Medical Practice Agreement (Pakistan)

A Medical Practice Agreement in Pakistan sets out the mutual obligations the parties accept and the terms that govern their dealings.

The Medical and Dental Degrees Act 1975 (Act No. XVI of 1975) is the foundational statute governing the recognition of medical and dental degrees and the qualifications required to practise medicine in Pakistan. The Act requires that all persons practising medicine or surgery in Pakistan hold a recognised qualification from a medical institution listed in the schedule to the Act, or an equivalent foreign qualification recognised by the Pakistan Medical Commission (PMC). A Medical Practice Agreement must state the PMC registration number of each practitioner, confirming that all parties are legally qualified to practise under the Medical and Dental Degrees Act 1975.

The Pakistan Medical Commission Act 2020 (PMC Act 2020, Act No. XXX of 2020) replaced the Pakistan Medical and Dental Council (PMDC) with the Pakistan Medical Commission as the regulatory authority for medical education and the registration of medical practitioners. Under the PMC Act 2020, only practitioners registered with the PMC may lawfully practise medicine or surgery in Pakistan. The PMC maintains a public register of all registered practitioners and issues annual renewal certificates. A Medical Practice Agreement between practitioners who are not both registered with the PMC is potentially void as a contract for an illegal purpose under Section 23 of the Contract Act 1872.

The Contract Act 1872 (Act No. IX of 1872) governs the general contractual terms of a Medical Practice Agreement — offer and acceptance, consideration, free consent, and the capacity of parties to contract. The provisions of the Contract Act 1872 on partnership (Sections 239–266) and agency (Sections 182–238) are also relevant where the medical practice arrangement involves profit-sharing or where one practitioner acts on behalf of another.

Provincial Healthcare Commission Acts — the Punjab Healthcare Commission Act 2010, the Sindh Healthcare Commission Act 2013, and their KPK and Balochistan equivalents — regulate the licensing of healthcare facilities in each province. A Medical Practice Agreement that involves the establishment of a clinic, hospital, or diagnostic centre must comply with the provincial healthcare commission's facility licensing requirements, including minimum infrastructure standards, equipment requirements, and staffing ratios. The Punjab Healthcare Commission (PHC) and Sindh Healthcare Commission (SHC) both require that the owner or medical director of a licensed facility be a registered medical practitioner.

The West Pakistan Industrial and Commercial Employment (Standing Orders) Ordinance 1968 and the Industrial Relations Act 2012 (IRA 2012) apply where junior doctors, house officers, or paramedical staff are employed under the medical practice arrangement. The agreement must address employment law compliance, including payment of EOBI contributions under the Employees' Old-Age Benefits Act 1976, social security contributions under the Pakistan Employees Social Security Ordinance 1965, and the National Minimum Wage prescribed under the Minimum Wage Ordinance 1961.

A Medical Practice Agreement in Pakistan is required whenever two or more registered medical practitioners, or a practitioner and a healthcare institution, establish a formal arrangement for the joint provision of medical services.

A Medical Practice Agreement is needed when two or more specialists — such as a cardiologist and a cardiac surgeon, or a group of general practitioners — establish a group practice or polyclinic in Karachi, Lahore, Islamabad, or any other Pakistani city. The agreement governs how patients will be managed, how revenues from consultation fees and procedures will be shared, how expenses for clinic rental, staff, and equipment will be allocated, and how the arrangement can be terminated if one partner wishes to leave.

A Medical Practice Agreement is required when a hospital or large healthcare institution — a private hospital regulated by the provincial Healthcare Commission, a military hospital operated by the armed forces medical services, or a mission hospital — engages a specialist physician or surgeon as a visiting consultant or on-call specialist. The agreement must specify the practitioner's session schedule, fee structure, billing arrangements, on-call obligations, and professional liability arrangements.

A Medical Practice Agreement is needed when a senior specialist doctor agrees to mentor and supervise a junior doctor or house officer in a private clinic under a supervised practice arrangement approved by the Pakistan Medical Commission. The PMC's supervised practice framework requires a formal agreement between the supervising senior practitioner and the supervised junior doctor, defining the scope of supervised clinical activities.

A Medical Practice Agreement is required when an overseas-trained Pakistani doctor — a practitioner who received their qualification abroad and has obtained PMC recognition of their foreign degree under the Medical and Dental Degrees Act 1975 and the PMC Act 2020 — enters into a practice arrangement with a local hospital or existing practice to establish their Pakistani practice.

