Other states, such as Texas and Tennessee, place limits on the agreements. In Texas, for example, a noncompete pact must allow doctors to have access to a list of their patients in the past year and access to their medical records, among other things, Mr. Clark found.
Medical board rules take it a step further. “In Texas, when a physician leaves, the practice is required to cooperate with a physician who wants to put up a notice that says this is where that physician can now be contacted,” said Kathy Poppitt, a partner in the health care and government and internal investigations practices at the Austin, Texas, office of King & Spalding.
The American Medical Association, which represents doctors, doesn’t oppose restrictive covenants outright, although its policy notes they can limit patients’ choices. “To the extent that these agreements disrupt continuity of care and disrupt patient choice, this is of great concern to the A.M.A.,” said Dr. Patrice Harris, the organization’s president-elect.
For patients in central Iowa, the departures of longtime urologists at the Iowa Clinic is dizzying. After Dr. Kellerman and his colleagues left, five of the clinic’s remaining seven urologists submitted their resignations. They are also subject to noncompete restrictions. They left the practice in mid-February.
Mr. Brown, the clinic’s chief executive, said the urology department had replaced four of the eight urologists and has nine nurse practitioners or physician assistants to treat patients. The clinic is continuing to recruit physicians and advanced practice providers like nurse practitioners.
Susan Murphy, 72, has seen a number of doctors in the urology department there. Dr. Richard Glowacki, one of the urologists who left with Dr. Kellerman, performed surgery to remove her kidney stones over a decade ago. Another, Dr. Stephanie Pothoven, did surgery to repair her prolapsed uterus a few years ago.
Ms. Murphy said she got a letter from Dr. Pothoven announcing her departure. It didn’t provide details about where she would be going.
“I’ve got it etched in my brain to find out where they went,” she said. She has no plans to return to the Iowa Clinic. “Somehow they lost sight of patient care and were more concerned about the bottom line,” she said.