Opinion ID: 2510251
Heading Depth: 4
Heading Rank: 3

Heading: The nature of the doctor-patient relationship affects the extent of Intermountain Eye's interest in protecting itself from competition by Dr. Miller.

Text: Since Marshall, courtsincluding this onehave considered the public interest impact of these agreements in determining the extent to which patients, existing and would-be, are protectable under the public interest prong of the test. The reason is that non-compete provisions between physicians and their employers implicate public policy concerns not present in the ordinary commercial context. A trend has evolved in some jurisdictions which recognizes that the doctor-patient relationship cannot be easily or accurately compared to relationships in the commercial context. Valley Med. Specialists, 982 P.2d at 1283. Indeed, the doctor-patient relationship goes beyond merely providing goods or services. Murfreesboro Med. Clinic, PA, 166 S.W.3d 674, 683 (Tenn. 2005). Thus, some jurisdictions apply a heightened level of scrutiny to already disfavored non-compete provisions in the medical setting. See Valley Med. Specialists, 982 P.2d at 1283; Ohio Urology, Inc. v. Poll, 72 Ohio App.3d 446, 594 N.E.2d 1027, 1031 (1991) (ordinary disfavor with which non-compete agreements are viewed is especially acute when considering reasonableness of non-compete agreements between physicians); Iredell Digestive Disease Clinic v. Petrozza, 92 N.C.App. 21, 373 S.E.2d 449, 455 (1988) (court extremely hesitant to deny the patient-consumer any choice whatsoever). When considering the degree to which a particular non-compete provision affects the public interest, courts focus on both the general public's interest in access to care, see Dick v. Geist, 107 Idaho 931, 934-35, 693 P.2d 1133, 1137-38 (Ct.App.1985), and the patients' interests in continuity of care and access to the physician of their choice. See Valley Med. Specialists, 982 P.2d at 1284; Karlin v. Weinberg, 390 A.2d at 1170. Among the jurisdictions that treat non-compete agreements between physicians and their employers with heightened scrutiny, several note the American Medical Association's view (held since 1980) that these agreements are not in the public interest. See, e.g., Valley Med. Specialists, 982 P.2d at 1282; Murfreesboro Med. Clinic, 166 S.W.3d at 679-80; but c.f. Karlin v. Weinberg, 390 A.2d at 1168 n. 4 (court hesitant to afford significant weight to those pronouncements of private professional organizations which have not been adopted by any governmental body or court). They also draw parallels between the practices of medicine and of law, noting that non-compete agreements violate the attorney rules of professional conduct. See Valley Med. Specialists, 982 P.2d at 1282-83; Murfreesboro Med. Clinic, 166 S.W.3d at 683; Karlin v. Weinberg, 390 A.2d at 1171 (Sullivan, J., dissenting) (characterizing attorney-client and doctor-patient relationships as indistinguishable, noting each is consensual, highly fiduciary, and peculiarly dependent on the patient's or client's trust and confidence in the physician consulted or attorney retained). Tennessee's supreme court has ruled such agreements are against the public interest and are therefore unenforceable as a matter of law. See Murfreesboro Med. Clinic, 166 S.W.3d at 683-84. Other states' legislatures have outlawed them. See Colo.Rev.Stat. Ann. § 8-2-113(3); Del.Code Ann. tit. 6, § 2707; Mass. Gen. Laws Ann. ch. 112, § 12X (1991). Still other courts have interpreted their antitrust statutes as prohibiting such agreements, even though those statutes were not aimed specifically at agreements between physicians. See Odess v. Taylor, 282 Ala. 389, 211 So.2d 805 (1968); Bosley Med. Group v. Abramson, 161 Cal.App.3d 284, 207 Cal.Rptr. 477 (1984); Bergh v. Stephens, 175 So.2d 787 (Fla.Dist.Ct.App.1965); Gauthier v. Magee, 141 So.2d 837 (La.Ct. App.1962); W. Montana Clinic v. Jacobson, 169 Mont. 44, 544 P.2d 807 (1976); Spectrum Emergency Care, Inc. v. St. Joseph's Hosp. & Health Ctr., 479 N.W.2d 848 (N.D.1992). Other courts, however, continue to apply to non-compete agreements between physicians the same standards applicable in