Financial incentives are finally forcing hospitals and physicians to work more closely than ever. In many cases, that means the hospital or health system buys the practice. But that doesn't equal alignment, as we've written many times here and elsewhere.
In fact, physician autonomy and alignment are far from mutually exclusive. Physician practice autonomy is still possible. It just requires a different kind of ownership.
This month, I wrote the cover story in HealthLeaders magazine, in which we took a look at the rapidly changing dynamic in physician and executive relationships. Those relationships have always been important, but in the past have been driven by a culture of suspicion and distrust.
As one of my key sources for the story put it to me, the cultures historically could be described thusly: One has corporate, bureaucratic, top-down governance, and the other a professional, collegial, familial culture that is very informal.
"Those two structures are at opposite ends of the business spectrum. As a consequence, even the sheer decision-making process between the orgs is misunderstood and often portrayed as being untrustworthy," says Ed Brown, chief executive officer of The Iowa Clinic, one of the few remaining independent physician group practices in the state.
"Iowa is probably the most integrated state in the country, as it relates to physician practices," he says.