Five questions that health system executives should answer for boards and their organizations

  1. If we had to employ all the physicians required for our mission, market strategy, clinical programming and financial well-being by tomorrow, how many would there be (including their specialty FTE and location)? 
  2. What is the “delta” between the number we employ today and the number forecasted in the preceding question?
  3. What would be the total cost of the efforts required to achieve the task described in #2?
  4. Would the task be affordable given the financial condition of our organization today?
  5. What would you do to optimize the full potential of the strategy?

Five simple questions I have asked of hundreds of well-experienced and seasoned healthcare executives. None have ever argued the utility of the questions and none have had the answers at-the-ready.

In an era where the interests of physicians in private practice is waning (especially for those emerging from training) the five questions, as presented, are pertinent, and the answers don’t need high levels of precision to be useful.

A few executives have responded with, “doesn’t apply to me, our market is different from others, we’ll never need to employ them all”. Maybe so, but any sufficiently sophisticated health system board should hold the CEO accountable for the answers to 1-5 above.

Answers to these questions have profound implications for health system: strategy, balance sheet condition, clinical models and organizational politics.


:  How the fully integrated model permits strategies that are unavailable or inefficient with the independent, affiliated medical staff model.

Balance Sheet

:  Effects related to balance sheet liquidity, especially; including the need to finance a comprehensive physician strategy to full fruition and productivity. 

Clinical Models:

  Areas of focus include: clinical service line strategies, use of physician extenders and other licensed professionals, and application of evidence-based best practices and total cost of care strategies.

Organizational Politics:

  Management of the reaction of independent physicians as the organization pursues employment and integration of physicians.

Daniel Zismer, Ph.D.2013