ATLANTA – The high number of diabetic patients walking through the door overwhelmed Janie McGhin, a nurse practitioner in South Georgia.

“It didn’t really feel like I had the time to teach these patients what they needed to know about diabetes,” McGhin said, who was working at a family physician’s office at the time. “I didn’t feel I was doing them justice.”

So McGhin decided to go out on her own and start a practice in Valdosta focused on helping adults manage their diabetes, although her clinic also sees patients with more general health needs.

But as a nurse practitioner, McGhin works under state-imposed limitations. Even though she has her own clinic, Partners in Health Management, state law requires she work under the supervision of a physician who must sign off on some routine day-to-day decisions, such as an order for a CT scan. 

“That is another step. Is that cost effective? No, and it delays care,” McGhin said. 

That’s why a key state lawmaker, Sen. Renee Unterman, R-Buford, wants to nix that limitation for nurses with advanced degrees who work in rural Georgia, where there’s a shortage of medical providers. 

Unterman, who chairs the Senate Health and Human Services Committee, has introduced a measure that would empower the nurses to practice to the fullest extent of their training.

“I just think it’s a shame that, here at the General Assembly, they’ve been held back and repressed for so long,” Unterman said during an interview at the state Capitol. 

Georgia has one of the most restrictive laws for nurse practitioners. Nationally, 22 states and the District of Columbia grant them what is known as full-practice authority. 

Meanwhile, there are nine counties in Georgia with no physician. Dozens of other counties have no pediatricians or obstetric and gynecological doctors. 

Proponents argue expanding the scope of practice for nurse practitioners could help fill in the health-care gaps in a growing state with increasing needs, especially with primary care. Nurse practitioners can also specialize in certain areas, such as pediatric care or mental health treatment.

“Everybody says, ‘Oh, it’s anti-doctor,’” Unterman said of her proposal. “It has nothing to do with that. It’s about access to care, and if you have a ready, willing and able workforce out there that’s willing to fill in the gap, I say let them have it.”

Nurse practitioners have tried to assuage those concerns with a charm offensive at the state Capitol. Groups of nurses representing advanced practice registered nurses recently descended on the Gold Dome with heart-shaped lollypops taped to this reassuring sentiment: “APRNs LOVE physicians!” 

Nurses want to work with physicians, just without the legal contract, proponents say.

But the Medical Association of Georgia, which represents the state’s physicians, hasn’t been wooed. 

Bethany Sherrer, a lobbyist for the association, noted that the proposal only identifies qualifying counties based on their population, not the actual need for medical providers. The bill would apply to nurses who work primarily in counties with fewer than 50,000 residents. 

Sherrer said nurse practitioners can set up in those same rural counties today, as long as they have an agreement with a physician.

Rather, the association would prefer to see state lawmakers spend their energy on expanding broadband in rural Georgia to support telemedicine, which enables doctors and others to use technology to treat patients remotely. 

“We just want to put patient care at the center of these decisions and make sure patients are getting high-quality care and that the care isn’t different for someone in a rural area versus someone in an urban area,” Sherrer said. 

Unterman said the battle brewing under the Gold Dome really amounts to a “turf war.” 

“It is an archaic system that is based on male dominance,” said the Republican lawmaker, who started her career as a nurse. 

She said her bill marks the first real push from nurses to expand their scope of practice in Georgia. 

The bill currently sits in Unterman’s Senate committee. If it clears the Senate, the measure may face tough odds in the House, where rural lawmakers recently decided not to spend the session grappling with the contentious issue.

McGhin and other nurse practitioners interviewed for this story made it clear they see expanded scope of practice for rural nurses as a first step toward obtaining the same privileges for their colleagues throughout Georgia, whether rural or urban. 

But they also stressed they know when to refer a patient to a physician. As an example, McGhin said she recently sent a patient with out-of-control sugar levels to an endocrinologist. 

“We are not trying to replace physicians,” said Serenia Carnegie, president of the South Georgia Association of Nurse Practitioners. “We are not trying to assume all health-care responsibilities. 

“We’re just trying to expand access to care so that people in the rural communities have good access to health care just like they do in bigger cities,” Carnegie said.

Jill Nolin covers the Georgia Statehouse for The Valdosta Daily Times, CNHI's newspapers and websites.

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