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Orangeburg is an exception in a key aspect of health care: doctors.

As a large rural county with a micropolitan area as its center, and with the presence of a health care facility such as the Regional Medical Center, Orangeburg is blessed with a healthy supply of doctors. Still, finding a physician ready to accept new patients can be a challenge.

That's not unusual across rural America.

The National Rural Health Association, a nonprofit membership and advocacy organization that analyzes health trends in non-urban areas, calls an inadequate number of doctors serving rural areas a national health care crisis with no end in sight.

A combination of factors – including the economy, cultural and social divides and the isolation of living in a remote area – have conspired "to create health care disparities and impede rural Americans in their struggle to lead normal, healthy lives," the NRHA says.

As of June 30, 2018, according to the federal Health Resources and Services Administration, there were more than 7,200 designated Health Professional Shortage Areas lacking adequate primary care nationwide – home to 85.5 million people. Of those areas, according to the HRSA, nearly 60 percent were in rural regions, and the nation needed 4,022 rural doctors to close the gap.

South Carolina lawmakers cannot alone solve the problem. But in 2019 they took an important step to expand access to care.

New legislation, which becomes effective Aug. 11, will allow physician assistants to increase care for patients through modernization of the regulation of PA practice.

PAs are medical providers who diagnose illness, develop and manage treatment plans, prescribe medications and often serve as a principal health care provider.

The new law will expedite PA entry into the health care workforce by streamlining licensure processes and removing requirements that serve no public protection role.

States are increasingly removing barriers in an effort to expand access to care that PAs provide.

“Many people in South Carolina lack adequate access to quality health care, especially in rural areas – partly because South Carolina ranks 40th among the states with just 77.5 physicians per 100,000 residents. Nationally, the number is 90.1 per 100,000. This problem is compounded by a strong bias in the distribution of those physicians to urban or suburban areas. S. 132 eases this access problem by empowering physician assistants to provide health care services that are commensurate with their increased level of education and training,” Beaufort County Sen. Tom Davis said.

The updated law allows:

• Full prescriptive authority for PAs, including increased prescriptive authority for Schedule 2 narcotic medications.

• Revision of onsite practice requirement: A PA with less than two years of continuous practice or switching specialties must practice with the supervising physician for at least 60 days before being allowed to practice at an offsite location, with a limited exception for retail medical clinics. The 60-day requirement may be waived in writing by the supervising physician.

• PAs can start practice 10 business days (or earlier if approved) after their scope-of-practice guidelines are submitted to the board of medical examiners.

• A PA may sign specified documents on behalf of the supervising physician or alternate supervising physician.

• End-of-life care: pronounce death, certify the manner and cause of death, sign death certificates, issue an order for a patient to receive appropriate services from a licensed hospice, execute a do-not-resuscitate order.

• Authorization for PAs to delegate a limited list of functions to unlicensed personnel (CMAs).

• Certify that a student is unable to attend school but may benefit from receiving instruction given in his home or hospital.

Sen. Brad Hutto, who represents the City of Orangeburg but whose district is otherwise heavily rural, sums up the importance of the legislation:

“It is clear that the future of South Carolina’s health care can only be met with an increased number of highly qualified physician assistants being an integral part of the process, particularly in rural South Carolina. This bill was needed to ensure that South Carolina residents’ health care needs can be met."

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