It is no surprise to anyone that health care in the United States is in turmoil. The costs are overwhelming while at the same time large portions of our population struggle with obtaining access to health care, primarily in rural areas. It seems everyone wants a solution but few are really ­interested in significant change when it affects them.


A subject of great interest to me is practice ownership. Many states, including my home state of Texas, have restrictions regarding who can own a medical practice. Here in Texas it is called a corporate practice of medicine (CPM) law.


These laws, many of which are very old, were originally intended to protect patients from the harm of being treated by snake-oil salesmen and their ilk. But times have changed. There are now numerous regulations and laws in place to protect patients’ health care, and the time has come for us to separate the ownership of a medical practice (business) from the actual practice of medicine.



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It should be no surprise that the primary opponents of opening up medical-practice ownership are physicians. They fear loss of autonomy in medical decision-making. Some would argue they fear loss of power, control, and money, but that is a debate for another time. What is certain is that physicians are opposed to this change.


I understand the argument. Given the amount of time, money, and work it takes to become a physician, it would be frustrating not to then have an appropriate degree of autonomy or, worse, to have your medical decision-making influenced by a “bean counter.”

The practice of medicine is already overburdened with regulations and agencies and managed care that make concentrating on patient care difficult. Is it possible for open practice ownership and independent medical decision-making to coexist? Yes, it is.


Texas has one of the tightest CPM laws in the country. We also have the distinction of recently being listed as 50th out of 50 states for providing care to our citizens in terms of health-care services and delivery, according to an annual scorecard issued by the Agency for Healthcare Research and Quality. That is not quite the desired “promotion” from last year’s 49th place. We have the largest number of underserved rural areas in the country.

How is that CPM working out for us? Not well. Many of the states that are doing better than us have no CPM statutes at all.


It is past time to put money, control, and politics behind the interests of the people we care for. It is time to develop rules that open up practice ownership to anyone with the spirit, drive, and ability to meet all the standards while still protecting the provider’s independent medical judgment. Let the market do what it is supposed to do and drive competition and innovation. The market abhors a void and access to care will improve. 


Certainly opening up practice ownership to anyone who wants to take it on will not be a panacea for all our health-care woes. However, it will result in better access to care.

More competition can only have a positive effect on costs. If this were to happen the world wouldn’t end and then, maybe, more significant changes in how we do business in medicine would be considered by more people. Who wants to go first, legislators? 


Scott Stegall, PhD, PA-C, is an Army-trained PA and COO of Physician Assistant ­Political Alliance. He practices in rural health.