Patients rarely see the contracts behind their care, but physicians feel them every day. And one contract clause in particular (the non-compete) is quietly worsening the physician shortage and blocking patients from seeing the very doctors who want to care for them.
I learned this firsthand.
After serving as a neurologist and EEG medical director in Portsmouth, Virginia, I was forced out of my role under a two-year non-compete. The restriction forbids me from practicing neurology anywhere within 15 miles of my former hospital system. That radius covers the entire community where many of my patients live, and the community I still call home.
Portsmouth already struggles with a shortage of neurologists. Patients wait months for appointments. Emergency departments call repeatedly trying to find coverage. Hospitalists stretch themselves thin managing complex neurological cases while hoping a specialist will return their call.
Removing even one neurologist from a community like this creates ripples: longer wait times, fewer outpatient slots, fewer inpatient consults, and days when the hospital has no neurological support at all.
Non-compete clauses were originally designed to protect legitimate business interests (things like proprietary processes or confidential client lists). But patients are not clients to be retained by an employer. They are members of a community whose access to care should not depend on whether a hospital chooses to enforce a contract.
Yet nearly 45 percent of physicians are bound by non-competes, according to the American Medical Association. In many cities (especially smaller ones) a non-compete covers every nearby hospital, effectively removing a doctor from the region entirely.
That’s not just a workforce issue; it’s a patient access issue.
The Association of American Medical Colleges projects a shortfall of up to 124,000 physicians by 2034. Neurology and psychiatry are among the hardest-hit specialties. Meanwhile, states like Virginia continue to enforce non-competes that prevent experienced specialists from practicing within driving distance of their own homes.
The burden falls hardest on safety-net communities. Portsmouth, like many medically underserved cities, already struggles to recruit and retain physicians. Broad non-competes don’t just “protect business interests.” They remove essential services from the very patients who can least afford to travel.
The fix is not complicated, and several states have already taken action.
California, North Dakota, and Oklahoma ban physician non-competes outright. The Federal Trade Commission has proposed a national rule that would invalidate most such contracts entirely. Even the AMA (once a defender of non-competes) now acknowledges that they disrupt continuity of care.
Virginia, and states like it, can do better. Reform could include:
- Prohibiting non-competes for physicians and advanced practitioners in designated shortage areas.
- Requiring hospital systems to justify any remaining restrictions by demonstrating true competitive risk.
- Allowing physicians to buy out non-competes at fair market value so they can remain in their communities.
These changes would not harm hospitals. They would strengthen trust, improve retention, and, most importantly, ensure that patients in underserved areas have the access they deserve.
Every week I hear from patients asking when I will be allowed to return to Portsmouth. I want to serve them again. I want to continue caring for the community that trained me, supported me, and trusted me.
Non-competes may protect corporate boundaries. But they do not protect patients.
It’s time for states to choose community health over contractual geography.
Sharisse Stephenson is a neurologist.
