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Opinion 3.05 Physician Employment by a Nonphysician Supervisee 

Physicians’ relationships with midlevel practitioners must be based on mutual respect and trust as well as their shared commitment to patient well-being. Health care professionals recognize that clinical tasks should be shared and delegated in keeping with each practitioner’s training and scope of practice. Given their comprehensive training and broad scope of practice, physicians have a professional responsibility for the quality of overall care that patients receive, even when aspects of that care are delivered by nonphysician clinicians.

When nonphysicians employ physicians to supervise the employer’s clinical practice, conditions are created that can lead to ethical dilemmas for the physician. If maintaining an employment relationship with a midlevel practitioner contributes significantly to the physician’s livelihood, a physician’s personal and financial interests can be put at odds with patient care interests. Similarly, the administrative and financial influence that employer status confers creates an inherent conflict for a physician who is simultaneously an employee and a clinical supervisor of his or her employer.

Physicians in such arrangements must give precedence to their ethical obligation to act in the patient’s best interest by always exercising independent professional judgment, even if that puts the physician at odds with the employer/supervisee. (II, VI, VIII)

Issued November 2009 based on the report "Physician Employment by a Nonphysician Supervisee," adopted June 2009.