Hospital-Physician Relations: Cooperation, Competition, Or Separation? | Health Affairs | 12.5.06
Because many services performed in hospitals can safely and conveniently be performed in ambulatory settings, physicians have become owners of entities directly competing with hospitals for patients in a new medical arms race. Hospitals and medical staff physicians face growing tensions as a result of physicians’ growing reluctance to take emergency department call and the consequences of hospitalists replacing physicians in the care of inpatients. Although there are increasing expectations that health system challenges will lead hospitals and physicians to collaborate, in many markets the willingness and ability for hospitals and physicians to work together is actually eroding.
More incentivized behavior and more fractioning of physician services:
- Hospital Associated:
- Emergency Medicine
- Hospitalists
- Intensivists (↑ eICUs)
- Radiology (teleradiology, nighthawking)
- Pathology
- Specialists (all kinds ↓ )
- Primary Care (↓, hospitalist impact)
- Hospital Non-Associated
- Specialists (all kinds ↑ )
- Primary Care (↓, hosptialist impact?)
- Radiology
Is the time coming that all “on-call” services will be paid for by hospitals, all the time? Seems the only way to stave off further movement of physicians to hospital non-associated venues. There are only two ways to incentivize the reverse trend: make hospital non-associated venues unattractive (regulated to the same degree as hospitals; EMTALA?) or make hospitals more attractive (which means money).
