South Carolina, with its estimated 3,600 primary-care physicians, ranks 40th among the states with just 77.5 physicians per 100,000 of population (compared with 90.1 per 100,000 nationwide). 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, in recent years, medical students have been choosing specialties outside of the primary-care field. There is now an emphasis and increased value placed on specialized skills. Primary-care providers have historically been the backbone of the rural healthcare system, and increasingly there are less of them to go around.
So what can we do to increase supply? One way is to better utilize our state’s estimated 3,500 advanced-practice registered nurses and 1,400 physician assistants. These non-physician healthcare professionals hold at least a master’s degree, 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, however, is that South Carolina laws severely restrict the health-care services these nurses and physician assistants are able to provide. Perhaps the most restrictive laws were the ones prohibiting them from providing care for any patient who lies outside a 45-mile radius of a supervising physician. Since the majority of physicians practice in urban or suburban areas, nurses and physician assistants who are ready, willing and able to fill unmet health-care needs are legally barred from doing so.
I authored two bills to remove these legal barriers so that these nurses and physician assistants stand alongside our primary-care physicians to provide basic health-care services to South Carolinians, and both of my bills were passed by the South Carolina General Assembly and signed into law by the governor. The result has been a dramatic increase in the supply of providers, which not only increases health care access and improves health care outcomes, but also drives down costs (since the market equilibrium price decreases when the supply curve shifts to the right).
In recognition of these legislative accomplishments, I received "Legislator of the Year" awards from the American Association of Nurse Practitioners and the South Carolina Public Health Association.