The CFA Perspective

Physician Employment Isn’t Always Equal to Alignment

Posted by Peter Rastello

1/17/12 5:06 PM

We have commented on this subject before (please see Physician/Hospital Integration and Pushback, posted April 22, 2011), but the issue was brought home to us recently by a client’s circumstances.  One would hope that when a hospital system merges with the largest multispecialty physician practice in their service area, a truly integrated system would be created and effective physician/hospital alignment would be achieved.  This is not necessarily so.  As we’ve said before, employment does not always equate to alignment; and alignment is not integration. 


This hospital system has a large, successful cardiovascular program staffed by a number of employed cardiologists. Some of the issues CFA found in the system were these:


  • Lack of strong physician involvement, leadership and commitment to successful management of the program.
  • Poor relationship between some physicians and cardiology staff leading to attitudes and behaviors that contributed to poor team-building and generally low morale.
  • Lack of a high level of coordination of care and collaboration between cardiology, cardiac surgery and vascular services.
  • Significant salaries with very limited pay-for-performance expectations in the employment agreements.
  • Physician staffing issues, call schedules and other related issues.
  • Less than consistently optimal levels of customer orientation and satisfaction.
  • Challenges with procedure scheduling, patient through-put and operations efficiency.
  • An overall service line culture described as “disempowering.”


In an attempt to obviate such issues, the health system has developed a document that delineates what is expected from each side in some level of specificity.  As evidenced by the presence of the issues outlined above, some physicians have not been abiding by this, nor in fairness, has the health system enforced it to the level it should.  As is frequently the case, this particular situation is somewhat unique with specific circumstances that have complicated both compliance and enforcement.


The challenging issues are certainly not unique to this health system, nor are they easy to deal with, but they are ones that can and should be addressed as part of any employment (or other alignment) situation if goal congruence and enhanced service line performance is to be achieved.  Setting reasonable and consensus-based employee expectations are a vital part of any employee/employer relationship and should not be significantly different when the employee is a physician.  Evaluating performance against expectations, particularly when agreed upon by both parties, should be a periodic and institutionalized process that insures both parties are given the opportunity to express their questions or concerns and reinforce expectations.  All employees should be held to the high standards of the organization. 


The CFA team invites your comments, suggestions and questions.