Historically, most states have limited the ability of physicians to work as
employees of hospitals or other businesses that are not controlled by physician
owners. Until recently, this meant that physicians tended to work as solo
practitioners, in small groups, or for physician-owned clinics. These businesses
employ both physicians and other personnel to aid in the practice of medicine.
These persons are protected by the usual business laws governing the
employer–employee relationship. In addition, they pose some special legal
problems related to medical licensure, the supervision of personnel, and
Physicians often employ nonphysician medical personnel, such as nurses,
laboratory technicians, physician’s assistants, and respiratory therapists. As
employers, the physicians assume both the general employers’ vicarious
liability for the acts of its employees, and the special duties of supervision of
medical personnel that are imposed by state and federal law. They must be
concerned with the appropriate level of delegation for medical care services
provided in their offices. Physician–employers must also recognize that while
physicians are licensed to perform all medical services, they are often not as
skilled as the midlevel practitioners in many routine procedures.
Finally, physicians must compete fairly with other physicians, resisting the
temptation to use quality-of-care issues as a cover for anticompetitive
activities. This has become a major area of legal conflict as medical practice
has become more competitive. The United States has traditionally valued free
enterprise and has strict laws governing attempts to restrict competition.
Physicians must balance the need to preserve good quality medical care
against the policy of allowing the market to regulate business activities.