Proposed bills pit nurse practitioners, doctors against each other

Nurses and doctors are having trouble agreeing on two bills that could help expand primary care access throughout the state.

Hundreds of nurses rallied at the Statehouse in Columbia this month to lobby for a bill that would allow them to practice more independently. They told lawmakers that too many South Carolinians can’t get to a primary care doctor because there aren’t enough physicians and that nurses with advanced training can help fill this gap.

But some South Carolina doctors say giving nurses too much authority is a bad idea — and would be harmful for patients.

“I do not think physicians in the state will ... be willing to support legislation that gives autonomous practice to nurse practitioners,” said Dr. Bruce Snyder, a Greenville surgeon and the immediate past president of the South Carolina Medical Association. “We will not make that concession.”

The state Medical Association not only opposes the bill, the group is throwing its weight behind a different proposal that some nurses say would further restrict their livelihood.

“I think that the doctors are worried that their business will be hurt if we give nurses independent practice,” said Rep. Jenny Horne, R-Summerville, who introduced House Bill 3078, which the nurses support. “I really disagree.”

Current law allows nurse practitioners, certified nurse midwives and clinical nurse specialists to practice in an office by themselves as long as they sign an agreement with a consulting physician within at least 45 miles of their location. The physician may only consult with up to three advanced-practice registered nurses in any shift.

Horne’s bill would lift the mileage restriction. Advanced-practice nurses would still need to sign a contract with a consulting physician, but the ratio of one physician for every three nurses would be eliminated.

“It’s going to improve the access for the patient,” Horne said. “We don’t have enough primary-care physicians to meet the medical needs of the citizens of South Carolina.”

The other bill — House Bill 3508 — which the Medical Association and its doctors support, would replace the 45-mile restriction with a 60-mile restriction and would amend the current law’s language to allow one physician to consult with up to six physician assistants or advanced-practice nurses.

“As with all health care, things modernize,” said Rep. Murrell Smith, R-Sumter, who sponsored the second bill, “and we need to incorporate that into the statutes.”

Smith’s bill would also establish a supervisory committee that nurse practitioner Stephanie Burgess says will only create more red tape.

“We’re certainly going to speak against (Smith’s bill) because that’s more restrictive than what we’re currently doing,” Burgess said.

After the Legislature passed a bill in 2013 that eased some of the restrictions placed on physician assistants, a group of advanced-practice nurses and the Medical Association organized a series of meetings to consider revisions to the current nursing law.

Both groups agree that early discussions were amicable and productive.

“Everyone was open and honest about what they felt was important,” Snyder said. “Some of the things we all agreed on.”

For example, both of the proposed bills would allow advanced-practice nurses to refer patients to physical therapy and hospice. They could also issue handicap placards.

Eventually, though, conversation between the groups broke down.

“We just could not overcome several hurdles at the very end,” Snyder said. “Although we value greatly the nurse practitioners and the nurse midwives, we think their level of education and training is significantly less than a physician’s.”

The South Carolina Hospital Association favors relaxing some of the restrictions placed on advanced-practice nurses, lobbyist Allan Stalvey said. Hospitals are increasingly opening outpatient clinics, he said, and have had trouble finding enough primary care providers to staff them.

Legislators have indicated that they want the Medical Association and the nurses to iron out their differences.

“We really need to focus on what’s best for the patients, not what’s best for the doctors and the nurses,” Horne said. “I am confident that we will get a bill passed this year. There will be some compromise on both sides.”

Smith said he hopes something will pass before the Legislature breaks this summer.

“Both parties need to come to recognize there’s so much agreement here,” he said. “Let’s not lose sight of what we agree upon just because we disagree on a few issues.”

Reach Lauren Sausser at 937-5598.