What North Carolina Physicians Should Know About Practice Drift
Physicians in North Carolina are held to high professional standards by the North Carolina Medical Board (NCMB). One issue the Board monitors closely is known as “practice drift”—when a doctor gradually (or suddenly) begins working in a clinical area outside their original training or specialty.
What Is Practice Drift?
“Practice drift” occurs when a physician shifts into a new clinical domain without formal training or certification in that field. For example, a family medicine physician may start performing cosmetic procedures, or a general practitioner may move into pain management or hormone replacement therapy.
The NCMB has a position statement on practice drift. However, it is vague and provides little detail or examples to guide physicians. In essence, the Board’s view can be summarized in one sentence:
If you are going to provide care in an area where you lack formal training, you must first educate yourself or obtain proper training.
Regardless of training, the NCMB will hold a physician to the same standard of acceptable and prevailing medical practice in the specialty area where the care was provided.
Why Practice Drift Matters to the NCMB
The NCMB’s mission is to protect patients. Practice drift raises concerns about competency, safety, and professional judgment. Even if a physician’s intentions are good, practicing outside their scope can expose patients to risk—and can trigger a Board complaint.
Lessons From the Legal Profession
Like doctors, lawyers also face restrictions when expanding into unfamiliar areas. The North Carolina State Bar prohibits attorneys from handling cases in practice areas where they are not competent—unless they (1) associate with a lawyer experienced in that field, or (2) devote the time and effort to educate themselves.
Physicians are expected to approach new areas of practice with the same mindset. In today’s information-rich world, lack of education should never be the reason for substandard care.
When Does Practice Drift Make Sense?
Appropriate practice drift: Pursuing a new field that requires significant additional training, education, or certification—for example, a physician formally retraining in a specialized area of medicine.
Inappropriate practice drift: Reverting to patient care that relies on only a basic or outdated understanding of medicine without relevant training, or adopting procedures outside your competency.
Physicians alleged to have “drifted” without the necessary expertise must either educate themselves thoroughly in the new specialty or avoid drifting into areas where they lack knowledge.
Potential Consequences of Practice Drift in North Carolina
If the NCMB believes practice drift has occurred, physicians may face:
Investigations into their scope of practice.
Consent orders requiring training, monitoring, or restrictions.
Public discipline posted permanently on the NCMB website.
In severe cases, suspension or revocation of their license.
Even without patient harm, the appearance of practicing outside your training can lead to serious licensing issues.
Protecting Yourself as a Physician
To minimize risk:
Stay current on CME and document all additional training.
Avoid advertising or offering services where you lack formal expertise.
Seek supervision or mentoring when expanding into a new clinical area.
Consult with legal counsel at the first sign of a Board inquiry.
How Attorneys Helps Physicians Facing Practice Drift Allegations
At Brooks Peterson PLLC, we defend physicians under investigation by the North Carolina Medical Board. If you’ve been accused of practice drift, we can:
Review the allegations and help you prepare a strong response.
Communicate directly with the Board on your behalf.
Defend you in interviews, hearings, or settlement negotiations.
Work to protect your license, career, and reputation.
This is not legal advice. If you do need legal representation call the office at: 919-616-3317