9.1.3. Licensee Employment

The Board recognizes that the practice of medicine continues to shift from licensees practicing in personally owned practices toward licensees practicing while subject to employment and other contractual relationships.  The medical practice of the employed licensee may present unique challenges to maintaining professionalism in the practice of medicine.  

In order for licensees to avoid putting themselves in professional situations that may expose them to sanctions by the Board, the Board recommends licensees consider the following when entering a new work environment:

• Understand the organizational structure and ownership of their potential employer.
• Employment agreements are legal documents.  Licensees are encouraged to seek their own legal counsel before signing them.
• Be familiar with your employer’s policies for healthcare delivery within the practice or healthcare system.
• Recognize that your professional obligation to provide care that conforms to the standards of acceptable and prevailing medical practice, or the ethics of the medical profession, supersedes your employment relationship.
• Patient welfare must take priority in any situation where the interests of licensees’ and employers’ conflict.

1. Responsibilities to Patients and the Profession 

a. Patient advocacy is a fundamental element of the patient-licensee relationship that should not be altered by the employer or setting in which licensees practice, or the methods by which they are compensated.

b. A licensee’s paramount responsibility is to their patients.  At the same time, employed licensees occupy a position of significant trust and owe a duty of loyalty to their employer.  Having two distinct loyalties can create conflicts of interest that employed licensees should strive to recognize and address.

c. When factors outside a licensee’s medical judgment (e.g., moral, religious, financial, etc.) influence or limit a licensee’s particular treatment or referral options, a licensee is ethically obligated to disclose those factors to the patient.  The Board reminds its licensees of the position statement “2.1.1 Licensee-Patient Relationship,” which states that it is unethical for a licensee to allow financial incentives or other interests to adversely affect or influence a licensee’s medical judgment or patient care.

d. Employed licensees should be free to exercise, in their individual capacity, their personal and professional judgment in voting, speaking, and advocating on any manner regarding patient care interests, the profession, healthcare in the community, and the independent exercise of medical judgment.

e. Licensees working in a supervisory or administrative role who direct individual patient care decisions of other licensees are themselves engaged in the practice of medicine and may be subject to Board scrutiny.  

f. Employed licensees have a responsibility to assure that bills issued for services they provide are accurate and should therefore retain the right to review billing claims as may be necessary to verify that such bills are correct.

g. Employed licensees should be free to engage in volunteer work outside of, and which does not interfere with, their duties as employees.

2. Consideration and Termination of Employment Agreements

a. Licensees are encouraged to obtain the advice of legal counsel when negotiating employment agreements.  Licensees are encouraged to work with their counsel to review, inquire about, and fully understand, the terms of proposed employment agreements, including, but not limited to, terms addressing:

i. The licensee’s work duties and other obligations;
ii. Compensation, including productivity and incentive compensation, as well as benefits;
iii. Restrictions contained in the agreement, including non-compete and non-solicitation clauses or other restrictions; and
iv. The terms of employment and any potential bases for early termination.

b. Licensees should be aware of the Board’s position statement on the Corporate Practice of Medicine and only accept employment that involves the practice of medicine with lawfully authorized employers.

c. Termination of an employment or contractual relationship between a licensee and an entity employing that licensee does not necessarily end the patient-licensee relationship between the employed licensee and persons under his/her care.  Whether serving in an employer or employee role, licensees should refer to the Board’s position statement “2.1.2: Departures from or Closings of Medical Practices” regarding patient notification and choice, continuity of care, and providing medical records to patients.  

d. Actions taken against a licensee’s privileges should be reported to the Board consistent with N.C. Gen. Stat. § 90-14.13.  Any licensee with reporting responsibilities for the privileging actions contained in N.C. Gen. Stat. § 90-14.13 has the professional ethical responsibility to assure that proper reporting has occurred and may face an inquiry by the Board for the failure to do so.