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Mar 1 2017

Position statement review: what changed in 2016?

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The Board reviews position statements at least once every four years, or more frequently if new information or issues come to light that may necessitate reconsideration, expansion or revision of an existing NCMB position. Here’s what the Board worked on in 2016:

New position statements
The Board adopted one new position statement in 2016, entitled, Corporate practice of medicine.

As a general rule, the North Carolina Professional Corporations Act (N.C. Gen. Stat. § 55B, et. seq.) requires corporations that provide certain professional services to be owned entirely by licensees of that profession. As a rule, medical practices must be owned by licensed physicians. Under some circumstances, a medical practice may be jointly owned by a combination of other authorized clinicians as listed in N.C. Gen. Stat. § 55B-14(c). NCMB recognizes medical practices owned by hospitals or health maintenance organizations as exceptions because state law authorizes these licensed and regulated entities to provide direct patient care.

Why was this position statement needed? Often, NCMB will investigate situations where a licensee is employed to work in a practice owned by medical professionals who are not licensed in NC or that is owned by individuals who are not medical professionals. Another common pitfall NCMB sees frequently is the problem of “straw ownership” of medical practices. A straw ownership arrangement is one in which a licensed physician is made the sole shareholder of a practice controlled and operated by a nonphysician. The new position statement can help licensees better understand the Board’s expectations with regard to practice ownership and, potentially avoid regulatory problems that arise from becoming involved in an inappropriate practice arrangement.

Amended position statements
The Board approved revisions to the following position statements:
    The Physician-Patient Relationship
    • Medical Testimony
    • End-of-life Responsibilities and Palliative Care


The Physician-Patient Relationship

What Changed? The position statement was updated to reflect circumstances faced by employed physicians. For example the position clarifies the Board’s expectation that, if an employer terminates a physician, either the physician or the employer provide patients with the physician’s new contact information. In addition, patients should be given the choice to continue to be seen by the physician in his or her new practice setting or to be treated by another physician still working with the employer.

Medical Testimony

What changed? The position was updated to include most recent version of the AMA Ethics Opinion on medical testimony.

End-of-life Responsibilities and Palliative Care

What Changed? The position statement was expanded to state that physicians and physician assistants should address Advanced Care Planning, including the establishing of a Health Care Power of Attorney and Advanced Directives, as appropriate.

Reviewed, no changes

The Board reviewed all of the following position statements and determined that no changes are needed at this time.
    • Advanced Directives and Patient Autonomy
    • Availability of licensees to their patients
    • Office-based procedures
    • The Retired Physician/Licensee


Repealed
The Board voted to repeal its position statement entitled, Competence and Reentry to the Active Practice of Medicine.

Why was this repealed? This statement is no longer relevant due to changes to 21 NCAC 32B .1370, which took effect January 1, 2016. Applicants who have not actively practiced clinical medicine for two or more years are required to demonstrate their competence to practice medicine upon application for a North Carolina license. Applicants may be required to complete a program of reentry before a license is issued. Overall, reentry is now a more individualized process developed on a case-by-case basis depending on the strengths, weaknesses, needs and practice plans of the individual seeking reentry. Learn more about reentry to the practice of medicine on NCMB’s website: www.ncmedboard.org/licensure/reentry.



What are the position statements of the Board and to whom do they apply?

The North Carolina Medical Board’s Position Statements are interpretive statements that attempt to define or explain the meaning of laws or rules that govern the practice of physicians, physician assistants, and nurse practitioners in North Carolina, usually those relating to discipline. They also set forth criteria or guidelines used by the Board’s staff in investigations and in the prosecution or settlement of cases.

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