The North Carolina Medical Society supports upholding the prohibition on corporate intrusion into the practice of medicine in North Carolina, as there is inherent conflict between a corporation’s fiduciary duty owed to its shareholders to maximize profits and a clinician’s legal and professional duty of care to their patients. Corporate intrusion into medicine, including the “corporate practice of medicine” (CPOM), can negatively impact clinicians and their patients by reducing autonomy in care decisions, lowering quality of patient care, and harming the patient-clinician relationship.

The North Carolina Medical Society supports regulation requiring the owner/s of a business engaged in the practice of medicine to be duly licensed to practice medicine in North Carolina.

The North Carolina Medical Society supports the many diverse settings in which our members provide care, such as nonprofit systems, for-profit systems, hospital authorities, federally qualified health centers, and independent practices.

The North Carolina Medical Society supports the promotion of robust competition within the healthcare space, as to provide patients with choice when selecting a clinician.

The North Carolina Medical Society supports the clinician’s duty to prioritize patient health without undue influence or interference from corporate entities.

NCMS supports the following guidelines, which should be enforced and applicable to all entities engaged in the practice of medicine, regardless of tax status or applicable ownership requirements:

Regarding Clinical Decision Making the North Carolina Medical Society:

• Supports a clinician’s obligation to the health of their patient over a corporation’s obligation to their shareholders or any non-clinician entity.
• Supports the right of the clinician and patient to make decisions, without adverse corporate interference, regarding the practice of medicine, diagnosis, treatment, and clinical care.
• Supports clinicians retaining control over clinical decisions and setting clinical standards and policies in a healthcare setting.
• Opposes prioritizing the needs of shareholders or any clinician/non-clinician who financially benefits from the provision of healthcare over the health of the patient.

Regarding Practice Management the North Carolina Medical Society:

• Supports active involvement of qualified clinicians in the business practices of hospitals, health systems, medical practices, health insurance companies, or any corporate entity involved in the provision of healthcare.
• Supports clinician-led governance and delineation of circumstances authorizing discipline or removal of a clinician from practice under a corporate structure.
• Supports clinician consult of legal and ethical counsel regarding employment contracts.
• Opposes straw ownership of businesses engaged in the practice of medicine. Straw ownership includes but is not limited to arrangements where a licensed clinician, or group of clinicians, are appointed as shareholder/s of a practice, to disguise the fact that the practice is truly controlled and operated by a non-clinician.

Regarding Practice Acquisitions the North Carolina Medical Society:

• Supports adequate notice be given to patients and clinicians when a change in the ownership of a healthcare entity or divestiture in service lines could impact the provision of care within or after the transition.
• Supports board seat requirements for active practicing clinicians licensed within the state of North Carolina and elected by their peers to serve, especially when a practice or system is acquired by another entity.
• Opposes gag orders placed on a clinician via contract, especially those which include clauses that prevent clinicians from sharing concerns over delivery of care with their place of practice or community.

Regarding Patient & Clinician Protections the North Carolina Medical Society:

• Supports the creation and expansion of protected pathways to report wrongdoing by corporations in clinical settings to government authorities.
• Supports accountable action and timely enforcement of sanctions when corporations are found to have committed misconduct in clinical settings.
• Opposes the unethical practice of fee-splitting, where a clinician refers a patient for a service, drug, or to another clinician in return to the clinician or their employer for a portion of the fee charged to the patient.
• Opposes organizational behaviors to increase use of services, unnecessary referral, or clinically inappropriate coding. These behaviors include, but are not limited to, financial incentives or disincentive for clinicians to provide or order care without clinical justification.
• Opposes corporate mandates that require a clinician to refer exclusively to a certain health care facility or to certain health care employees.
• Opposes geographical or financially restrictive and excessively broad noncompete agreements, as they can decrease essential access to care.
• Opposes retaliatory discipline of a clinician for raising concerns about standard of care, including concerns regarding quality, safety, access, and fairness of care.