District of Columbia's Corporate Practice of Medicine Doctrine: Navigating Flexible Enforcement for Telehealth and Medspa Operations

The Corporate Practice of Medicine (CPOM) doctrine is a foundational principle in healthcare regulation across the United States, generally prohibiting corporations, or other unlicensed entities, from employing physicians or otherwise interfering with the independent professional judgment of licensed medical practitioners. The District of Columbia (DC) upholds a CPOM doctrine, though its enforcement and interpretation are often characterized as more flexible compared to states with explicit statutory prohibitions.

Understanding DC's CPOM Framework

Unlike many states that have explicit statutes or regulations outlining the CPOM doctrine, DC's prohibition is largely derived from common law principles, interpretations of professional licensing acts, and ethical guidelines. The core principle is that medical decisions and the practice of medicine must remain under the control of licensed professionals. Unlicensed individuals or entities cannot own a medical practice, employ physicians, or direct clinical care.

While DC does not have a single, overarching statute explicitly codifying CPOM, the prohibition is inferred from various sources, including:

• Professional Licensing Acts: The DC Health Occupations Revision Act of 1985 (D.C. Official Code § 3-1201.01 et seq.) establishes the framework for licensing and regulating health professionals, including physicians, nurses, and other practitioners. These acts define the scope of practice and implicitly restrict who can engage in or control the practice of medicine.
• Board Regulations and Opinions: The DC Board of Medicine, like other professional boards, issues regulations and advisory opinions that reinforce the independence of medical judgment and the prohibition against unlicensed practice. These often address scenarios where corporate entities might exert undue influence.
• Common Law and Attorney General Opinions: Historically, common law principles in DC have supported the CPOM doctrine, and past Attorney General opinions have sometimes addressed the legality of certain corporate structures in healthcare.

What 'Flexible Enforcement' Means in DC

When discussing DC's CPOM, the term