A Medical Practice Agreement is needed when a telemedicine platform — operating under guidelines issued by the Pakistan Medical Commission for telemedicine practice — engages registered doctors to provide online consultations. The DRAP Act 2012 and PMC guidelines on telemedicine (issued as circulars following the COVID-19 pandemic) require documented arrangements between telemedicine platforms and RMPs.

A Medical Practice Agreement is required when two previously independent practices merge — for example, a dental clinic and a medical clinic combining into a multi-specialty outpatient department (OPD) — requiring clear documentation of the merged entity's governance, patient records management, and revenue arrangements to satisfy provincial Healthcare Commission licensing requirements.

A valid Medical Practice Agreement in Pakistan under the PMC Act 2020, the Medical and Dental Degrees Act 1975, and the Contract Act 1872 must contain the following essential elements.

Practitioner Identification and Qualifications: Full legal name, CNIC number, PMC registration number, and recognised medical degree of each practitioner party. The PMC registration number must be current and in good standing — the agreement should include a representation by each practitioner that their PMC registration is valid and will be maintained throughout the agreement's term. Lapsed or suspended PMC registration automatically disqualifies a practitioner from practising under the arrangement.

Nature of Practice Arrangement: An explicit statement of the legal structure of the practice — whether it is a partnership under the Partnership Act 1932, an employer-employee relationship, an independent contractor arrangement, a fee-sharing arrangement, or a hospital-consultant visiting arrangement. The legal structure determines the tax treatment (Federal Board of Revenue (FBR) income tax on professional income under the Income Tax Ordinance 2001), liability exposure, and applicable labour laws.

Scope of Practice: A description of the medical specialties, services, and procedures each practitioner is authorised to provide under the arrangement, consistent with their PMC registration specialty. The agreement must not authorise practitioners to perform procedures outside their recognised specialty, as this would violate PMC ethical standards and expose the practice to regulatory action.

Practice Location and Facility: The address and description of the clinic, hospital, or healthcare facility where practice will be conducted, including the provincial Healthcare Commission facility licence number. Any satellite locations or outreach clinics must also be specified.

Schedule and Availability: The practitioner's agreed weekly schedule — consultation hours, operating theatre sessions, ward rounds, on-call duties, and leave arrangements. The schedule must comply with the Working Hours regulations applicable under provincial labour law and the PMC's guidance on safe working hours for medical practitioners.

Revenue Sharing and Billing: The mechanism for fee collection — whether patients are billed by the facility with the practitioner receiving a fixed salary, a percentage share of fees, or a specified fee per consultation or procedure. The billing arrangement must comply with the Income Tax Ordinance 2001 withholding tax requirements on professional fees (Section 153 WHT) and the Sales Tax Act 1990 if the practice is registered for sales tax.

Expense Allocation: How practice expenses — clinic rental, staff salaries, utility bills, medical supplies, equipment maintenance, medical indemnity insurance premiums, and provincial Healthcare Commission licence fees — are allocated between the parties.

Professional Indemnity: A statement that each practitioner maintains adequate professional indemnity insurance or is covered by the facility's medical liability policy. Professional indemnity insurance is not yet compulsory in Pakistan under any statute, but is strongly recommended given the increasing volume of medical negligence claims in Pakistani civil courts.

Patient Records and Confidentiality: Compliance with PMC ethical standards on patient confidentiality and record-keeping. Patient records are the property of the facility but must be accessible to the treating practitioner. Data protection obligations under the emerging Personal Data Protection framework must be addressed.

Non-Competition: A time-limited, geographically reasonable non-competition clause — confirming that a departing practitioner does not immediately establish a competing practice within the same locality and approach the shared practice's patients. Under the Contract Act 1872, Section 27, agreements in restraint of trade are void unless reasonable — courts in Pakistan have upheld non-competition clauses in professional service agreements that are proportionate in time (maximum two years) and geographic scope.

Termination: Notice period for termination (typically three to six months for specialist practitioners), provisions for handling pending patient appointments and ongoing patient care responsibilities upon termination, and the treatment of receivables and work in progress.

Forms-legal.com provides this Medical Practice Agreement (Pakistan) template as a practical starting point for medical practitioners and healthcare institutions. Given the complex regulatory environment — PMC oversight, provincial Healthcare Commission licensing, FBR tax obligations, and labour law compliance — parties should obtain advice from a healthcare law specialist or an advocate enrolled at a provincial Bar Council before finalising the agreement.