By Dr. Marcelo Hochman
The 2026 calendar year marks the final year before the full effect of Act 20 of 2023 — the Certificate of Need repeal — will be felt in South Carolina’s health ecosystem.
This law will unleash competitive forces in the marketplace and reshape how care is delivered across our state.
But the job is not finished. One critical omission remains: The General Assembly has yet to address employment non-compete agreements imposed on physicians.
When a physician is prevented from continuing to practice in the community they serve, patients don’t get to vote on that decision. The continuity of medical care — something every clinician is trained to protect — can be severed by an administrative clause about which patients don’t even know.
In medicine, the real consequence lands on patients.
In other industries, non-competes may protect trade secrets or competitive advantage. In health care, they restrict something far more personal: the relationship between a patient and the doctor they trust.
A non-compete doesn’t just tell a doctor where they can work. It dictates whether their family must move and whether they can continue providing care in the very community they may have served for years.
In rural areas — where access to care is already stretched thin — the effects are amplified.
One restrictive contract can leave thousands without timely access to a primary care doctor, surgeon, or specialist. Non-competes give employers control of the labor force and take that control away from the communities that depend on those physicians.
Non-compete clauses for physicians are ethically objectionable because they subordinate the physician’s duty to patients to the employer’s business interests.
They treat the doctor–patient relationship as if patients were assets of the hospital rather than autonomous people, which is inconsistent with the special moral status of medical care.
Physicians are fiduciaries, expected to put patient welfare ahead of financial or institutional interests. A non-compete imposed as a condition of employment creates a built-in conflict between that duty and an employer’s interest in protecting market share, making a physician’s ability to continue caring for patients dependent on corporate permission rather than clinical judgment or patient choice.
Non-compete clauses also strip patients of meaningful choice and continuity of care.
When a physician leaves an employer, these provisions can force the doctor to relocate or stop practicing locally, abruptly severing long-standing relationships and compelling patients to transfer care regardless of trust or preference.
Patients are never parties to these contracts, yet they bear the consequences when a trusted physician disappears from their community. Any agreement that makes it harder for physicians to meet their duty of non-abandonment places contractual obligations above professional ethics — a reversal that should give policymakers pause.
Unlike states that have taken legislative action, South Carolina’s approach to non-competes is governed almost entirely by case law.
On paper that means contracts must be “reasonable.” In practice, it leaves individual physicians to challenge large systems on their own — something few are willing or able to do.
Most doctors will not risk becoming a test case, fearing retaliation or years of costly litigation.
The result is predictable: non-competes go largely unchallenged, even as their use expands.
Some South Carolina health systems use non-competes; others do not. National systems that operate in states where non-competes are restricted or prohibited function perfectly well without them, demonstrating these clauses are not essential to stable hospital operations.
Recent scrutiny of non-compete clauses has highlighted a broader gap: oversight reaches only certain entities. In a state like ours — where nonprofit systems dominate — outside enforcement often ends just as the impact on patients begins.
A patient doesn’t feel the difference between a for-profit and nonprofit employer when their doctor is suddenly forced to stop practicing in their community.
What they feel is loss, disruption, and too often the burden of starting over with a doctor assigned to take over their care.
Consider this: Lawyers are prohibited from blanket non-competes, and many lawmakers are attorneys themselves. Patients lose access to their doctors, and physicians lose the ability to practice freely in the communities that need them.
Health care is not a commodity; patients are not assets and doctors are not indentured servants.
South Carolinians deserve a system built around their right to choose who cares for them. If we want a stronger, healthier future for our state, removing non-competes as a condition of employment in medicine is one of the most impactful steps our Legislature can take — for patients, for physicians, and for every community that relies on us.
Dr. Marcelo Hochman is a double board-certified facial plastic and reconstructive surgeon and the president of Independent Doctors of South Carolina. He is the founder of The Facial Surgery Center and an advocate for physician autonomy, patient choice, and access to independent medical care. Hochman writes and speaks on health care policy and reforms that strengthen community-based care. He lives in Charleston County and has received the Order of the Palmetto for his humanitarian medical efforts.
