In the business of healthcare, the physician-hospital relationship is critically important. Not only does the status of this relationship impact the success of a medical center, but it also affects the overall health of a community as well. As with any healthy relationship, trust and cooperation are fundamental. If these elements are to be achieved between physicians and hospitals, the relationship must be built on a foundation of mutual understanding. The dynamics of the healthcare industry in general — and the physician-hospital relationship in particular may mean mutual understanding is an elusive goal. Understanding these 10 dynamics of the physician-hospital relationship will make healthcare stakeholders more aware of the potential obstacles that stand in the way. 1. The Dynamic of Significance Physicians are the healthcare stars. Because they diagnose and treat patients, they drive the need for improved hospital facilities and healthcare technologies. Patients primarily select hospitals on the basis of physician recommendations. Moreover, hospital costs are controlled to a great extent by the power of the physician's pen. Traditionally, hospital leadership is responsible for creating a workshop conducive to the physician's success in diagnosing and treating patients. Hospitals--especially community hospitals--fulfill an important void as a healthcare safety net for many of society's poor and disadvantaged. The manner in which hospitals are operated has a direct correlation with patient morbidity and even mortality. The relationship deteriorates when the parties begin to view one another as simply commodities. Physicians and hospitals each fulfill an important purpose and should be recognized for the significance of their responsibilities 2. The Dynamic of Trust There is a growing predisposition of mutual mistrust among physicians and hospitals. Physicians may hear from colleagues, medical school faculty members, chief residents and residency program directors that hospital administrators aren't to be trusted. Hospital administrators hear tales from mentors and colleagues about selfish and greedy physicians who aren't to be trusted either. When stereotypes form the foundation of the physicians' and hospital leaders' perceptions, the challenge of forging healthy relationships can be daunting. 3. The Dynamic of Leverage Physicians and hospitals are cautious about placing all of their eggs into one basket. Hospitals don't like to be dependent upon one physician or a sole medical group. Physicians hesitate to affiliate with only one medical center. They each tend to fear that the other may gain and misuse positions of strength. This dynamic may lead to healthy competition. Hospitals cannot take their physician affiliates for granted and physicians cannot assume that they have the local market cornered in their specialty. However, this way of thinking may also lead to counter-productive behavior. For example, physicians may spread themselves too thin as they attempt to fulfill the obligations of two or more hospital medical staff memberships. On the other hand, hospitals may enter into proprietary relationships with other physicians in a negative reaction to the growing leverage of an established physician group. 4. The Dynamic of Efficiency Physicians place a high value on efficiency in their professional life. Unfortunately, the responsibility for adherence to numerous hospital regulations falls on their shoulders. Hospitals should minimize intrusions into the physician's private practice through increased efficiencies and by sensitizing their workforce to the issue. If not, an increasing number of physicians will seek opportunities that do not require them to be integrated with the hospital. Hospitals also depend on physicians to be responsive to patient schedules. While physicians often encounter legitimate conflicts, some are notorious for their disregard for hospital patient schedules. Mutual respect is warranted for the time demands of physicians as well as the patient scheduling needs in the hospital setting. 5. The Dynamic of Recruitment Physician recruitment is often a double-edged sword. A perceived physician recruiting need by the community or hospital may be perceived as a threat by one or more existing physicians. Behind the scenes, the arrival of a new physician may garner a negative reaction among some longstanding MDs in the community. The drivers of this reaction may be fear of economic impact, intrusion upon professional turf or exposure of clinical weaknesses. In some situations, physician recruiting may become a zero sum exercise: Whatever is gained by bringing in the new recruit may be partially, if not entirely, offset by the reactions of the offended party. Dynamics six through ten will be discussed in the December Birmingham Medical News. Jay Weatherly, former CEO of Cullman Regional Medical Center, and Steve Nyquist are co-founders of Salient Health Ventures based in Cullman. Reprinted with permission from HCPro., Inc. Copyright HCPro, Marblehead, MA. www.healthleadersmedia.com. November 2006