Medical Legislation Requires Physician Leadership
South Carolina operates on a two-year legislative cycle, and we are now in the second year of the 2025–2026 session. Bills that did not pass last year remain alive and can move quickly, while new bills introduced this year must clear both chambers before the session adjourns.
Important Wins from Last Year: One of the most significant physician victories last session was the passage of House Bill 4067 requiring a physician to be physically present in hospital emergency departments at all times. This bill was driven by emergency physicians and supported by the SCMA. South Carolina became one of the first states to pass this legislation, along with Virginia and Indiana. The bill reflected a simple but critical principle: high-acuity, unpredictable care requires the training, judgment, and accountability that only physicians can provide. It was important to pass this law as a study published in the 2025 Journal of the American College of Emergency Physicians (JACEP) Open found that one in 13 emergency departments in the U.S. did not have an attending physician on-site 24/7. Ensuring physician presence protects patients, supports care teams, and reinforces public trust in emergency care.
Another reform that passed was increasing the number of anesthesiologist assistants (AA) that an anesthesiologist may supervise from two (2) to four (4). The bill also made it easier for AAs to get licensed. House Bill 3996 took several years to pass due to the push back from CRNAs who wanted to keep supervision limited to two AAs.
These wins did not happen by accident — they were the result of sustained physician engagement and testimony. We appreciate each physician who testified in 2025 and 2026; you made a difference.
WHAT IS MOVING THIS YEAR
Physician Noncompete Agreements – A bill prohibiting non-compete clauses in physician contracts has advanced through the House 3M committee and is on the House calendar at the time this magazine is going to press. Physicians testified powerfully about how non-competes force them to leave communities, disrupt patient relationships, and worsen access — especially in rural areas. The issues of non-competes is a patient-access issue, not a business dispute, and harms patients who lack continuity of care when a physician leaves. Also, ending noncompete agreements represents an important step in assuring physician autonomy, as prohibiting physicians from leaving a facility dismisses the physician voice in a work setting. The bill is gaining momentum with the addition of numerous co-sponsors. The bill may pass this year, or it may take another year to get it through both the House and Senate due to push back from several hospitals that favor noncompete agreements.
Scope Issues – Team-based care versus independent practice remains a central issue this session. Senate Bill 669, the Team-Based Health Care Act, continues to be the physician-supported alternative to proposals that expand independent practice based on arbitrary hour thresholds. As physicians have emphasized, hours do not measure the quality or rigor of training. Team-based care works best when it is physician-led, transparent, and accountable, principles reflected in S. 669.
The SCMA knows that physician-led care is best and has provided detailed information on the educational background of physicians compared to APRNs and PAs. Access problems cannot be solved simply by redefining scope or substituting credentials. Patients benefit most when care is delivered by coordinated teams with clear roles, accountability, and physician leadership. That principle underpins the South Carolina Medical Association’s position and our support for meaningful, durable workforce solutions.
A key concern with many scope expansion proposals is their reliance on “hours-based” thresholds as a proxy for competency. Hours alone do not measure the quality, rigor, or consistency of clinical training. Educational pathways vary widely, particularly among advanced practice nursing programs, including programs delivered almost entirely online with limited standardized clinical oversight. Two clinicians may report the same number of hours yet have vastly different training experiences and preparedness to manage complex, high-risk patients. Reducing competency to a numeric hour requirement oversimplifies clinical reality and puts patient safety at risk.
However, 37 states have provided a path for some form of independent practice for APRNs and PAs, with some requiring additional post-graduate clinical hours and others utilizing a numeric-hour requirement. Groups such as BlueCross BlueShield have offered support for independent practice. Accordingly, this issue will continue to be a big topic this year, and we will likely continue discussions in the 2027-2028 session.
PHYSICIAN ENGAGEMENT MATTERS
Year two is when bills move quickly to final votes. Many decisions that will shape physician practice for years are being made now – often behind the scenes. Legislators consistently say that physician testimony and real-world examples change votes. The SCMA and SCMedPAC continue to track hundreds of bills affecting medicine, even when there is no formal policy position. The goal is simple: protect patient safety, preserve physician-led care, and ensure South Carolina remains a place where physicians can practice medicine – not just navigate regulation. The SCMA’s work at the State House defines the future of healthcare delivery in South Carolina. Physicians’ voices remain essential.
