Doctors and Corporate Medical Practice II

Texas doctors and their professional organizations are bracing for another round in the ongoing effort to make it legal for doctors to be employed by private corporations. Today, in Part 2 of his two-part series, Jim Bell reports the Texas Hospital Association is pushing that change.


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Texas doesn’t allow what’s called the corporate practice of medicine. Lay people cannot hire doctors to provide medical services. The law allows exceptions, and they’re everywhere in the non-profit sector, but in all those exceptions, the doctors maintain full autonomy over how they treat their patients. Their lay managers can’t tell them what they can or cannot o do. Harris County Medical Society President Dr. Tom Garcia says state law now guarantees doctors that right. Changing the law, he says, would open the door to abusing the time-honored private relationship between doctors and patients.

“It’s just normal you look at who’s signing the check and you start realizing ‘well I gotta please, you know, the boss’, right?”

Doctor-patient confidentiality is the heart of this issue for Dr. Garcia, and for the Texas Medical Association. It’s the argument the TMA made to the legislature several years ago when bills were passed to exempt hospitals in some small towns from the corporate practice prohibition. The Texas Hospital Association lobbied in favor of those bills. THA General Counsel Charles Bailey says Dr. Garcia’s fears are unwarranted.

“Hospital administrators are not interested in telling physicians how to practice medicine. I think what they are interested in doing is trying to collaborate with their medical staffs, trying to work in a way that would be cost efficient, but not telling a doctor how to practice.”

Bailey says he understands TMA’s concerns, but there’s another issue that’s equally important: a critical shortage of doctors in small towns and rural areas. Many small Texas towns and some entire counties don’t have a single doctor. Bailey says the legislature can change that by allowing hospitals in those areas to hire doctors and guarantee them a salary with benefits. He says this would make it easier to attract and retain doctors in those areas, and he doesn’t think it would do violence to the doctor-patient relationship. He says Texas doctors should have the right to make that choice.

“A change in the law merely provides this option. And if physicians are interested in that option, and are comfortable that that’s the type of practice they want and are not going to be inappropriately influenced, they should have an opportunity to do that.”

Bailey says he thinks doctors should also have the option of working for large companies with medical departments that serve their employees. He thinks it can be legalized in ways that wouldn’t undermine the doctors’ rights to make independent medical judgments.

Jim Bell, KUHF, Houston Public Radio News.

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