How the physician-hospital relationship is changing

Six physicians recently joined Becker's to discuss the relationship between physicians and the hospitals they work for. 

Editor's note: These responses have been lightly edited for length and clarity. If you would like to contribute to our next question, please email Paige Haeffele at

Question: How is the physician-hospital relationship changing in your market?

Adam Bitterman, DO. Chairman of Huntington (N.Y.) Hospital Department of Orthopedic Surgery and Assistant Professor at Zucker School of Medicine at Hofstra/Northwell (Uniondale, N.Y.): The relationship between doctors and the hospital is extremely dynamic. While care models demonstrate that certain cases should be completed in an outpatient setting, there will continue to be extremely complex medical and surgical cases that require the management of an inpatient setting. Doctors must continue to collaborate with hospitals in order to provide care for the sickest patients while those physicians in the outpatient setting facilitate efficiency and maintain the highest levels of quality care. Cost of care will continue to be an important discussion point for all physicians across the healthcare continuum, whether inpatient or ambulatory. 

Jeff Carstens, MD. Service Line Medical Director and Cardiologist at UnityPoint Health (Des Moines, Iowa): I think that the physician-hospital relationship is always in a state of evolution.  At UnityPoint Health, we have the opportunity to work with employed and independent physicians, including some who are owned by private equity. We strive to maintain a strong focus on patient outcomes as well as continue to grow our programs. There is certainly some tension in markets where ASCs are developing, but I think coming back to what is best for patients helps to drive decision-making on both sides and helps to maintain provider engagement. This has led to the opportunity to grow our inpatient census as well as procedure volumes in our markets.

Scott Huitink, MD. Pediatrician at Compass Pediatrics (Gallatin, Tenn.): Hospitals and hospital administrators are having to work harder and harder to demonstrate value in the market. As outpatient care is growing and the expense of healthcare is magnified when care is delivered through a hospital system, physicians are finding ways to provide high-quality care that is no longer dependent upon the very expensive brick and mortar of hospitals. Examples of changes in the market where physician and patient desires more closely align without the additional burden of the hospital include telemedicine, mobile clinics, outpatient surgery centers, free-standing ERs and direct primary care. Physicians and patients are learning how to survive and thrive without the hospital. 

Terry Lichtor, MD, PhD. Neurosurgeon and Professor at Rush Medical Center (Chicago): Hospitals, unfortunately, in my opinion have a negative impact on patient care and the physician relationship. First of all, hospitals only seem interested in making money and not what is best for patient care. I am a neurosurgeon and although I do most procedures and all emergency procedures, nobody in this field does everything. There are some procedures that I do not have a lot of experience with and think that it is in the best interests of the patient to transfer to a surgeon with more experience with that procedure, but hospitals do not like this practice. They seem only concerned about losing a patient to another facility.  

I have gotten a variety of complaints over the years and the hospitals never support a physician like me. 

In summary, I would say that hospitals really only care about their profits and not about good patient care or good relationships with the physicians. I have not noticed much change regarding that issue over many years. As you know, the healthcare business has become very competitive and several hospitals in this area have closed. This is in part because Illinois Medicaid pays very little, and Medicare does not pay much more. Healthcare in itself is expensive and in Illinois malpractice is a major issue for all providers and hospitals.

Richard Vaglienti, MD. Associate Professor of Anesthesiology, Behavioral Medicine and Psychiatry and Neuroscience and Director of Pain Services, WVU Hospital (Morgantown, W.Va.): I practice in an academic setting where all the physicians are employed by the school of medicine. However, we exist within a larger health system that employs some of its own physicians also. This arrangement can complicate things because of duplication of services and internal competition for patients. Some of the service duplication is necessary due to geographic and economic impediments patients must deal with to receive care. Obviously, physicians are more often than before choosing employment arrangements over private practice.

These arrangements can decrease the burden of running a practice, but unfortunately that time is rapidly filled with insurance and other documentation requirements and other non-patient care activities.

Thomas Vail, MD. Professor and Chair Emeritus at University of California Department of Orthopedic Surgery (San Francisco): The SF market seems to resemble other areas of the country where consolidation of musculoskeletal providers is occurring. Small practices are having a hard time competing and accessing provider networks established by health systems and foundations. This circumstance has led to practice mergers to create larger independent entities that can compete more effectively, dissolution of some practices, and transition of some independent practices to health systems or foundations in employed or integrated practice models.

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