Physicians often hesitate to speak out about safety, harassment or fraud concerns in their workplaces for fear of losing their jobs or suffering other forms of retaliation. And that fear is justified. Physicians have been retaliated against numerous times for raising such concerns, sometimes with grave personal and professional consequences.
In many states, physicians employed by physician private practices, hospitals and health systems have enjoyed legal protections from retaliation for some time. Until recently, however, physicians working as independent contractors largely have not.
In 2022, the House of Delegates directed the AMA to develop a model state legislative template to help protect physicians—including those working as independent contractors—from corporate, workplace or employer retaliation when reporting safety, harassment or fraud concerns at licensed health care institutions or in the government.
“Physicians must be protected for voicing quality-of-care concerns even when it might be at odds with their place of employment,” AMA Trustee Scott Ferguson, MD, said at the time. “Patients are relying on physicians’ independent medical judgment. Physicians shouldn’t face retaliation for following their professional responsibility.”
The AMA’s model state legislative template (PDF) is available free to members of the AMA Federation of Medicine.
Driven by changes in employment
One state that has stepped up to protect physicians working as independent contractors is Arizona, whose legislature in 2021 enacted House Bill 2622, extending them the same protections as physicians employed directly by health care organizations.
“Medicine’s employment environment has changed a lot since Arizona’s first anti-retaliation statute was written, in 2003,” said Amanda Sheinson, director of government relations at the Arizona Medical Association. “More and more physicians are employed by third-party contract management groups rather than hospitals or private practices."
An AMA Policy Research Perspective (PDF) found that, as of 2022, independent contractors made up 6.4% of the physician workforce, up from 5% a decade before.
“This was about closing a loophole,” Sheinson said, noting that the Arizona Medical Association had worked with hospitals and even some of the larger staffing agencies to make sure everyone’s concerns were covered. “The bill sailed through the legislature with positive collaboration from health care community stakeholders and strong bipartisan support.”
Tailored to states’ needs
The model state legislative template is broken out according to the varying concerns and goals of advocates and lawmakers. For example, it explores:
- From whom do you want to protect physicians?
- Do you want to protect physician employees from retaliation by their employers for making complaints about, or participating in investigations concerning, their current employers or about other employers?
- Does the Federation of Medicine advocate want to require prior internal reporting or permit physicians to take their concerns directly to the authorities?
- To what third parties can physicians report their concerns or otherwise involve and still be protected?
- Do you want to limit protection to employed physicians or extend protection to nonemployed physicians?
- Do you want to protect individuals in addition to physicians?
- What kinds of physician conduct do you want to protect?
- How do you want to define “retaliation?”
It then provides sample language, often from numerous states, for each answer option. It also features sample language for presumption of retaliation, keeping the physician’s identity confidential, and remedies.
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