the ordinary commercial context and do not consider the difference between the doctor-patient relationship and ordinary commercial producer-customer relationship. See Raymundo v. Hammond Clinic Ass'n, 449 N.E.2d 276 (Ind.1983); Rash v. Toccoa Clinic Med. Assocs., 253 Ga. 322, 320 S.E.2d 170 (1984); Duneland Emergency Physician's Med. Group v. Brunk, 723 N.E.2d 963 (Ind.Ct. App.2000); Gant v. Hygeia Facilities Found. Inc., 181 W.Va. 805, 384 S.E.2d 842 (1989). We find that doctor-patient relationships are different from most other relationships between service providers and their customers. While the public has a strong interest in freedom of contract, that interest must be balanced against the public interest in upholding the highly personal relationship between the physician and his or her patient. While doctor-patient relationships are somewhat analogous to attorney-client relationships, requiring closer scrutiny than other consumer-provider relationships, regulating the practice of law is the business of this Court; regulating the practice of medicine is not. For that reason, an outright ban is unwise. [4] See Murfreesboro Med. Clinic, 166 S.W.3d at 685 (Holder, J., dissenting) (calling for a case-by-case analysis of the enforceability of non-compete provisions between physicians). Instead, the reasonableness of a particular non-compete provision should be left to the finder of fact in light of the interests involved. See Valley Med. Specialists, 982 P.2d at 1283. We adopt the view expressed by the supreme courts of Arizona and New Jersey. The extent of Intermountain Eye's interest in those patients Dr. Miller inherited when he joined the firm and those patients it provided him thereafter is limited by those patients' interests in continuity of care and access to the health care provider of their choice. Valley Med. Specialists, 982 P.2d at 1284; Karlin v. Weinberg, 390 A.2d at 1171. The reasonableness of the non-compete provision and practice fee was not evaluated against these interests and, therefore, a trial is necessary to determine whether the prohibition and practice fee are no more restrictive than necessary to protect these interests. The firm's interest in protecting the time, money, and resources it spent in assisting Dr. Miller in developing a viable medical practice is similarly limited, since protecting that interest includes a prohibition on treating patients with whom it had no relationship and thus no goodwill. See Weber v. Tillman, 913 P.2d at 92. In other words, perhaps the firm should be able to protect its investment in its employee and its own interest in the marketplace, but there is less justification for a firm to protect itself against competition for those patients with whom the firm has established no goodwill, given the patients' interests described above. The extent of that business interest, and whether the practice fee is no more restrictive than necessary to protect it, must be determined by the trier of fact. Another relevant factor in determining the extent of the firm's interest would be the degree to which Dr. Miller is using his former employment with Intermountain Eye to obtain patients. See Weber, 913 P.2d at 92 (protected interest exists where employee obtains unfair competitive advantage from employment with employer); Fields Found., Ltd. v. Christensen, 103 Wis.2d 465, 309 N.W.2d 125, 130 (Ct.App.1981) (unfair competitive advantage existed where employee's identification with the employer's goodwill made him a more formidable competitor). It may be that, since Dr. Miller appears to be an in-house employee of St. Luke's, his patients primarily or exclusively are persons assigned to him by the hospital and not persons who were obtained as patients during his tenure with Intermountain Eye. This will need to be considered on remand. An additional factor to consider is the degree to which the training provided by the employer enabled the physician to succeed on his own. Since these factors were not considered by the district court, further factual inquiry is necessary to determine whether the prohibition and practice fee are no more restrictive than necessary to protect those interests.