Physicians for Act 432 is a non-profit group of physicians and community supporters. We provide a safe way, free from retaliation by health systems, for physicians to educate and advocate to restore the primacy of the patient-doctor relationship, re-enfranchise the voice of the physician, and secure the future of quality health care.

We believe that by working together we can raise the bar of care back to where it belongs.

Modern healthcare in America has evolved through unique transactional relationships involving four traditionally independent entities: 1) physicians, 2) hospitals/health systems, 3) payors (governmental & private) and 4) institutions of research and higher education. While not perfect, these relationships have produced a high standard of acute care and a platform capable of addressing most contemporary healthcare challenges. Fundamental to the interdependent success of the four has been preservation of the independent nature of each. Thus, the health of our population is dependent upon a tenuous system of checks and balances developed between these entities.

Because of marked inequality in economic strength, physician independence is most vulnerable to being diminished or lost. What makes this critical is that, of the direct and indirect partnerships patients have with each of the four entities, the patient-doctor relationship is the one in which the most immediate and personal care decisions are made. Therefore, it is the independent voice of the physician that most frequently must advocate for appropriate best treatment of the patient.

Over the past 30 years, communities have experienced progressive alignment between doctors and hospitals through employment of most community physicians by large health care systems. While such alignment has advocates and care coordination is a legitimate benefit of integrated health care systems, the checks and balances of the transactional interaction between the doctor and the hospital have not been maintained and the independent voice of the physician has been sacrificed.  This imbalance has created a dominance by the more financially powerful entities (the corporate health systems and the payors) and loss of the checks and balances that assure primacy of the patient-doctor relationship and preservation of the independent voice of the physician.

Attempts by doctors to reestablish their independence and the primacy of the patient-doctor relationship have been thwarted by the health systems through market control, retribution for leaving employment, and retaliation for attempting to compete as independent providers. In places like The Upstate, this has resulted in the most expensive care in the southern United States, loss of patient choice, suppression of independent physician decision-making, corporate control of patient care resources, and de-emphasis of academics threatening the quantity and quality of doctors serving the community now and in the future. 

While Act 432 was created to govern health care in Upstate South Carolina, we believe its spirit is universal — rooted in what every patient, physician and elected leader wants for their community.

The Upstate South Carolina legislative delegation had the foresight in 1947 to establish by statute SC Act 432 a political subdivision (special purpose district) governed by a board of trustees to facilitate access to health care and promote the well-being of the citizens of Greenville County and beyond. Through the years the trustees have been wise stewards of regional health—insisting that the management team and medical staff: 1) establish the best facilities and the highest standard of care possible; 2) assure the primacy of the patient-doctor relationship, value the physician voice, and support physician leadership unencumbered by corporate or governmental interference; 3) provide access to care for all; 4) commit to development of the future healthcare workforce through academics; and 5) maintain fiscal responsibility. These have become known as the operating ideals of statute Act 432.

In 2016, in an effort to achieve scale, the trustees (known now as the Greenville Health Authority or GHA) leased all assets of the political subdivision, including the facilities and its 2000+ physician/extender providers, to a private nonprofit organization for management. In the terms of that lease (and the amended statute defining the responsibilities of the GHA trustees to oversee the lease), several Act 432 ideals failed to be specified.  Most notable of these were commitments to physician leadership, primacy of the patient-doctor relationship, and dedication to academics for development of the future workforce.

While the trustees may have reasonably satisfied their lease oversight obligations, it is the opinion of many long-time community physicians that the trustees have failed to meet their fiduciary responsibilities as it pertains to upholding the traditional ideals of Act 432 .

By working together, physicians, patients and community leaders can hold trustees and health systems accountable for fulfilling their obligations to our communities – and not just in Upstate South Carolina. Ours is a message relevant everywhere.