Under Texas law, certain healthcare services may be provided only by
specified types of entities. The Texas Business Organizations Code (TBOC)
classifies these entities as “professional entities,” characterized by the fact
that they provide “professional services.”[1] A professional service,
as defined by the TBOC, is any type of service “that requires, as a condition
precedent to the rendering of the service, the obtaining of a license in this
state,” including but not limited to the personal services provided not only by
physicians, but also by architects, attorneys, certified public accountants,
dentists, and veterinarians.[2]
This article surveys the
three types of entities that may provide healthcare services in Texas:
professional associations (PAs), professional corporations (PCs), and
professional limited liability companies (PLLCs). While the TBOC contains
provisions that are specific to professional entities, PAs and PCs are also
subject to the TBOC provisions governing non-professional corporations and
PLLCs are subject to the TBOC provisions covering non-professional limited
liability companies to the extent that they do not conflict with the provisions
specific to professional entities.[3] Choice of entity will
depend on the type of healthcare services to be provided and preferences of the
owners regarding governance and structuring of the entities.
Professional Associations. A PA is the most restrictive
type of professional entity. A PA may be formed only for the purpose of
providing professional services rendered by the following: doctors of medicine
or osteopathy, podiatrists, dentists, chiropractors, optometrists and
therapeutic optometrists, veterinarians, and licensed mental health professionals.[4] The list is exclusive.
No other type of licensed professional can own or provide services through a
PA. The owners of a PA are referred to as members. A PA may provide services
only through individuals licensed by the State of Texas to provide the same
service that the PA provides.[5] For example, only
physicians licensed by the Texas Medical Board can own a PA engaged in the
practice of medicine. As with a business corporation, the members may adopt
bylaws for the PA.[6] A PA is governed by a
board of directors or an executive committee elected by the members.[7]The board or executive
committee elects officers, which must include a president and secretary.[8] All officers and all
members of the board or executive committee must also be members of the PA, and
the president of a PA must also be a member of the board or executive
committee.[9]
Professional Corporation. A PC is structurally
much like a PA except that a PC cannot be formed for the practice of medicine
by physicians, surgeons or other doctors of medicine.[10] All other types of
healthcare services that can be provided by PAs can also be provided by PCs. In
addition, many types of health care services that are not permitted to be
provided by PAs can be provided by PCs, including but not limited to services
provided by audiologists, dental hygienists, EMS personnel, nurses, physical
therapists, and physician assistants. The PC is also less restrictive than the
PA in terms of permissible owners. While a PA may be owned only by individuals
licensed to provide the service that the PA provides, a PC may be owned by
appropriately licensed individuals or other professional entities.[11]Furthermore, while a PA may
only provide its services through individuals licensed by the State of Texas, a
PC may provide services through individuals licensed by the State of Texas or
another jurisdiction.[12]Except for the requirement
that directors and officers of a PC must be licensed professionals, the rules
regarding governance of a PC are much like those that are applicable to
non-professional corporations.[13]
Professional Limited Liability Company. The PLLC is the least
restrictive form of professional entity. Any type of healthcare service that
may be provided by a PA or a PC may also be provided by a PLLC. Therefore,
while doctors of medicine and osteopathy may form and practice through PAs but
not PCs, they, along with all other types of licensed healthcare professionals,
may form and practice through PLLCs. Like PCs, a PLLC may be owned by
appropriately licensed individuals or by other professional entities that
provide the same service as the PLLC.[14] A PLLC may elect to be
governed either by its members or by managers. Unlike either a PA or a PC, a
PLLC’s governing authority, whether managers or members, may include either
appropriately licensed individuals, professional entities providing the same
service as the PLLC, or both.[15] A PLLC is not required
to have officers, but if it does, each officer must be a licensed professional
individual.[16]
Group Practices. The general rule set by the
TBOC is that a professional entity may provide only one type of service and may
render that service only through individuals who are licensed to provide the
same professional service as is provided by the professional entity.[17] Strictly read, this
would mean that a medical practice group organized as a professional
association could only employ or provide services through doctors and not any
non-physician personnel. In order to allow such physician groups to function,
the TBOC states that its provisions shall not be construed to prohibit a
professional entity “from employing nurses or from employing individuals who do
not, according to general custom and practice, ordinarily provide a
professional service, including clerks, secretaries, bookkeepers, technicians,
or assistants.”[18]
Professional entities are generally limited to providing only one type of
service, but the TBOC does permit certain types of healthcare providers to
jointly practice and provide services through a single professional entity.
Specifically, the following types of healthcare providers may jointly form PAs
or PLLCs: (1) doctors of medicine, osteopathy, and podiatry;[19] (2) doctors of medicine
and/or osteopathy and optometrists, including therapeutic optometrists;[20] and (3) professionals
other than physicians “engaged in related mental health fields such as
psychology, clinical social work, licensed professional counseling, and
licensed marriage and family therapy.”[21] In addition, licensed
physicians and licensed physician assistants may jointly form, own, and
practice through a PA or PLLC, though restrictions apply. The restrictions,
which are intended to ensure that physician assistants will not interfere with
the practice of medicine by physicians, prohibit physician assistants from
serving as officers of the entity and from owning, collectively, a majority
ownership interest in the entity. Furthermore, no individual physician
assistant may own an interest in the entity that is greater than or equal to
the interest owned by any individual physician.[22]
In choosing the type of entity to provide healthcare services, the rules of
the TBOC that govern professional entities must be observed and tax
considerations may also play a role. All professional entities are subject to
the Texas franchise tax, but PAs and PCs will be taxed as corporations, as
opposed to partnerships or pass-through entities, unless they elect otherwise.
In addition to consulting a tax professional, one must also take care to choose
an entity form that is permitted to provide the service or services in question
and to structure it appropriately.
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