has no physicians at all.

This supply problem is compounded by the fact that medical students increasingly are choosing specialties outside of the primary-care field, as our society places an emphasis and increased value on specialized skills. Primary-care providers have been the backbone of the rural health-care system, and there are ever fewer of them to go around.

So how can we increase supply? One way, I think, is to better utilize our state’s estimated 3,500 advanced-practice registered nurses. These nurses hold at least a master’s degree in nursing, supplemented with advanced education and clinical training to autonomously assess, diagnose and manage a patient’s health care at the primary-care level.

The problem is that South Carolina laws severely restrict the health-care services these nurses are able to provide. These restrictions impose limitations on delivering care and prescribing certain medications, referring patients for diagnostic care and certifying hospice or long-term care for patients.

Perhaps the most restrictive law is the one that prohibits these nurses from providing care outside a 45-mile radius of a supervising physician. Since the majority of physicians practice in urban or suburban areas, nurses who are ready, willing and able to fill unmet health-care needs are legally barred from doing so.

I filed S. 345 to remove these legal barriers so that these nurses are able to stand alongside our primary-care physicians and provide basic health-care services to South Carolinians. Since prices decrease when the supply increases, such a dramatic increase in the supply of providers would not only improve health-care outcomes but also drive down costs.

Moreover, a multitude of studies show that the quality, efficiency, patient satisfaction and cost-effectiveness of advanced-practice nurses’ care is as good as the care provided by physicians. In any event, I believe patients should have the option of choosing to receive health care from these nurses, especially since the alternative now is in far too many cases no care at all.

By passing S. 345, we can cut the red tape that prevents nurses from providing the care they are qualified to give. Better access to health care at a lower cost is a clear win for all South Carolinians.