The ongoing development of new diagnostic and therapeutic options in medical science, along with the associated complexity of treatment, has led medical service providers to rely on a division of labor and a team-oriented service organization. The implementation of process optimization in hospitals becomes problematic when it results in a decline in outcome quality, which in turn poses an unacceptable increase in the risk of complications for patients. This can occur when medical tasks are systematically delegated to personnel who are not sufficiently qualified for these responsibilities in order to save on personnel costs, or when the concentration of medical specialists on purely medical activities is intended to create professional incentives. This study addresses the existing uncertainty regarding the civil law foundations of vertical division of labor and provides a legal dogmatic solution, taking into account relevant case law as well as the positions of medical professional societies.