In South Carolina, 42 out of 46 counties are designated as rural or medically underserved by the federal government. According to the U.S. Health Report Card, South Carolina ranks “F” in overall health status, emergency care, chronic disease management and prenatal care. Our state ranks 7th in the nation in infant mortality and 47th in low birth weight.

Whether you support the national health care reform efforts or not, the simple fact remains that in 2014 the Patient Protection and Affordable Care Act will bring 30 million new patients into an already broken system that is unable to provide needed care.

In South Carolina alone, we will have to find a way to provide primary health care services to a projected 800,000 new patients.

Consider how long you may be in the waiting room for a visit for your child and consider how long it will take to get an appointment. The average wait time in an emergency room in 2011 was 64.3 minutes. Some experts expect that to double soon, especially in rural areas.


Because folks who cannot access primary care use the emergency room for primary care.

We are in a state of crisis. We need to serve more people with fewer physicians.

The American Medical Colleges Center for Workforce states that there will be a national shortage of about 63,000 primary care physicians by 2015.

South Carolina already ranks 33rd for the lowest ratio of those physicians. According to a 2012 article in Medical Care magazine, the number of nurse practitioners in the U.S. will increase by 94 percent by 2015. We have 2,592 advanced practice registered nurses (APRNs) already in South Carolina.

Among these APRNs are nurse practitioners (NPs) and certified nurse midwives (CNMs), who hold at least a master’s degree in nursing with advanced education and clinical training to assess, diagnose and manage a patient’s health care at the primary care entry while working collaboratively in teams for the optimal patient outcome.

Allowing patients the option to select an APRN as primary provider could give people access to over 3,000 additional primary care providers when this crisis hits.

Currently, the barriers to practice for these advanced level nurses include: the inability for APRNs to order handicapped placards and durable medical equipment, inability to refer patients for diagnostic care, limitations on prescribing certain medications.

An APRN cannot provide care for a patient or prescribe any medication unless he has permission and “supervision” of a physician within a 45-mile radius. This archaic constraint means that patients struggle to get the care they need in a timely and safe manner.

Several months ago, a patient suffered a life-threatening illness and his nurse practitioner could not prescribe the needed medication because of these legal limitations.

After considerable precious minutes spent, the nurse practitioner was able to find a physician at a local ER who was able to accept the patient and provide the necessary emergency treatment. Accessing care is difficult and barriers exist everywhere.

The Institute of Medicine in its 2010 report, “The Future of Nursing,” calls for the removal of barriers for APRNs so access to primary care can be improved.

According to The Washington Post, about 6,000 APRNs have already opened independent practices.

Nineteen states have already removed barriers and now allow APRNs to practice to the fullest extent of their education and training. There is no longer an excuse for South Carolina to have an “F” in the health care rankings.

We hope our policy leaders will take action and allow qualified APRNs to provide the care that so many South Carolinians need before the burden on our health care system becomes even greater.

Research shows that APRNs deliver safe, cost-effective, high quality, autonomous care to manage a patient or population’s health, while working collaboratively in teams for the optimal outcome.


Shoals Drive

Mount Pleasant


Corlis Street


Lesley Rathbun is owner and director of the Charleston Birthplace. Rhonda Parker is vice chairman of the Coalition for Access to Health Care.