AMA strengthens opposition to corporate practice of medicine

CHICAGO — Physicians and medical students at the Annual Meeting of the American Medical Association (AMA) House of Delegates yesterday adopted a sweeping policy refining the organization's longstanding opposition to the corporate practice of medicine. The new policy establishes some of the most specific AMA guidance to date intending to protect physician autonomy and patient care from corporate influence.

The policy significantly revises previous policy concerning corporate investors and corporate entities in physician practices. The new language reinforces that physician practices should remain under the ownership, governance, and clinical control of licensed physicians, and it explicitly opposes corporate arrangements that are thought to allow non-licensed entities to exercise direct or indirect control over medical practice.

"The House of Delegates has taken a bold step to protect the integrity of the patient-physician relationship and ensure that medical decisions remain in the hands of physicians rather than corporate interests," said Marta J. Van Beek, MD, MPH, a member of the AMA Board of Trustees.

The newly adopted policy builds upon existing AMA policies opposing the corporate practice of medicine and recognizing the risks that investor-driven healthcare models can pose to patient care. The revisions reflect growing national concern regarding private equity ownership and other corporate arrangements that may undermine physician independence.

Among its key provisions, the new policy:

• Affirms AMA support for physician ownership, governance, and independent medical judgment in physician practices.
• States that physician practices delivering medical care should be majority owned by actively practicing licensed physicians who retain final authority over clinical decision-making and operational decisions affecting patient care.
• Opposes specific corporate ownership structures and contractual arrangements that could permit non-licensed entities to exercise control over the practice of medicine.
• Identifies certain contractual mechanisms that might enable non-licensed entities to exert direct or de facto control over physician practices.
• Opposes noncompetition, nondisclosure, non-disparagement, and non-interference clauses that restrict physicians' ability to exercise independent professional judgment, advocate for patients, report unsafe or unethical conditions, or continue caring for patients consistent with ethical and legal obligations.
• Supports greater transparency regarding physician practice ownership, governance structures, management agreements, and contractual control rights.

The policy echoes emerging state-level proposals that seek to preserve physician control over clinical decision-making and limit corporate interference in patient care by imposing requirements on physician practice ownership or management structures and banning specific contractual arrangements.

“The AMA has warned that corporate intrusion threatens patient-centered care, can erode the ethical patient-physician relationship, and creates conflicts of interest between corporate profit and best medical practices,” Dr. Van Beek said. “The House of Delegates has reaffirmed the principle that medical decisions should be guided by clinical expertise and patient welfare, not corporate priorities.”

The adopted policy seeks to clarify that while physicians may enter business relationships with investors and management organizations, those arrangements must remain subordinate to physician ownership, governance, and professional medical judgment.