A New Approach to Physician Employment

April 1, 2021
April 1, 2021

This blog post excerpts an article by Bryan J. Warren, Manager of Healthcare Solutions, Select International and Samuel G. Agnew MD, Orthopaedic Trauma Surgeon, HCA North Florida in the Q4 2015 issue of PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience.

What will success look like in this new era of physician employment? We need to create a culture where hospital and physician goals intersect. How do we reconcile the health system’s goals of quality, safety, patient experience, cost reductions, and market share with the physician’s goals of quality patient care, career success, and satisfaction? We are asking physicians to figure out what it means to be an employee while maintaining the professional autonomy they value—and at the same time asking them to lead, to innovate, and to collaborate. Are they prepared to succeed? Are we preparing them? We can take our cue from other industries where talent at the highest levels is systematically chosen and developed. We can do this without sacrificing the special nature of medicine—the sacred pact between doctor and patient and the physician’s role as a patient champion. At its most basic, a new approach begins with three simple steps: 

1. Define What Success Looks Like. One thing hasn’t changed. Talent wins. Attract and retain the best physicians and you increase your chances of success. The difference is in how we define talent. Graduates from the best schools, from the most prestigious fellowship programs are still valuable, but in addition, we need to consider other critical skills. What are the specific behavioral competencies that will predict success and define specific performance expectations?

2. Align Goals and Expectations. Evaluate the goals and expectation of physicians and whether they match those of the system. What is the system’s ability to meet these goals? Address any misalignment of expectations so there are no surprises. Decide what operational resources are necessary and available to support each physician. Some hospitals are accomplishing this via a more detailed analysis of operational “fit” and needs, a more predictive physician interview, and use of progressive, physician-specific behavioral skills assessments.

3. Develop Each Physician Resource. You bring a physician into the organization. You’ve done all you can to address realistic expectations and goals. While you don’t have complete alignment, you both understand where there are challenges. You  understand the physician’s behavioral tendencies and they fit your culture. Now what? At this point, most physician groups or hospitals drop the ball. They plug the physician in and hope for the best. Perhaps there is a report card tracking performance metrics. Perhaps there are meetings where performance metrics are discussed. Perhaps a more senior physician teaches newcomers how to navigate organizational challenges. Perhaps the physician develops into the high performing leader you need—or perhaps not.

In most industries, we’d never leave this much to chance. Think of the physician as an executive that you need to develop if you are going to succeed. Consider the following framework of a development program:

  • A useful practice report card that tracks meaningful metrics. There should be both individual and organizational metrics to encourage ownership and accountability for organizational success. Engage physicians in defining success.
  • On-going evaluation of operational barriers to success—satisfaction with practice growth efforts, ancillary services support, facilities, staff, etc. (and efforts to address them). Nothing frustrates a physician more than to be questioned on performance when no one recognizes or addresses the operational barriers.
  • Engage the physician in creating a development and growth plan. What are the short and long term career goals and the step necessary to achieve them?
  • Develop specific behavioral skills.


System success depends on physician success. Rather than looking at employment as a method to better control the medical staff, it should be a model that meets the needs of both the system and physician. It’s an employment relationship unlike any other. As both sides of this relationship adjust to the changes, the strategies should be driven by the needs of the patients. Success will require an alignment of goals and incentives between hospital and physician. Physicians need to understand their role in system success and that success needs to be based on meeting the needs of patients and the community. At the same time, systems need to commit to a more deliberate approach to physician selection, development and success.