If agreement on vision and value is not possible, there is little chance of future success. Value may be more a matter of customer service than shared financial gain. A hospital may not need or want the degree of operational and governance entanglement that is a consequence of investing large sums in physician groups. When both sides stand back and identify what is really important to them, they may find that a high level of financial integration is not required. Hospitals and physicians tend to do better when they have less economic interdependence.
Physician leadership is essential to group practices, particularly in their formative years.
Physicians will grow into these positions, but they need to be given the time and tools to become effective. During the transition period, these doctors will face pressure from many constituencies. A group practice CEO, particularly in a start-up group, will not be able to dictate results. He or she will have to build consensus in the group for any significant change before it can be implemented. Hospitals may be frustrated by the lack of a clear and decisive hierarchy, but they must understand that that is the reality of a professional service organization.