Physician assistants welcome new law

May 22, 2019
A physician assistant holds up one finger in front a a girl seated on an exam table
Physician assistant Jennifer Marshall examines 7-year-old Nia Campbell as part of a surgery consultation. Photos by Sarah Pack

A trio of MUSC graduates led the successful effort to update South Carolina’s law to grant physician assistants more authority to practice as they are trained to do. Supporters say the updated law will make it easier for these licensed medical providers to work in the state, thereby increasing access to health care for more people. 

“It’s really setting us up for the next step in the modernization of health care,” said Megan Fulton, a certified physician assistant and director of PA Practice at MUSC Health.

She and Kevin Harmon, who practices at the Ralph H. Johnson VA Medical Center, are legislative co-chairs for the South Carolina Academy of Physician Assistants. Along with their colleague, MUSC Children’s Health’s Jennifer Marshall, president of SCAPA, they worked with legislators and the South Carolina Hospital Association to craft an update to the law.

Physician assistants study for more than two years in programs that combine classroom and clinical work to earn a master’s level degree. PA programs are highly competitive – the MUSC College of Health Professions received more than 830 applications for about 60 seats in the PA program. Physician assistants can be found working under the supervision of doctors in every medical specialty. And PAs provide excellent care, Fulton said, with studies showing good outcomes for patients who see physician assistants or nurse practitioners.

Eliminating some of the restrictions on PAs allows physician assistants to work to the highest level that their training and education has prepared them for while freeing up doctors to concentrate on the patients who most need their expertise.

Such is the case for Marshall, who sees pediatric patients at the MUSC Children’s Health R. Keith Summey Medical Pavilion under the supervision of pediatric neurosurgeons Ramin Eskandari and Libby Infinger.

“If there’s somebody who doesn’t need to see the surgeon, then I can see them so she can spend more time with the patients who do need to see a surgeon,” Marshall said.

two women talk in an administrative area 
Physician assistant Jennifer Marshall, standing, talks to Dr. Libby Infinger about her conclusions after a patient exam.  

On a recent Monday, Marshall examined a 7-year-old girl who was in for a surgical consult. She then presented her findings to Infinger, who then met with the patient. Often, for routine follow-ups, the patient can be seen by the physician assistant alone.

Either way, Marshall works under the supervision of a specific doctor with whom she has a scope of practice agreement. Under the old law, if that agreement came to an end – if, for example, her supervising physician took a job out of state – Marshall would have had to immediately stop practicing until she could find a replacement supervisor. That wouldn’t be so much of a big deal at a large hospital system system like MUSC, with departments that have multiple alternate supervising physicians. But in a small practice in a community setting, if the doctor leaves or dies then not only would a PA find him- or herself out of a job, but the patients would find themselves without a provider, with neither a doctor nor a PA available to see them. The new law allows a PA to work with a temporary alternative supervising physician for 90 days until he or she can secure a new agreement with a new supervising physician.

There are other ways the new law should make it easier for patients to see a provider, Marshall explained. The law increases the number of PAs and NPs that a doctor can supervise and collaborate with to six from three. It also does away with restrictions on the geographic distance between the PA and the supervising doctor. Before, the law required that the two could be no further than 60 miles apart, which made it difficult to place MUSC PAs in outreach clinics in places like Beaufort or Murrells Inlet.

With telemedicine and modern communications, Fulton believes that there’s no reason collaboration-minded PAs and doctors can’t work together over long distances.

“It doesn’t matter if I’m 60 miles away or across the hall,” Fulton said.

The new law also allows PAs to prescribe a five-day supply instead of a three-day supply of Schedule II narcotics. Such drugs include powerful pain relievers typically prescribed after surgery or during cancer treatment. The two-day extension is a small change that could make a big impact on patients.

“A three-day supply doesn’t get a patient very far,” Marshall said of those who are being discharged after surgery. “With a five-day supply, they may make it until their follow-up appointment.”

graphic outlines changes to PA law 
Graphic by Leslie Cantu

The new law also authorizes PAs to certify patients as handicapped so they can apply for a handicapped parking permit, to refer patients to physical therapy and to certify that a student is unable to attend school.

Legislators who sponsored the bill said the new law will help improve medical care throughout the state and particularly in rural areas. State Sen. Tom Davis, R-Beaufort, said South Carolina ranks 40th among states for the number of doctors per capita; many of the doctors who do practice in the state are concentrated in urban and suburban areas, he said.

“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,” said state Sen. Brad Hutto, D-Orangeburg.

There are more than 1,600 physician assistants currently practicing in South Carolina, 95 of whom work at MUSC.

The new law takes effect Aug. 11.