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A Problematic Repeating Pattern of Physician Beliefs in Community Hospitals and Health Systems

Leadership Coaching Corner

A Problematic Repeating Pattern of Physician Beliefs in Community Hospitals and Health Systems

Daniel Zismer, Ph.D.

The following article was featured in The Governance Institute's E-Briefings in May 2019. Article includes contributions from Daniel K. Zismer, Ph.D., Greg Carlson, Ph.D., Greg Hagfors, M.B.A., and Elliot D. Zismer, M.S. For more information visit

Article Overview

Most community hospitals and health systems in the U.S. are in a transition from independent physicians dominating the composition of medical staffs to employed physicians assuming this position. Depending upon where an organization is in this transition, the relative proportion of these two groups can create challenging dynamics for organizational success and stability. Governing boards, along with senior leadership teams, should understand how related dynamics and potential “situational disorders” can affect organizational performance and culture.

Key Board Takeaways

Governing boards should work with senior leaders and physician leaders to understand:

  • The status and expected direction of the ratio of employed to independent physicians, by specialty, over the next five years with related rationale presented by senior leaders.

  • The organization’s current and projected net operating margin and net operating cash flow productivity derived from the work of employed and independent physicians over the next five years.

  • The “alignment” of key stakeholder groups on the whole of the variable set presented here to serve as a road map to the integrated culture that will be required to effectively meet mission and strategic goals in the face of increasingly complex health policy and related market dynamics.